Transcript Medicine through time - The High Arcal School

An Overview of the Course.
History of medicine timeline
The prehistoric period – 3000 BC to 43
The first 3,000 years of our study fall in the
prehistoric period. 'Prehistory' means before
writing, which means we have to rely on other sources
for information about health and medicine.
Archaeologists can use cave paintings
and preserved skeletons to find out
what life was like. We can also study
people whose lives have not changed for
thousands of years, like Aborigines.
We think that people at this
time believed illness was caused
by spirits. Charms were used to
ward off sickness.
Surgery
There was very limited use of surgery in prehistoric times. One amazing operation
did take place. This was trepanning or trephining, which involved cutting a hole
in the skull, possibly to release evil spirits which were causing illness.
Archaeological evidence suggests
that people did survive
trepanning, although we don't
know whether it had any positive
effects.
The Ancient World
The ancient world
During the prehistoric period there was
progress in other parts of the world –
particularly the Egyptian, Greek and
Roman civilizations.
Although these ancient civilizations
produced the world’s first doctors and
reasoned medical theories, most ideas
about the causes and treatment of
diseases were based on superstition.
In Britain, for most of this
period, their was no medical
progress. It was only when the
Romans came that there was any
investment in medicine.
Egyptian medicine
Egyptian’s medical knowledge and beliefs
The Greek Empire
Greek society
The success and wealth of the Greek Empire allowed the Greeks to develop a love
of learning and to try to find answers to the mysteries around them.
There were two main strands to Greek medicine.
The first stemmed from their strong belief in the
gods. The god of healing was Asclepius (also spelt
Asklepios or Aesculapius).
The second stemmed from new ideas from Greek
doctors, the most famous of whom was
Hippocrates.
The most famous of these Asclepeia was built at a remote location called
Epidaurus, and was part of what would be regarded today as a health complex!
Remains of the stadium at Epidaurus.
Remains of the gymnasium at Epidaurus.
There were baths, a gymnasium, a stadium, a library, a theatre and
accommodation, as well as temples to other gods.
New Greek medical ideas
As well as believing in the healing powers of Asclepius, there was also a lot of
respect for other medical theories.
The Greeks loved philosophy and came up with lots
of new ideas as a result. One important Greek
philosopher was Aristotle, who originally developed
the Theory of the Four Humours which became
the basis for Greek medical practice.
Hippocrates developed the theory further. Despite being wrong, it was a theory
which was to be widely used by doctors for nearly 2,000 years. The reliance on the
theory was so heavy that it prevented doctors from looking elsewhere for causes
of disease.
The Theory of the Four Humours
The Theory of the Four Humours was influenced by Greek ideas about
balance.
The Greeks believed that the world was made up of four elements:
Air
Fire
Earth
Water
They noted that these elements had different properties – water was wet, fire
was hot, etc.
Through observing the four seasons, they believed that each season must have
a dominant element.
Greek doctors noted that patients’ symptoms varied with the seasons – heat
rashes in summer, wet runny noses in winter.
From this, they deduced that the human body was made up of four vital liquids
which they referred to as ‘humours’:
blood
phlegm
yellow bile
black bile.
Each of the humours was related to a season and element:
Air
Fire
Earth
Water
Spring
Summer
Autumn
Winter
Blood
Yellow bile
Black bile
Phlegm
The theory stated that these humours had to be in balance for the body to be
well, that is there had to be the correct amount of each fluid.
In order to find out which humour was imbalanced, Greek doctors would perform
a diagnosis on the patient by studying their symptoms.
Diagnosis
Prognosis
Observation
Treatment
Clinical diagnosis
If there was too much or too little of one or more of the humours it was thought that
the person would become ill. Medical treatments aimed to put the humours back in
balance.
Can you explain why Hippocrates is regarded as such an important figure in the
development of medicine?
Growth of the Roman Empire
•Roman Army
•Hygiene
•Public Health
•Preventative Methods of Illness
How did the Romans improve public health?
Religious beliefs
Although there were developments in medicine and public health, many people
still relied on the gods for cures. This was often their first step in treating disease.
People prayed to Salus, the
Roman goddess of health, and the
Greek god of medicine,
Asclepius.
Galen
Rome’s most famous doctor was Galen.
Name:
Galen
Born:
AD 129 in Greece
Occupation:
Doctor
Education:
Studied medicine from age 17; Later studied
in Alexandria.
Career highlights:
Worked in an Asclepeia in Greece;
Surgeon at gladiators’ school;
Doctor to the Roman emperor Marcus
Aurelius;
Teacher of doctors.
Galen’s four methods and his importance
The fall of the Roman Empire
The Roman Empire grew until it could no
longer control its borders successfully.
Barbarian tribes overran the western parts
of the empire, and by AD 500 Europe
consisted of many small, feuding tribal
kingdoms. These kingdoms were often at
war with each other.
What effects do you think these wars had on the benefits that the Roman Empire
had brought?
The Middle Ages – AD 500 to 1400
The Middle Ages saw some medical progress, including the
setting up of universities, and some regress (decline), due partly
to the end of the Roman Empire, when much of the knowledge of
the ancient civilizations was lost.
In the Middle Ages the church
controlled those who were
allowed to practise medicine
and new ideas were not
encouraged.
Life expectancy was just 36
years for women and 37 for
men, compared to 38 and 40
years for those living in the
Greek and Roman civilizations.
37 36*
What other barriers do you think might have existed against the
development of medicine at this time?
* Life expectancy figures are almost impossible to verify and are rough estimates only.
The church and medicine
The Black Death
In 1348–49 Britain faced the worst crisis in its history. A deadly disease,
originating in Asia, arrived from Europe.
This disease was the bubonic plague. The
symptoms were a fever, headache, tiredness and
painful swellings (buboes) the size of apples in
the groin and armpits. Small, oozing red and
black spots appeared all over the body, giving the
disease the name the Black Death. Many patients
only lasted a few days before a painful death.
Nearly 40% of the English population died.
What was believed to cause the Black Death?
It was not until 1894 that it was discovered that the
bubonic plague was caused by germs, carried by
the fleas which live on black rats.
Back in 1349 people had very different ideas about the cause of the disease.
Look at the list of the causes people believed in on the next slide.
Which beliefs have we seen already in prehistoric medicine?
Which beliefs are new?
Why do you think no one suspected the fleas?
Breathing bad air (miasma) – medieval
towns were very smelly and the smell was
supposed to contain diseases.
Touching a
victim.
The position of the planets –
the relationship of the
planets and the movement
of the Sun affected health.
Annoying God – the
plague was his
punishment.
What did
people believe
caused the
Black Death?
An imbalance of the
body’s four humours –
Galen can’t be wrong!
Looking at a victim – the
disease was spread by eye
contact.
Drinking from poisoned
wells – Germans believed
the Jews were poisoning
drinking water to kill off
non-Jews.
The Medical Renaissance – 1400 to 1750
Renaissance means ‘rebirth’. The Renaissance period in Europe
saw a rebirth of the learning and knowledge lost from the Classical
period (Greek and Roman civilizations).
This was a time when many
new discoveries were made
about the human body, some of
which over-turned ideas that
had been around for more than
a thousand years.
Despite these new developments, health hardly
improved as many doctors were suspicious of new
ideas, and there was still no knowledge of what
caused disease.
Life expectancy for women
increased by about two
years, and for men four
years.
* Life expectancy figures are almost impossible to verify and are rough estimates only.
41 38*
Renaissance Man #1 – Andreas Vesalius
Andreas Vesalius studied the human body
very closely. His books contained very precise
drawings of the human body and had a big
impact on anatomy.
Vesalius dissected human bodies to help him understand how they worked and
commission life-like drawings. Galen had dissected animals, but this had led to
mistakes.
Because Vesalius had a detailed knowledge of the way the human body was put
together, he was able to challenge some of Galen’s ideas, which had been accepted
for over a thousand years.
For example, Vesalius found that Galen had been wrong about the human jaw.
Galen wrote that it was made of two bones, whereas Vesalius found only one.
He also found that the septum in the
heart was too thick and had no holes for
the blood to flow through, as Galen had
said.
The impact of Vesalius’s work
Vesalius showed that some of Galen’s ideas were wrong. Many doctors refused to
believe him, but his work did encourage doctors to question ancient ideas rather
than just accept them.
In the long-term, Vesalius’s work on anatomy was of huge importance and
helped doctors make new discoveries about the way the body worked.
What impact do you think Vesalius had on ordinary people’s lives?
How much of a difference did he make to the development of medicine?
Renaissance Man #2 – Ambroise Paré
Ambroise Paré was a French army surgeon who
treated many wounded soldiers on the battlefields.
He became an expert in treating sword and
gunshot wounds.
He is important for two major discoveries. At the time, surgeons used
cauterization to treat gunshot wounds. This meant sealing the wound with a redhot iron, then pouring boiling oil on it to stop infection.
On the battlefield, Paré ran out of oil. In desperation, he created a cold ointment
of egg white, rose oil and turpentine. The next day he found that soldiers treated
with this salve felt less pain than those treated with hot oil.
Paré’s second major discovery was that of ligatures. This was a method of sealing a
wound after a limb was amputated.
Paré thought that instead of cauterizing the wound, surgeons should try to tie
the arteries and veins with thin silk threads.
However, ligatures for amputations were not really practical until the invention
of the tourniquet two centuries later. Also, without antiseptics or knowledge of
germs, the silk thread used as ligatures easily carried bacteria into the body and
caused infection.
Renaissance Man #3 – William Harvey
William Harvey was an English doctor who
discovered how the heart worked and how
blood circulated around the body.
Before Harvey, doctors had learnt from Galen that the body used blood like a
fuel. He had written that the liver continually produced blood to replace that
which the body had burnt up.
Harvey’s discoveries included that:
the heart works like a pump
blood flows in one direction only around the body
one-way valves stop the blood going the wrong way
blood is re-circulated and not replaced.
What did Harvey prove?
Harvey showed that blood
returns to the heart from the
body via veins.
It is then pumped to the
lungs.
Blood carrying oxygen flows
from the lungs to the heart.
Blood leaves the heart to
circulate round the body via
arteries.
Harvey’s methods
Harvey’s methods included:
Dissecting live, cold-blooded animals. Their very slow heartbeat allowed him
to observe the actions of the heart. He also gained a good knowledge of the
human body through dissection.
Carrying out hundreds of painstaking experiments.
Carefully recording all his findings so that he could prove why he was right.
Calculating the total volume of blood by measuring the amount of blood
pumped by each heartbeat.
Experimenting with rods in the veins. He found he could only push them
through the valves one way.
The impact of Harvey’s work
Harvey couldn’t see the tiny capillaries which carry blood, though he knew they must
exist. With the invention of the microscope in the 17th century, Harvey was proved
right.
Like Vesalius three-quarters of a century before him, Harvey had dared to challenge
Galen and the other ancient writers. Many doctors again regarded these new ideas as
dangerous and carried on with their own methods.
However, Harvey’s discoveries were vital to the understanding of the way the body
works we have today.
What impact do you think Harvey had on ordinary people’s lives?
How much of a difference did he make to the development of medicine?
The medical Renaissance – a summary
Despite the medical advances made by Vesalius, Paré and Harvey, the Theory of
the Four Humours was still used to treat sick people and there was little change
in the medical methods used.
Ordinary people still used wise women and herbal remedies.
The Industrial Revolution – 1750 to 1900
It was during the Industrial Revolution period that the causes
of disease were discovered, and scientists and doctors could then
use their knowledge of ‘germs’ to begin to find cures.
Preventing illness was also
important and the invention of
vaccinations began to eliminate
certain killer diseases such as
smallpox.
Public Health Acts were passed which helped
improve conditions in towns. The discovery of
antiseptics and anaesthetics improved surgical
techniques.
These improvements led to a greater life expectancy, but
poor living and working conditions prevented any further
progress.
* Life expectancy figures are almost impossible to verify and are rough estimates only.
45 49*
Killer diseases of industrial towns
Correct answers are in the notes below (click on View, Notes Page).
Housing was
overcrowded
(often 10 people in
one room) and
often damp.
There was little
sanitation.
Why did these diseases became enormous
Why
people
in Britain
suffer
problems
indon’t
the new
industrial
towns?
from these diseases today?
Lack of fresh water –
water was often
contaminated with
sewage.
Poor diet, pollution and long
working hours in factories
weakened people’s resistance to
diseases.
Inoculation
In our society, babies are vaccinated to stop them catching diseases. But until the
19th century, vaccination was not known.
Until then, the only method available to prevent smallpox, one of the deadly
diseases, was inoculation.
Inoculation had been introduced to Britain by Lady Wortley Montague, who had
seen ‘smallpox parties’ in Turkey.
Inoculation gave a mild dose of smallpox, with the aim being long-term
immunity to the disease.
“…the old woman comes with a nutshell … of smallpox, and rips open [a vein] and
puts into the vein as much smallpox matter as can lie upon the head of her needle.”
This method was often effective but it could have a terrible side-effect: what do
you think this was?
Edward Jenner and vaccination
Edward Jenner (1749–1823) trained as a doctor in London. He
set up practice in Gloucestershire and, like other doctors,
offered smallpox inoculation to his patients.
Jenner was surprised to find that many people refused the inoculation.
According to local folklore, those who had had cowpox (a cattle disease passed
on to dairymaids and other farm workers) never caught smallpox.
Jenner wondered whether inoculating patients with cowpox would give them
immunity against smallpox. It would be less dangerous than inoculating them
with smallpox matter, because cowpox was only a mild illness.
Jenner’s first vaccination
The impact of Jenner’s findings
Jenner sent his findings to the Royal Society but many were opposed to his idea
and the society refused to publish his work.
Using his own money he published the work himself in 1798 and it was read
by many people all over the world.
At last his work was recognized and the government gave him large amounts of
money to open and run a vaccination clinic in London.
Around the world, the smallpox vaccination was used to protect people against the
deadly disease. In 1852, smallpox vaccination became compulsory in Britain. It is
now wiped out as a disease.
Understanding the cause of disease
A major feature of the history of medicine before the 19th century was the lack of
understanding of the causes of disease.
Without that knowledge, attempts at the prevention and treatment of disease
were based on superstition and guesswork.
In the 1850s, however, one man was to make a major
breakthrough in the discovery of what caused disease –
Louis Pasteur, a French scientist.
Louis Pasteur and germ theory
Pasteur trained as a chemist in Paris and then developed an interest in biology.
He worked at Lille University, in the heart of an industrial area. There
he specialized in fermentation. He investigated why vats of beer kept
going bad at a local brewery.
Pasteur discovered it was because of micro-organisms in the beer.
He called these germs because they were germinating, or growing. His theory
was that these germs were causing the decay.
Spontaneous generation and germ theory
How did he do it?
Pasteur was not the first to discover micro-organisms, but he was
helped hugely by the powerful microscope lenses developed in the
19th century, which could magnify 1,000 times without distortion.
Pasteur’s ideas were ridiculed by some scientists and he knew he had to have
undisputed proof. He carried out a number of carefully planned and recorded
experiments.
Next you will learn how Pasteur carried out his experiments. Think how
individual genius and technology helped the discovery of the germ theory.
Pasteur’s experiments
To prove that micro-organisms lived in the air, Pasteur collected air in sterile
flasks in Paris. He found that bacteria grew in the flasks.
By repeating this experiment in different places he found that the air in some
places, like Paris, had far more micro-organisms in it than places without so
many people or so much pollution.
Air from Paris
Air from a less
polluted area
Pasteur applied his theory of decay by micro-organisms in beer to the cause of
disease in humans.
If bacteria could cause beer to go bad, then presumably they could make animals
and humans ill.
He looked at the French silk industry, which was suffering
because of a disease attacking silkworms. Pasteur identified
the bacteria which was causing the disease.
He also proved that bacteria could be killed by heating a liquid in
a flask which he then sealed. It remained fresh. Today we have
pasteurized milk – heated to kill harmful bacteria.
Robert Koch
Robert Koch was a German doctor who built on Pasteur’s
germ theory. During the late 1870s he identified the bacteria
which caused anthrax, a disease in cattle, sheep and
sometimes humans.
He achieved this by meticulous experiments and research. He injected the bacteria
that he thought caused anthrax into 20 generations of mice. All the mice caught
the disease and the bacteria he isolated in the last generation were the same as
those that he had started with.
Koch used the painstaking method of experiment in his work. Using the same
process, his team of scientists identified the bacteria causing cholera and
tuberculosis.
He also developed a medium for growing the bacteria and a method of staining
them so that they could be identified and classified.
What were Koch’s main contributions to medical development?
There was great competition between Koch and Pasteur, not just scientifically,
but also because of Germany’s defeat of France in the Franco-Prussian war of
1871.
vs.
How might the rivalry between Pasteur and
Koch have been both good and bad for the
progress of medicine?
Pasteur’s search for vaccinations
Pasteur continued his search for vaccines by trial and error.
He was asked to look at chicken cholera, because it
was devastating French farming.
He isolated the chicken cholera bacteria and injected chickens with different
strengths of it, without success. His laboratory closed for the holidays in the
summer of 1879.
Pasteur was now to have a bit of luck. Some chicken cholera bacteria were left out,
exposed to the air. The bacteria were weakened severely and when injected into
chickens had no effect.
When subsequently injected with new bacteria (which should have killed them)
the chickens suffered no ill effects. Pasteur had found a vaccine against chicken
cholera.
Apart from helping the French farming industry, why was
Pasteur’s discovery so important?
By 1881, Pasteur and his team had developed a vaccine for anthrax.
To prove it worked, he vaccinated 25 sheep with a weak strain of the disease.
Injected with weak
anthrax strain
No injection
Two weeks later he injected both the vaccinated and unvaccinated sheep with the
full strength bacteria.
Injected with full
strength anthrax
Injected with full
strength anthrax
The 25 vaccinated sheep remained fit and well, whereas the unprotected 25 sheep
all died.
Sheep all well
Sheep all dead
Koch criticized Pasteur’s methods, but in spite of this Pasteur achieved
international acclaim for his discoveries.
Two years later he had developed a
vaccine for rabies, a terrible disease in
dogs. A bite from a rabid dogs was
fatal to humans.
Doctors now knew that once the bacteria causing a disease had been
identified, a vaccine could be searched for. By the end of the 19th century the
causes of the following diseases had been identified:
smallpox, TB, cholera, typhus, tetanus, pneumonia, meningitis, plague,
diphtheria and dysentery.
All of these were killer diseases against which there had previously been no
protection.
The development of anaesthetics
Surgery without anaesthesia had to be fast. Napoleon’s surgeon
amputated 200 limbs in 24 hours at the Battle of Borodino in 1812.
During the 18th and 19th centuries, scientists experimented with
the properties of chemicals and the effect they had on humans.
In 1799 Humphrey Davy (who later invented the safety lamp for
miners) discovered that pain could be reduced by using laughing
gas.
Ether was later found to put patients to sleep, and was used successfully as an
anaesthetic. However, it could cause the patient to cough or vomit, not ideal when a
surgeon is cutting them with a knife! It was also highly inflammable.
James Simpson
In 1847, a breakthrough was made by James Simpson, a professor at Edinburgh
University. He and several assistants tested several different chemicals at his home.
In the process a bottle of chloroform was knocked over and when Mrs Simpson
entered the room she found them all asleep.
Simpson was so excited with the effects
of chloroform that he used it on 30
patients that week.
Now operations could be performed at a sensible speed,
and more intricate operations could be attempted. Yet
many were fiercely opposed to pain relief.
Some feared side effects from the new anaesthetic, and
an overdose could kill. Others objected to pain relief
during childbirth, claiming that pain was sent by God.
In 1853, however, Queen Victoria was given chloroform
during the birth of her eighth child. Her approval of it
was enough to silence the critics and put it into general
use.
The development of antiseptics
For generations, surgeons had gone from
one operation to the next without washing
their hands or wearing masks or gowns or
overalls. Infection was the cause of many
post surgical deaths, with gangrene being
very common.
A far higher proportion of women who
gave birth in hospitals died of infection
than those who gave birth at home.
Joseph Lister
Joseph Lister was a surgeon who had studied Pasteur’s work with
interest. He thought that the high death rate of surgical patients
might be caused by the micro-organisms in the air.
Lister experimented by spraying wounds with carbolic spray to kill the microbes.
He found his patients healed without developing gangrene.
There was opposition to his ideas by other surgeons. Complaints included:
antiseptics cost money
Lister’s methods extended surgery time
many did not accept the germ theory.
In 1878 Koch identified the bacteria which caused septicaemia (blood poisoning).
Within a few years Lister’s antiseptic procedures were finally in place in most
operating theatres.
These procedures included:
meticulous cleaning of hospitals and theatres
steam-sterilization of all instruments
use of sterilized rubber gloves.
Lister also applied his antiseptic idea to ligatures, used to tie blood vessels. He used
catgut which could be sterilized and would be less likely to cause infection.
Blood transfusions
Although Lister had improved the use of
ligatures, it was still not possible at the end of
the 19th century to replace lost blood through
blood transfusions.
Not only did doctors not know how to stop
blood clotting, but when they did manage
transfusion the patient often died, which they
could not explain. In the 20th century it was
discovered that there were different blood
groups.
Florence Nightingale
While they couldn’t become doctors, women were still regarded as natural nurses.
They tended to come from the middle classes, it being seen as too lowly a job for
wealthier women.
One such woman was Florence
Nightingale (1820–1910). Her upper-class
upbringing had groomed her for marriage
to a rich man, not a career. Florence,
however, believed that God was expecting
her to be a nurse.
Nightingale visited many hospitals to learn about nursing and was appalled by the
conditions of the buildings, the nurses and their level of care.
In 1854, the government asked her
to go to the Crimea to help at the
army hospitals set up to treat the
wounded in the war between
Russia and Britain. The conditions
were awful; half the soldiers had
died in the hospitals.
The Crimea
Nightingale transformed the Crimean hospitals in six months. She insisted on
good food for her patients, clean airy wards, boiled sheets and taught her team
of nurses professional nursing practise.
When the army refused to pay for what she said she needed, she bought it
herself. Her improvements reduced the death rate amongst her injured soldiers
from 50% to 3%. She gained the nickname ‘Lady with the Lamp’.
On her return to England, Nightingale worked to improve conditions in British
hospitals. She set up a training school for nurses. Her influence on the nursing
profession continues today.
The 20th century
In the 20th century more progress was made in improving
medicine and health than in the previous 5,000 years.
The causes of most diseases were discovered in the 20th century, and by the year
2000 the vast majority of illnesses could be prevented or cured.
Shorter working hours, better housing, the introduction
of a free National Health Service and better diets all led to
far higher life expectancy than ever before.
72 78*
There are many reasons for improvements in health in the 20th century. Which do
you think has had the biggest effect?
* Life expectancy figures are almost impossible to verify and are rough estimates only.
World War I
Between 1914 and 1918 a totally new type of war ripped Europe apart. Huge
quantities of mass-produced weapons caused unprecedented death rates and
horrendous injuries. Instead of men fighting one to one, a machine gun could
obliterate hundreds in a few moments.
This cemetery in Belgium contains the graves of 11,000 soldiers
who died at the Battle of Passchendale in 1917, and
commemorates the 33,000 whose bodies were never found.
How World War I affected medicine
The huge number of casualties meant that surgeons and doctors gained a wealth
of surgical experience. Practice led to improvements in mending broken bones,
grafting skin and all types of surgery.
These surgeons were used to working in clean, wellequipped hospitals. Suddenly they were trying to
operate in dirty conditions just behind the front line or
in a field hospital, often without the supplies they
needed. This led to them having to improvise,
resulting in new discoveries.
Paré had improvised on
the battlefield almost
400 years earlier.
The experience gained in the war led to many surgeons specializing in
different forms of surgery after the war.
Were these benefits realized in the short- or long-term?
Can you think of any ways in which World War I hindered the progress of
medicine?
The fight against infection
World War I interrupted an important research programme into fighting
infection. Research had been going on for years to find a chemical compound
which would kill bacteria in the body.
Robert Koch had found a way of staining bacteria to identify
them. Paul Ehrlich, a member of his team, decided to take
this idea further.
Ehrlich thought that a chemical compound could be used not only to stain the
bacteria causing an infection, but which would kill them (and only them) as
well. Ehrlich said this would be like a magic bullet.
What do you think this means?
Magic bullets
A magic bullet would ‘shoot’ the bacteria, but not harm the patient.
Ehrlich had seen how the body produces antibodies to attack the specific bacteria
causing an infection, and believed he could find a chemical which would work in the
same way.
After many years, in 1909 he was proved right. His team had tried 605 varieties of
an arsenic compound to cure syphilis, a common venereal disease. The 606th one
killed the syphilis bacteria. They had discovered the first magic bullet, and they
called it Salvarsan 606.
This was a major step in the progress of medicine, although Salvarsan 606 needed
to be improved upon, because it could kill the patient as well as the infection as it
was made from arsenic.
After World War I research into magic
bullets resumed. The number of men
who had died because of infection in
the trenches made it all the more
necessary.
Salvarsan 606 injecting kit c. 1920.
In 1932 Gerhard Domagk found the second magic bullet after years of methodical
research. This was a red dye called Prontosil.
He injected mice with a lethal dose of a streptococcal infection. He then injected
them with Prontosil, which cured them.
Soon he had the chance to try it out on a human, his own daughter, who was
seriously ill with the same streptococcal infection. Having no other cure, he
injected her with Prontosil and she recovered.
The next task was to find out which component of Prontosil made it a magic
bullet.
With the aid of the new, powerful electron
microscopes which had been in use since the
early 1930s, scientists found that the active
ingredient was a sulphonamide which came
from coal tar.
The discovery of sulphonamides led to the development of drugs which cured
gonorrhoea, pneumonia, meningitis and scarlet fever. They led to the number of
mothers dying following postnatal infection being slashed from 20% to 4.7%.
Fleming and the discovery of penicillin
Alexander Fleming had worked on wounds and infections during World War I and
spent years researching the body’s natural defences against infection.
In 1928, chance helped the scientific search for anti-bacterial drugs, as it had
helped Pasteur.
Fleming returned from holiday to find that mould had grown on the cultures in
some of the petri dishes in his laboratory.
He noticed that in one dish the staphylococci cells
had disappeared around the edges of the mould. He
realised that the mould had killed the bacteria. He
identified the mould as penicillium, which had
probably blown in through the open window.
The development of penicillin
Fleming had discovered that penicillin would attack certain forms of bacteria, but
he did not have the resources to research whether or not it could be used to fight
infection.
Two British scientists, Howard Florey and Ernst Chain and their assistants,
continued with the study.
Florey and Chain grew penicillium (the mould which produces
penicillin) to experiment with, and tested successfully on mice.
In 1941 they conducted a trial on a dying man, who recovered
until they ran out of penicillin.
To continue their research, they
looked to the USA, who had entered
the war in 1941 and feared heavy
casualties. It financed drugs
companies to mass-produce
penicillin. By 1945 the US army used 2
million doses a month.
The first antibiotic had been created.
The effects of World War II on medicine
The entry of the USA to World War II had an impact on the development of
penicillin. The war had other effects as well.
The National Health Service (NHS)
In 1942, William Beveridge, a civil servant, advised the government to set up a
welfare state, including a free national health service, which was to give benefits
‘from the cradle to the grave’ for all.
The plans were passed by the post-war Labour government in 1946. Two years later
the National Health Service (NHS) began. It was available free to everyone in the
nation, and was to cover every aspect of health care.
Training of
doctors and
nurses
Medical
aids
Hospitals and
ambulance service
Dentistry
Vaccination
programmes
Medical
research
What the
NHS
provides
Eye tests
Consultants
Medicines
Surgery
Maternity care
GPs, surgeries, health
clinics, district nurses.
The effect of the National Health Service on people’s health was dramatic. For
the first time ever, everyone had the right to free health care. Before the NHS
many could not afford to visit the doctor, let alone buy medicines or have
regular treatment.
By the end of the 20th century, however, the NHS was facing one financial crisis
after another. Prescription charges, introduced in the 1950s, rose steeply. Charges
were introduced for dental treatment and eye tests. Unable to pay for the
necessary staff, many beds remained empty while the waiting lists grew longer.
Despite the problems, anyone could be treated free when needed, regardless of their
ability to pay or whether they had insurance.
What diseases kill people today?
Medicine and health progressed dramatically during the 20th century.
Vaccination meant that diseases such as smallpox or diphtheria were no longer a
threat. Other illnesses became treatable with antibiotics. Previously incurable
conditions can be treated with the latest surgical techniques.
There are, however, diseases which kill people today which were not known in
earlier times.
What modern diseases can you think of?
Factors affecting medicine in the 20th century
Match up the individuals with their
discoveries
Andreas Vesalius
The circulation of the body.
Ambroise Pare
Discovered Chloroform as a form of anaesthetic.
William Harvey
Small pox vaccination formed from cowpox
Jenner
Using carbolic spray over the wound during surgery
limited Infection
Louis Pasteur
Came up with the Germ theory
Robert Koch
Isolated and stained Bacteria
James Simpson
Tied ligatures to stop bleeding.
Stopped using hot oil and instead used his own
mixture.
Joseph Lister
showed that Galen was wrong in some
important ideas. – Jaw / Heart
Match up the individuals with their
discoveries
Andreas Vesalius
Vesalius showed that Galen was wrong in some
important ideas. – Jaw / Heart
Tied ligatures to stop bleeding.
Ambroise Pare
Stopped using hot oil and instead used his own
mixture.
William Harvey
The circulation of the body.
Jenner
Small pox vaccination formed from cowpox
Louis Pasteur
Came up with the Germ theory
Robert Koch
Isolated and stained Bacteria
James Simpson
Discovered Chloroform as a form of anaesthetic.
Joseph Lister
Using carbolic spray over the wound during surgery
limited Infection
Four-in-a-row