Medical Treatments in Modern Britain (Edexcel GCSE History)

Approaches to Treatment in the 20th Century - Summary

Since the Renaissance, scientists have experimented with chemicals to create medical treatments. Modern scientists are now able to study the molecular structure of different chemicals. This is the result of technological advances. It has helped in the development of more effective chemical cures. At the beginning of the 20th century, scientists searched for a treatment that targeted harmful microorganisms without hurting the entire body. Ehrlich and Domagk proved this was possible by creating 'magic bullets for diseases such as syphilis and blood poisoning. 

The concept of 'Magic bullets' started the development of antibiotics. Alexander Fleming accidentally discovered penicillin in 1928. Howard Florey and Ernst Chain then applied Fleming's findings to mass-produce penicillin (an antibiotic) in 1941. World War Two forced the British and American governments to finance Florey and Chain's research. The government dropped their laissez-faire attitude and began to value the advancement of medicine. Before 1945, people were more likely to die from an infection in a minor wound. These types of deaths in modern Britain are almost unheard of. 

The biggest change to medical care was the creation of the National Health Service (NHS) in 1948. The less wealthy were no longer denied healthcare. The NHS revolutionised access to care. It incorporated general practitioners (GPs) and hospitals in a unified system. New developments in surgery improved the levels of care the NHS provided. Advances in science and technology resulted in x-rays, robotic surgery and hypodermic needles.

Even in the 21st century, there are still diseases which medicine cannot treat. Scientists have been unable to create specialised treatments for different types of cancers.  Microbes can evolve to become resistant to drugs. Some people have difficulties accessing NHS services. Many GPs do not have enough time to see every patient that requires their services. New diseases like COVID-19 mean there is a need for the constant development of treatments. Despite these challenges, medical advances have transformed treatments in the 20th and 21st centuries.

Antibiotics - Ehrlich & Domagk

'Magic Bullets'

• By the 20th century, doctors understood the idea of antibodies

  • Medical professionals had discovered that vaccination worked by producing a reaction from the patient's immune system

  • Scientists believed the human body was capable of producing antibodies to other chemical compounds

• A 'magic bullet' was an early 20th-century concept. The idea was that one chemical treatment could attack harmful bacteria without hurting the rest of the body

Ehrlich and Syphilis

• Syphilis continued to be a problem in the 19th and 20th centuries

  • When Britain fought the Boer War (1880-1902) and World War One (1914-1918), it became clear that many young men had syphilis. The army could not conscript enough healthy men

  • Scientists needed to find an effective cure for syphilis. Medical professionals were still prescribing the mercury treatments of the 16th century

• Paul Ehrlich tested arsenic compounds to find a cure for syphilis

  • By 1907, Ehrlich had tested more than 600 versions of arsenic but had not found a cure

• In 1909, Japanese scientist Hata retested the arsenic compounds Ehrlich had experimented with

  • He discovered that compound 606 cured syphilis

  • He named the chemical cure Salvarsan 606

    • This became the world's first 'magic bullet'

Domagk and Antibiotics

• Scientist Gerhard Domagk discovered in 1932 that a red dye called Prontosil killed infections in mice

• Domagk did not know if this would cure bacterial infections in humans

  • He tested Prontosil on his daughter, who was dying from blood poisoning. Prontosil saved her life

  • Queen Charlotte's Maternity Hospital in London used Prontosil to treat puerperal fever

    • Death rates in puerperal fever dropped from 20% to 4.7%

• Domagk's and Ehrlich's success encouraged scientists to pursue the development of antibiotics

Fleming and Penicillin

Fleming's Discovery of Penicillin

• Fleming was a Scottish doctor working at St. Mary's Hospital in London

• Alexander Fleming:

  • Pioneered the use of Salvarsan 606 to treat syphilis

  • Worked in battlefield hospitals during World War One and saw men who died of syphilis infection

• During the 1920s, Fleming began to study a type of bacteria called Staphylococcus

• Staphylococcus was resistant to the 'magic bullets' available at the time

  • It is a deadly bacteria which can cause blood poisoning and toxic shock syndrome

• In 1928, Fleming accidentally discovered penicillin

  • Fleming went on a holiday, forgetting to clean a petri dish which contained the staphylococcus bacteria

  • On his return, Fleming noticed mould in the petri dish. This mould prevented staphylococcus from growing

    • Medieval people observed that mouldy bread had healing qualities. Fleming's examination demonstrated that mould could fight bacteria

    • Fleming published his findings in 1929

• Fleming didn't realise the potential impact of his discovery on humans

  • Scientists at the time were more interested in looking for chemical cures for disease. Germ Theory states that microbes are dangerous and they do not possess the ability to heal

  • His first experiment showed penicillin was ineffective when combined with blood

Florey and Chain and the Development of Penicillin

• Florey and Chain worked together at Oxford Medical School

  • Howard Florey was an Australian pathologist

  • Ernst Chain was a German biochemist who had escaped from Nazi Germany

• In 1939, during their study of antibiotics, Florey and Chain discovered Fleming's work on penicillin

  • Chain was able to grow mould and extract enough penicillin to run tests

• In 1940, they successfully tested penicillin on mice

  • Eight mice were infected with staphylococcus  

  • Four mice received penicillin while four mice did not receive treatment

  • The four mice without treatment died

  • Penicillin saved the other four mice

• Florey and Chain's research caught the attention of the British government

• At this time, Britain was fighting Germany in World War Two

  • In World War One, many soldiers died from their wounds becoming infected

  • The British government knew that the effective treatment of wounds could be the difference between winning or losing World War Two

  • Florey and Chain received £25 from the government to fund their research into penicillin

    • Today, this would be approximately £1100

• By 1941, penicillin was ready for human trial

  • Albert Alexander was a local policeman

    • He was in hospital suffering from septicaemia, a deadly blood poisoning

    • Alexander had developed the infection after scratching himself on a rose thorn

  • Albert took penicillin and showed signs of recovery. Florey and Chain ran out of their supply of penicillin

  • Despite Albert's death, the trial proved that penicillin worked on humans

Mass Production of Penicillin

• In July 1941, Florey flew to America to persuade pharmaceutical companies to mass-produce penicillin

  • Florey had approached British companies but, due to the Second World War, they did not have the time or resources to grow penicillin

  • Mass production of penicillin required growing the mould in beer vats

  • It was a slow process. After a year, the American companies had only produced enough penicillin for ten doses

• America recognised the potential of penicillin

  • The US government gave money to 21 pharmaceutical companies to produce the drug

  • British pharmaceutical companies began to mass-produce penicillin in 1943

• Towards the end of the Second World War, penicillin became vital

  • By 1945, the US Army had access to two million doses of penicillin per month

  • An estimated 50% of wounded soldiers survived their injuries because of penicillin

A storyboard showing the discovery and development of penicillin

Factors Which Enabled the Development of Penicillin

• Institutions

  • The US government funded Florey and Chain's research

  • The British government invested in medical research for the first time

• Technology

  • The use of beer vats and milk churns to mass-produce penicillin

• Attitudes in society

  • The Second World War motivated the government to discover a treatment that prevented soldiers from dying from infection

  • The urgency for penicillin to be available meant that thorough medical trials were not considered necessary

• Science

  • Scientists were able to observe how penicillin mould killed staphylococcus

  • The scientific team at Oxford worked together to test and produce penicillin

• Individuals

  • Alexander Fleming discovered penicillin

  • Florey and Chain proved the impact penicillin could have on infections in humans

  • Florey persuaded American pharmaceutical companies to mass-produce penicillin

  • Florey refused to patent penicillin, believing it should be readily available to all

Modern Development of Antibiotics

• Penicillin inspired scientists to research other moulds and fungi for their antibiotic abilities

  • Selman Wakston discovered Streptomycin in 1943. This was effective against tuberculosis

  • Dorothy Hodgkin mapped the chemical structure of penicillin in 1945. This allowed other scientists to create synthetic antibiotics which were adapted to treat different bacteria

    • John C. Sheehan created the first chemical copy of penicillin in 1957

• Science and technology impacted the development of antibiotics

  • Antibiotics were distributed in capsule form. This is an easier method to administer medicine

  • Those with serious infections have antibiotics administered by hypodermic needles. This allows an accurate dose of medicine to be placed directly into a patient's bloodstream

  • Drug trials ensured that new antibiotics worked and had limited side effects

• In the 21st century, some bacteria have become resistant to penicillin

  • Penicillin-resistant strains of bacteria emerged in 1942

  • When antibiotics became readily available in the 1950s, doctors prescribed them too often

    • Antibiotics only work for bacterial infections yet they were being offered to patients with viruses

  • A government report in 2018 discovered that GPs in England incorrectly prescribed 20% of patients with antibiotics 

  • Bacteria like MRSA are a danger to public health

  • MRSA is resistant to some antibiotics mainly penicillin. It can still be treated with other antibiotics

Modern Surgery - Transplants, Transfusions & Keyhole Surgery

• An extensive range of operations are now available to patients

  • For example, people in modern Britain have access to operations like hip replacements and organ transplants

• Surgery in modern times is much safer

  • Modern surgery has methods to cope with the three major problems of surgery:

    • Blood loss

    • Pain

    • Infection.

• The contributions of Lister and Simpson resolved the issue of pain and infection. Blood transfusions combated blood loss in the mid-20th century

• Surgeons are now able to complete deeper, more complex operations like brain surgery

New Surgical Technology

Medical Care: The Impact of the NHS

• The Liberal Party won the 1906 general election. They passed a series of reforms which attempted to improve medical care:

• In 1907, children received free medical inspections in school

• The National Insurance Act of 1911 provided health insurance for male workers earning under £160 per year. The Act entitled eligible workers to 25 weeks of sick pay

• In 1912, school-aged children became entitled to free medical treatments 

• Many people still did not receive the medical treatment that they needed

  • The provision of healthcare depended on each local authority

  • National Insurance did not cover women or a worker's family

  • Areas outside of London and the South East of England did not have enough hospitals. Built in the 19th century, the available hospitals required updating 

  • People still had to pay for doctors. As a result, many continued to rely on purchasing herbal treatments like Beechams from pharmacies

Structure of the NHS

• The Labour government under Aneurin Bevan launched the NHS (the National Health Service) in 1948

• It provided free care for everyone

  • Workers funded the NHS through their National Insurance payments. The government continue to apply this tax

• The government used the existing provision of hospitals and medical services and took them under their control

A flowchart showing the structure of the NHS

The Impact of the NHS

The Extent of Change in Care & Treatment

Improved Access to Care

• In 1919, the government established the Ministry of Health

  • This showed a desire by the government to ensure a good standard of healthcare across Britain

• The NHS gave free healthcare to all

  • People were no longer turned away for being unable to pay for treatment

• The role of hospitals transformed

  • Before, hospitals provided facilities for the elderly to rest 

    • People questioned where the elderly would go if they had no family to care for them

  • Now, hospitals are only for the treatment of disease

Improvements to Treatments

• Deaths by infectious diseases fell significantly

  • In 1900, 25% of all deaths were the result of infectious diseases

  • By 1990, this percentage had fallen to less than 1%

• Chemical treatments were available

  • At the start of the 20th century, people relied on herbal remedies

  • After 1945, a range of 'magic bullets' were available to treat a variety of illnesses

Issues with Treatments

• It is difficult to make vaccines for viruses

  • There is a new flu vaccine every year because there are lots of variant of the disease

  • Microbes can evolve to become resistant to certain treatments

    • An example of this is newer strains of COVID-19

• Newer or more complex diseases sometimes do not respond to treatment

  • Scientists can take many years to develop successful treatments. There are few specialised medical cures for diseases with many variations like cancer

• Lifestyle factors have caused diseases like heart disease to increase

  • Scientists do not fully understand the impact of all lifestyle choices on public health