Edexcel GCSE 9-1 History

Medicine in Britain, c1250 to present workbook

Key Topic 4

c1900–present: Medicine in modern Britain v3

Name:

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Key Words

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Key Words

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Key Words

TASK: Read the following statements and decide if they belong to the following people:

William Harvey, Andreas Vesalius, Thomas Sydenham, Louis Pasteur, John Snow, Florence Nightingale, Joseph Lister or Edward Jenner.

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Guess Who?

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Guess Who?

TASK: Circle the statement that you think is the odd one out and explain why you have chosen that in the end column.

HOT: Create two of your own.

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Ideas about the cause of disease and illness

Advances in understanding the casues of illness and disease.

By 1800, Germ Theory had been around for nearly 40 years, and microbes had been clearly linked to outbreaks of disease. People finally understood what caused common disease, such as cholera and diphtheria.

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Because of this, throughout the 20th century Doctors no longer referred to miasmata, the Four Humours or the supernatural when diagnosing illness. This is the first period in which doctors were working solely with solid scientific discoveries. For the first time, they had more than just ideas about what caused diseases and illnesses - they had solid, evidence-based, knowledge.

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At the start of the 20th century, diagnosis was something that happened between a doctor and a patient. The doctor would observe the patient and consider the symptoms. He would consult medical textbooks and diagnose the disease based on this knowledge.

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During the 20th century, there was a move towards laboratory medicine. With more examination of samples. These samples might include skin or blood, or more detailed samples of flesh gathered from the patient in a procedure called biopsy. The samples would be examined by medical scientists in a laboratory, using microscopes and other technology. In addition, the patient might be x-rayed to allow doctors to see what was going on inside the body, and the pictures produced would be examined by doctors looking for the cause of the disease or illness. All of this additional information meant that diagnosis was, and is, now more accurate. The exact microbe causing a disease can be identified and targeted

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Therefore, the biggest change in diagnosis in the 20th century was that instead of being based on symptoms, and the experience and knowledge of the doctor, it was now based on medical testing.

TASK: Answer the following questions

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1. What caused common disease? _________________________________________________________________________________________
2. What did doctors no longer refer to? ___________________________________________________________________________________
3. Doctors were now working with what?_________________________________________________________________________________
4. What was diagnosis like at the start of the 20th century? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
5. How did this change? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
6. What is biopsy? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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7. As a result, what happened to diagnosis? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. What was the biggest change in diagnosis during the 20th century? ___________________________________________________

__________________________________________________________________________________________________________________________________

Ideas about the cause of disease and illness

Advances in understanding the casues of illness and disease.

By 1951, scientists knew that characteristics were passed down from parents to children, as children often look like their parents. They theorised that a substance in human cells passed on this information from one person to the next. This substance also passed on a variety of hereditary disease. However, it was not until 1953 that technology finally made it possible for scientists to find the missing piece of the puzzle: DNA.

James Watson was an American biologist. Francis Crick was an English Physicist. In 1953, they were both working at Cambridge University where they shared an office. Even though neither men were investigating DNA, they both had a strong interest in researching and finding out more about human biology.

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Crick and Watson saw the x-rays provided by Franklin and Wilkins. They built their model of DNA and shared it with Franklin, who made a correction based on her x-rays. Wilkins also shared clearer photographs that they had managed to take of the DNA. Due to this addition input, Crick and Watson were able to solve the puzzle of the structure of DNA. They discovered that it was shaped as a double helix, which could ‘unzip’ itself to make copies.

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Watson and Crick published their paper in April 1953. Crick suggested that they had discovered the secret of life. Understanding the shape of DNA meant that they could now begin to look at its structure and identify the parts that caused hereditary disease.

Watson, Crick and the discovery of the human gene.

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TASK: Illustrate the discovery of the structure of DNA in 4 steps

Ideas about the cause of disease and illness

Advances in understanding the casues of illness and disease.

TASK: Decide if the statements below are causes or DNA being discovered or consequence of DNA being discovered. Use two separate colours and create a key.

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TASK: Which fact, from the above, do these images represent?

HOT: Which was the most significant cause and consequence? Why?

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Ideas about the cause of disease and illness

Advances in understanding the casues of illness and disease.

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Ideas about the cause of disease and illness

Advances in understanding the casues of illness and disease.

Understanding that information - mapping the DNA’s code - was vital to helping scientist understand the cause of genetic diseases, such as haemophilia.

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The Human Genome Project was launched in 1990. It was originally led by James Watson himself. For a decade, 18 teams of scientists all over the world worked together to decode and map the human genome. Even though hundreds of scientists were working towards this goal, they did not complete the first draft until 2000.

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Once the human genome was mapped, it then became possible for scientists to use this blueprint of human DNA to look for mistakes or mismatches in the DNA of people suffering from hereditary diseases.

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For example, scientists have now been able to identify a gene that is sometimes present in women who suffer from breast cancer. Although they cannot use this knowledge to treat breast cancer, women now have the opportunity to prevent this disease by identifying their risk of developing the disease and then having a mastectomy. A famous example of this is the actress Angelina Jolie who had herself tested for the gen because her mother had died of breast cancer.

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TASK: Reduce each paragraph to one sentence and convert to one symbol.

Factors helping the development of genetics

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Ideas about the cause of disease and illness

Advances in understanding the casues of illness and disease.

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The influence of other lifestyle factors

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• Drinking too much alcohol, either through binge drinking or drinking a lot over a long period of time, can lead to liver diseases and kidney problems.

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• People now recognise that sharing bodily fluids with other people, either through intravenous drug taking (in vein with needles) or unprotected sex, can lead to the spread of certain diseases.

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• The fashion for tanning, either naturally or using sung eds, has led to a rise in the number of cases of skin cancer worldwide

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TASK: If the is the answer, what is the question?

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1900: ___________________________________________________________________________________

2000: ___________________________________________________________________________________

Electron Microscope: _______________________________________________________________________

‘Big science’: ______________________________________________________________________________

Missing information in the genome: _____________________________________________________________

1950s: __________________________________________________________________________________

Too much sugar: ___________________________________________________________________________

Ideas about the cause of disease and illness

Advances in understanding the casues of illness and disease.

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Common technologies we use to make a diagnosis

BLOOD TEST

(FROM THE 1930S)

Use blood samples to test for an enormous number of conditions.

No need for invasive diagnosis methods

BLOOD SUGAR MONITORING

(FROM THE 1960S)

People that suffer from diabetes can check their blood sugar

X-RAYS

(FROM THE 1890S)

Help to see inside the human body.

Help diagnose problems such as broken bones.

MRI Scans

(FROM THE 1970s)

Use magnets and radio waves to create an internal image of the body

They are better suited to diagnosing soft tissue injuries like ligament damage

More advanced than x-rays, they can be used to diagnose tumours.

CT SCANS

(FROM THE 1990S)

ULTRASOUND SCANS

(FROM THE 1940’S)

Use soundwaves to build up a picture of the inside. Can diagnose gall and kidney stones.

ENDOSCOPES

(FROM THE 1900’S)

Use a camera on the end of t thin tube to see inside the human body.

Used to investigate digestive symptoms such as vomiting blood.

Could be used to carry small surgical instruments into the body.

BLOOD PRESSURE MONITORS

(FROM THE 1880’S)

Help to diagnose high and low blood pressure.

ECGs

(FROM THE 1990S)

Use electrical impulses to track heart activity.

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New methods of diagnosis

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The development of machines and computers has enabled doctors to have a better understanding of a patient's symptoms than in any previous time. For example, x-rays and CT scans. Mean that doctors no longer have to use surgery to diagnose all diseases.

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The impact of technology

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The enormous leap forward in technology since 1900 has made diagnosing disease much more accurate. This has, in turn, had a huge impact on doctor’s ability to treat patients. New methods of diagnosing disease are being developed all the time.

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Ideas about the cause of disease and illness

Advances in understanding the casues of illness and disease.

Improvements in diagnosis: the impact of the availability of blood tests, scans and monitors

TASK: Place the common technologies used to make a diagnosis in chronological order.

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1. __________________________________________________________________________________
2. __________________________________________________________________________________
3. ___________________________________________________________________________________
4. ___________________________________________________________________________________
5. ___________________________________________________________________________________
6. .__________________________________________________________________________________
7. __________________________________________________________________________________
8. ___________________________________________________________________________________
9. ___________________________________________________________________________________

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TASK: Which 3 advancements of technology had the greatest impact on diagnosis? Think about how many people use them and the types of illness they help detect.

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________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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TASK: In the summary pyramid note the following using a separate level of the pyramid for each question.

The 1 year that DNA was discovered.

The 2 doctors that discovered DNA.

3 Influences of ‘other lifestyle choices.

4 Factors that helped in the development of genetics.

5 Common technologies used to make a diagnosis.

TASK: Complete the table below showing the change and continuity of ideas regarding the cause of disease. Draw an arrow from where the belief starts and where it ends and draw a symbol to represent that cause. One is done for you.

Ideas about the cause of disease and illness

Advances in understanding the casues of illness and disease.

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

Medical Treatments

The first chemical cures: magic bullets

The term ‘magic bullet’ was used to describe a chemical cure that would attack the microbes in the body causing disease, whilst at the same time leaving the body unharmed. In the late 19th century, more microbes responsible for specific diseases were being discovered. This meant that scientists could begin to search for substances to attack and destroy these microbes.

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Doctors now understood that the body produced antibodies to fight disease that had previously infected it - this is how vaccines work. The hunt was on for artificial or chemical antibodies that would work in the same way, attacking the infection without harming the body.

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The first big breakthrough was made in the treatment of syphilis. Syphilis continued to be a problem throughout the 19th and 20th centuries, and treatment of it had not really improved since mercury treatments of the 16th century. There had been some success with arsenic compounds. However, it was very difficult to find a form of arsenic that attacked the disease and not the body, as arsenic is poisonous.

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The term antibiotic is used to describe any treatment that destroys or limits the growth of bacteria in the human body. The first true antibiotic was penicillin. Penicillin was different to Salvarsan 606 and Prontosil as it was created using microorganisms, not chemicals. Penicillin was isolated from a mould sample by Alexander Fleming in 1928 and developed into a usable treatment by Florey and Chain in 1940.

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Inspired by the discovery of penicillin, other scientists investigated moulds and fungi in the search for more antibiotics. Streptomycin was discovered by American scientists Selman Wakston in 1943. This antibiotic was so powerful that it was even effective against tuberculosis which had previously been thought to be incurable. During the 1950s and 1960s, even more antibiotics were discovered.

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Research into the development of new antibiotics has not stopped. In the 21st century, pharmaceutical companies continue to test substances to develop a resistance to the antibiotics. This is because some bacteria have developed a resistance to the antibiotics we already have. If new treatments are not developed, scientists fear that the old antibiotics will become totally ineffective against diseases that against diseases that we think we have beaten, such as septicaemia (blood poisoning).

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Therefore, in the short term, antibiotics have been a miracle cure for a variety of disease. However, their long-term impact has yet to be measured.

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

The development of antibiotics

TASK: Answer the following questions based on what you have just read.

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1. What does the term ‘magic bullet’ mean? ________________________________________________________________________________________________________________________________________________________________________
2. How do vaccines work? ________________________________________________________________________________________________________________________________________________________________________
3. What was Salavarsan 606? ________________________________________________________________
4. What does antibiotic mean? ________________________________________________________________________________________________________________________________________________________________________
5. What has been the impact of antibiotics? ________________________________________________________________________________________________________________________________________________________________________

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As with diagnosis, the way that we treat diseases now is almost unrecognisable from the way that people treated them before 1900. This is largely due to huge advances in science and technology.

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Scientists have now developed medicines that pinpoint and treat specific diseases. Even if they are unable to cure some diseases, such as diabetes and lung cancer, treatments have been developed to help patients manage their illness. Scientists are now able to identify the causes of disease in most cases, because they know what they are looking for example, a microbe, a tumour or an unusual gene. This is a huge change from the 19th century.

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Improved scientific understanding has also led to better testing and trialling of new treatments before they are given to patients. In the past, drugs did not have to go through the process before being used to treat disease. This meant that mistakes were made. The most famous of these mistakes was the use of the drug thalidomide in the 1960s to treat pregnant women suffering from morning sickness. The drug caused birth defects.

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Now, it takes several years for a new drug to be trialled thoroughly before being used. This slows down progress but ensures drugs are safe for everybody.

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New technology has made it easier to create and provide drugs to treat diseases:

• Mass production of pills has made the distribution of drugs much easier.
• The development of capsules, which dissolve in the stomach to release the drug, means taking drugs to treat disease is easier.
• Hypodermic needles allow the precise dose to be introduced directly into the bloodstream.
• Insulin pumps for young people suffering from diabetes deliver insulin without the need for injections.

Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

The impact of science and technology on advances in medicines

TASK: Draw on the next page to show when the different drugs described in this section were developed. Label each part of the timeline with details, such as who was responsible for its development and which diseases the drug fights.

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

TASK: Draw a timeline to show when the different drugs described in this section were developed. Label each part of the timeline with details, such as who was responsible for its development and which diseases the drug fights.

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

Phase one: Improved access to care

The National Health Service (NHS) was launched in 1948 by the government. Its aim was to provide medical care for the entire population of Britain. It was paid for by National Insurance contributions, taken from wages in the same way as tax. It was the largest government intervention in medical care. The new NHS took over existing hospitals and medical services.

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There are three parts of the NHS in 1948:

• Hospitals, managed by regional hospital boards
• General Practitioners (GPs) and dentists, otherwise known as primary care.
• Additional services, such as the ambulance service and health visitors.

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The government aimed to provide the same level of service for everybody in the country, no matter how rich or poor they were.

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For example, workers earning under a certain amount were already entitled to medical care through the 1911 National Insurance act. However, this did not extend to women who were at home raising their families. After 1948, women were able to get treatment for painful conditions like varicose veins, which might previously have been left untreated. Similarly, children could be treated for minor problems before there was any lasting damage.

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To begin with, hospitals there was not much change due to the launch of the NHS. Post-war Britain did not have a lot of money to spend on medical care. The government was now responsible for 1,143 voluntary hospitals and 1,545 city hospitals, which was a huge undertaking. Many of the hospitals had been built in the 19th century and desperately needed updating. There were also more hospitals in London and South East than there were across the rest of the county.

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Similarly, many GP surgeries were in need of modernisation, as well as the standards of the GPS themselves. Studies in the 1950s suggested that up to a quarter of GP were not satisfactory. With little time or opportunity to keep up-to-date with medical developments, many GPs were behind the times. The problem was made worse by the NHS, because more and more people began visiting GPs. Waiting times increased and appointment times decreased.

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Therefore, access had improved because the NHS was available to all. However, provision had not improved in the short term. During the 1960s, however, the government implemented changes to improve the NHS. Plans were made to ensure that hospitals were even spread across the whole country. In 1966, a GP’s charter was introduced, which encouraged GPs to work in group practices and gave them incentives to keep up with medical developments. The government had to manage the NHS rather than just fund it. This led to improvements in standards in care.

The development of the NHS

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

Phase 2: High-tech medical and surgical treatments in hospitals

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Hospital treatments have changed a lot since 1900. Treatments that we consider routine today, like hip replacements and blood transfusions, did not exist before 1900. Patients benefit from high-tech treatments that would have been unimaginable in previous centuries. Once the three major problems of surgery - pain, infection and blood loss - had been solved, doctors were able to carry out more daring and intrusive surgeries than ever before. The development of new machinery to treat the body and even replace parts of it that had stopped working also improved treatment in hospitals.

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There are hundreds of examples of new high-tech medical and surgical treatments being carried out. The information below shows a few examples of these advancements.

The development of the NHS

Medical Treatments

Advanced x-rays

Doctors can now also use x-rays to target and shrink tumours growing inside the body, using a treatment known as radiotherapy. Combined with chemotherapy, this is an effective treatment for many types of cancer.

Smaller, cheaper machines

Process like dialysis, where the blood of patients with kidney failure is ‘washed’ by a machine, and heart bypasses, where a machine performs the functions of the heart, have become more widely available as machines have become smaller and more portable. .

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

Robotics

Better prosthetic limbs are now produced. This is partly in response to the number of soldiers surviving bomb attacks in recent wars in Iraq and Afghanistan.

Surgical Treatments

The first successful kidney transplant was performed between identical twins in the USA in 1956. This paved the way for transplants of other organs, including lungs (from 1963), and livers and hearts (from 1967). These were made possible by improved surgical techniques, including the use of microsurgery to reattach tiny nerve endings and blood vessels.

Microsurgery

Using tiny cameras and narrow surgical instruments, surgeons can now operate inside the body through tiny incisions some distance away from the area to be operated on. This allows for quicker healing and less trauma to the body.

Laparoscopic (keyhole) Surgery

Surgeons can now use computers to control instruments inside the body, allowing for more precise surgery with smaller cuts. Operations can be performed on a tiny scale where precision is of vital importance - for example, in brain surgery.

Robotic Surgery

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

TASK: Answer the following questions.

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1. When was the NHS formed and what was the purpose of the NHS? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. What were the 3 parts of the NHS in 1948? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3. What was the governments aim? ________________________________________________________________________________________________________________________________________________________________________
4. Why did hospitals not change that much initially? ________________________________________________________________________________________________________________________________________________________________________
5. What did studies in the 1950s show about GP surgeries? ________________________________________________________________________________________________________________________________________________________________________
6. What was the short-term impact of the NHS? ________________________________________________________________________________________________________________________________________________________________________
7. What is dialysis? ________________________________________________________________________________________________________________________________________________________________________
8. How are robotics used for treatments? ________________________________________________________________________________________________________________________________________________________________________
9. When and where was the first transplant? ____________________________________________________________________________________
10. What is keyhole surgery? ________________________________________________________________________________________________________________________________________________________________________

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

Treatment

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Looking back to the 17th century, when Thomas Sydenham imagined a world in which each disease would have its own treatment, the change in the way diseases have been treated is immense.

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In the 20th century, medical science made a huge leap forward towards Sydenham’s dream. In 1900, 255 of deaths were caused by infectious diseases. By 1990, that number had fallen to less than 1%.

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In c1900, most people were still taking herbal remedies or patent medicines, such as Beechams, bought from the chemists to treat their illnesses. Now thanks to advances in science after 1900, there are a wide variety of specific, effective medicines matched with the disease that they treat.

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However, scientists continue to face problems when developing treatments.

• It is very difficult to develop a vaccine against some viruses. A different flu vaccine is available every year, as scientists develop it in response to the most common strain of the flu virus at that time.
• New diseases keep appearing, which do not respond to any chemical treatments that we currently know about. Scientists have to go back to the lab and continue testing compounds in the hope that they might find one that is effective.
• Lifestyle factors have caused an increase in illnesses such as heart disease and cancer, for which there are no certain cures.
• Microbes are living organisms and they have evolved to beat some of the cures doctors have been using. This led to drug-resistant bacteria, such as MRSA. Tuberculosis cases are once again on the rise in the UK.

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We may not be facing all the same problems as our ancestors when researching treatments for illness and disease, but we face many new ones. Therefore, alternative remedies, such as herbal medicines, acupuncture and homeopath, are still popular treatments for disease.

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Improved access to care

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In C1900, most sick people were still cared for in the home by women. Doctors had to be paid and so were only used for serious illnesses.

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The situation improved slowly during the first half of the 20th century. In 1919, the government set up the Ministry of Health to help determine the level of health care across the country.

The extent of change in care and treatment

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

There was rapid improvement in the availability of care outside the home from 1948 onwards. The NHS made medical services free at point of service. This gave everybody access to medical care and treatment.

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However, the introduction of the NHS made it clear once and for all, that hospitals were just for treating the sick. In earlier periods, hospital had been places for the elderly to rest. This change left a gap in services. Up until the end of the Second World War, elderly people with no family had often lived on the last days of their life in hospitals. This was no longer possible.

TASK: From the reading on the previous page, decide if the following statements are true or false. If the statement is false, write the correction in the end column.

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

Preventing Disease

By c1900, many different approaches to preventing disease had been put in place. The government now took responsibility for providing clean water and removing waste. The public understood the importance of these factors, due to the development of Germ Theory. As more people were given the vote, the government paid more attention to what its citizens wanted.

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The government has taken significant action to improve the public's health since the beginning of the 20th century. The laissez-faire attitude was now behind them. There are two reasons for this.

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1. Increased understanding of cause

Now that we understand what causes disease, the government recognises that its intervention can have an impact. Without this understanding, the British government would not have acted in the same way, because they did not know that their intervention could change things.

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2. Increased understanding of methods of prevention

Once the causes of disease and health problems was understood, methods of prevention could be tested and introduced. These have included:

• Compulsory vaccinations: inspired by the positive impact of the smallpox vaccination, other campaigns were launched in the 20th century.
• Passing laws to provide a healthy environment: these include the Clean Air Acts and adding the chemical fluoride to the water supply to help prevent tooth decay.
• Communicating health risks: lifestyle campaigns help people to identify and tackle health risks. During times of global epidemics, such as during the 2014-15 outbreak of Ebola in West Africa, the government tracked travellers from affected regions and put quarantine measures in place to stop the spread of disease. Communicating risks to the population has become key in preventing disease.

What responsibilities did the government take on?

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Why did they do this?

Draw 3 symbols to represent the 3 different methods of prevention.

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

Charities also contribute to healthy lifestyle campaigns. For example, he British Heart Foundation creates adverts encouraging people to protect their heart by giving up smoking, eating less fat and exercising.

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New approaches to prevention: Mass Vaccinations

The national vaccination campaign against diphtheria was launched in 1942 - the first of its kind. Before this, local governments were responsible for vaccination campaigns that were not funded by the central government, which meant they were not widespread. Around 2,000 children died each year of diphtheria.

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During the Second World war, the government put a national campaign in place to immunise all children against diphtheria. There were fears that the cramped conditions of air-raid shelters during the war might lead to an epidemic. Because of this, infection rates plummeted. By the middle of the century, diphtheria was seen as a disease of the past.

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Another significant vaccination campaign was against poliomyelitis (polio). Polio is a very contagious disease that causes paralysis. In the early 1950s, there were as many as 8,000 cases reported every year in Britain. The vaccination was developed in the USA by Jonas Salk and was introduced to the UK in 1956, followed by a more effective vaccination in 1962. As with diphtheria, the number of infections dropped very rapidly. The last case of a person contracting polio in the UK was in 1984.

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Some vaccines are aimed at protecting future generations. Rubella, or German measles, is not a life-threatening disease for most people - however, it can be very dangerous if a pregnant woman catches it because it will affect the unborn child.

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Other vaccines target disease that can lead to other disease. The HPV vaccine, for example, protects women against infection from a sexually transmitted disease that has been linked to cervical cancer.

Who was responsible for vaccination campaigns?

What fears did the government have during WW2?

What polio?

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How successful was the vaccination campaign?

How are some vaccines aimed at protecting future generations?

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

There continues to be controversy surrounding vaccinations. Many people resent government intervention and choose not to vaccinate their children. A lack of trust in the medical profession has led to fears that vaccines are unsafe. While vaccination is the best way to prevent the spread of dangerous epidemic disease, there is still freedom of choice to reject this method.

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New approaches to prevention: government legislation

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The government has passed laws to provide a healthy environment for the population. Examples of these were the Clean Air Acts of 1956 and 1968. They were triggered by bad episodes of smog in London in 1952.

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Smog is very heavy fog caused by air pollution. In an era a time when everybody burned coal to heat their homes, there was a great deal of smoke and soot in the air, particularly in London, where a lot of people lived. Sometimes there was so much pollution that smog would cover the city for days at a time.

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Smog is no longer a significant problem in the UK. However, the government continues to pass laws to protect the population from air pollution. An example of this is by limiting car emissions.

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New approaches to prevention: government lifestyle campaigns.

As well as providing direct intervention to prevent disease, the government also aims to help people prevent disease themselves, by promoting healthier lifestyles. Some examples of their work include:

• Advertising campaigns warning against dangers to health, such as smoking, binge drinking, recreational drug use and unprotected sex. .
• Events such as Stoptober, which encourage people to stop smoking for a month
• Initiatives encouraging people to eat more healthily and get more exercise, such as the Change4Life campaign.

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What have been some controversies with vaccinations?

What were the reasons for the Clean Air Acts?

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What is smog?

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How do the government continue to protect the population from air pollution?

In your own words, what are the government lifestyle campaigns?

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

TASK: Read through each statement carefully. 

• If it is a full sentence write S in the final column
• If it is a fragment write F in the final column

TASK: Read back through the statements.

1. Repair the sentences by adding capital letters and punctuation in the right places in the table above.
2. Convert the fragments into full sentences with capital letters and punctuation in the table below

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Approaches to prevention and treatment

The extent of change in care and treatment. The impact of the NHS and science and technology

TASK: Look at the table below and all the different methods of prevention through out the time periods we have studied, tick which time period these methods were used in. They may fall into more than one time period.

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Case Study: Penicillin

Fleming, Florey and Chain

Following the development of the first ‘magic bullet’ in 1909, the search for effective treatments continued throughout the 20th century. The development of penicillin into a usable drug revolutionised the way that infections were completed and has saved countless lives.

Alexander Fleming and the discovery of Penicillin

Alexander Fleming was a British doctor working at St Mary’s Hospital in London. He had a particular interest in bacteriology and had been one of the first doctors to use the first ‘magic bullet’ to treat syphilis. During the First World War, Fleming had worked in battlefield hospitals trying to improve treatments for wounded soldiers. He was dismayed at the number of men who died from simple infections.

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During the 1920s, Fleming research substances that might be effective in combating these simple infections. In 1928, he noticed something unusual about his dirty petri dishes, one of them had developed some mould. This mould appeared to have killed off the harmful staphylococcus bacteria that had been growing in the dish.

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Fleming tested the mould and identified it as penicillin. He was not the first person to notice what it could do: in the Middle Ages, people were aware that mouldy bread had healing properties, and Joseph Lister used it to treat a patient in 1871. However, Fleming published his findings at a time when scientists were actively looking for chemical treatments for disease, and so more notice was taken of it.

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Unfortunately, Fleming did not believe that penicillin could work to kill bacteria in living people. His first experiments with the mould showed that it became ineffective when mixed with blood in test tubes in the laboratory, so he did not pursue funding to perform further tests on the mould.

Howard Florey was an Australian pathologist working at Oxford medical school. His colleague, Ernst Chain, had escaped Nazi Germany, where he had been a biochemist.

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Florey and Chain were conducting research in the field of antibiotics. As part of this, they were looking for neglected

Florey and Chain and the development of penicillin

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Case Study: Penicillin

Fleming, Florey and Chain

research that might be worth investigating. They came across Fleming’s findings and decided that the mould should be tested further. Chain grew the mould in his laboratory and used extracts of it in tests for treatment.

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In 1940, Florey and Chain tested their extracted penicillin on infected mice. The results were promising it looked as though the penicillin was killing the infection. Unfortunately, it was very difficult to produce penicillin in large quantities. The active ingredient in the liquid produced by the mould only represented one part per two million - that meant growing a great deal of mould before it was possible to get started on a human trial.

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The scientists set about growing as much penicillin as possible. They used whatever they could to grow the mould: milk churns, bedpans and even a bathtub. By 1941, Florey and Chain had a human patient on whom to try the drug: a local policeman who had developed an infection. He had been scratched by a rose bush and had developed septicaemia - fatal blood poisoning.

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Florey and Chain only had a very small amount of penicillin, but they gave it to the policeman anyway. He showed signs of recovery almost straight away. However, there had not been enough penicillin to cure him completely and there was no more available. Florey and Chain collected the patient’s urine and extracted leftover penicillin from it. This was then given to the patient and, again, he showed signs of getting better. Unfortunately, this could only be done so many times and the patient eventually died.

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Nethertheless, penicillin had proved to be effective in fighting infection in the human body.

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Mass production of penicillin

Florey and Chain proved that penicillin was effective in treating infections, but they were still struggling to mass produce it. They need a large-scale factory where the penicillin could be grown and extracted on an industrial scale.

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Florey first approached British pharmaceutical companies for assistance. Unfortunately, this was during the Second World War and the companies were busy producing materials for the war effort.

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However, the USA had not yet joined the war. In July 1941, Florey visited the USA and convinced pharmaceutical companies to begin penicillin production. The companies started growing penicillin in beer vats. It was a very slow process - after a year, the US companies only had enough penicillin to treat ten people.

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However, once this had begun, the impact of penicillin could be shown. The US government, observing the benefits of the drug, funded 21 pharmaceutical companies to begin mass producing it. British pharmaceutical companies became involved in 1943, when they too stated to mass produce the drug. By D-Day, in June 1944, there was enough penicillin available to treat all Allied casualties.

34

Case Study: Penicillin

Fleming, Florey and Chain

TASK: Below are a list of false statements, you need to correct them.

TASK: Create a fact file on Fleming, Florey and Chain.

35

Case Study: Penicillin

Fleming, Florey and Chain

Factors enabling the development of penicillin

Institutions

The US government agreed to fund Florey’s research for five years. This enabled him to develop methods to mass produce the drug.

Technology

The development of new ways of mass-producing and storing penicillin made the drug available in vast quantities.

Attitudes in society

There were no treatments for simple infections during the First World War. The need to find a solution to this problem became more important during the Second World War. Because of this, the clinical trials and evidence needed before the treatment was made available to the public was minimal.

Science

Scientists were able to observe how penicillin attacked staphylococcus bacteria and this enabled them to modify it to attack other types of bacteria.

Individuals

Florey and Chain built on the work of Fleming. All three were actively looking for a chemical treatment for disease and illness. Florey also refused to patent the drug saying that it should be available for everybody. This meant that developing it didn’t cost as much money.

Main Factors

36

Case Study: Penicillin

Fleming, Florey and Chain

Use of penicillin

Penicillin is effective in treating diseases caused by a certain family of bacteria. Penicillin is also used to prevent infection, particularly with patients who have had teeth extracted. The development of penicillin also encouraged scientists to look for other moulds that could be used to fight bacterial infections - such as streptomycin, which was the first drug found to be effective against tuberculosis. Once Dorothy Hodgkin had mapped the chemical structure of penicillin, scientists were able to begin working on synthetic versions of it that were slightly modified to treat specific disease.

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Now that doctors could offer treatments that worked against a wide range of illnesses, confidence in medical treatments began to rise. Patients were more willing to seek out medical treatments from Doctors.

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Unfortunately, some bacteria are now resistant to penicillin. Bacteria can mutate to resist attack from penicillin mould. The first penicillin - resistant strain of bacteria appeared in 1942. Pharmaceutical companies continue to work hard to develop new forms of penicillin and other antibiotics that will kill ff the bacteria.

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TASK: How do the following phrases/word link to the development of penicillin?

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1. Magic bullet: ________________________________________________________________________________________________________________________________________________________________________
2. Alexander Fleming: ________________________________________________________________________________________________________________________________________________________________________
3. US Government: ________________________________________________________________________________________________________________________________________________________________________
4. Attitudes in society ________________________________________________________________________________________________________________________________________________________________________
5. Streptomycin: ________________________________________________________________________________________________________________________________________________________________________

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Case Study: The Fight against Lung Cancer

The use of science and technology in diagnosis and treatment, government action

Lung Cancer

Lung cancer was extremely rare 150 years go. Its frequency increased greatly in the early 1900s and today it is the second most common form of cancer. Over 40,000 people are diagnosed with it each year. Medical evidence has proved conclusively that cigarette smoking (which first became common in the early 1900s and especially during the First World War) is the major reason for contracting lung cancer. Nearly 90 per cent of cases are the result of smoking, in some cases of passive smoking.

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Lung cancer is particularly deadly because it is extremely difficult to diagnose in its early stages. It is usually diagnosed once symptoms have developed which means cancer may have spread. Only one in three people live for as long as a year after diagnosis. Only 10 percent live for more than five years. This compares very badly with survival rates from other cancers where 50 per cent live for at least ten years after diagnosis.

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The devastation caused by lung now means that huge efforts are made in prevention, diagnosis and treatment. Governments have launched major campaigns to prevent people developing lung cancer. Campaigns warn people of the extreme dangers of smoking , through advertising the dangers, banning advertisements for cigarettes and making them as invisible as possible in shops. New laws have made public places such as cafes, cinemas, sports grounds, workplaces and pubs smoke free, aiming both to reduce the effects of passive smoking and to help people give up smoking. Other campaigns, aim to improve rates of early diagnosis.

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Governments have also, through the NHS, invested large sums of money in improved treatments which in turn are dependent on developments in science and technology on research undertaken by scientists. However, there is at this stage (2015) not national screening programme because the technology does not exist to pick up the earliest signs of lung cancer. As a step towards this, the screening of high-risk individuals is being developed.

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TASK: If this is the question, what is the answer?

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Over 40,000: ______________________________________________________________________________

90%: ____________________________________________________________________________________

Difficult to diagnose: _________________________________________________________________________

Public places: ______________________________________________________________________________

Large sums of money: ________________________________________________________________________

38

Case Study: The Fight against Lung Cancer

The use of science and technology in diagnosis and treatment, government action

The use of Science and technology in diagnosis

One of the reasons why lung cancer is so hard to treat is that usually, by the time the cancer is detected, it is also already very advanced. Patients often mistake their symptoms for other disease. There is no national screening programme for lung cancer, so people are not routinely tested to see if they have it. This is because tests are not accurate enough to outweigh the negative effects of the screening (for example, exposure to radiation during an x-ray scan).

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Diagnosis is also difficult, although technology has led to improvements in this area.

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Diagnosing lung cancer

Before more advanced technology had been discovered, lung cancer was diagnosed using an x-ray machine. A doctor would examine the x-ray to look for a tumour.

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This way of diagnosing was not ideal. Often other things, like lung abscesses, might be mistaken for cancer – or, worse, cancer could be mistaken for something less threatening. X-rays were not detailed enough to accurately diagnose cancer.

39

Case Study: The Fight against Lung Cancer

The use of science and technology in diagnosis and treatment, government action

The use of Science and technology in diagnosis

TASK: Answer the following questions:

1. Explain the most common causes of lung cancer ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. Explain why lung cancer is difficult to treat ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3. How has science and technology helped in the diagnosis of lung cancer? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The use of science and technology in lung cancer treatment

If lung cancer is diagnosed early, doctors can perform an operation to remove the tumour and the infected portion of the lung. This can range from the removal of just a small piece, to the removal of the entire lung. It is possible to breathe normally with only one lung. There are also other treatments to consider.

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Transplants

It is possible to replace cancerous lungs with a transplant form a healthy donor. However, this raised a number of ethical problems if the patient developed lung cancer after smoking for a long period of time. Is it fair to give new lungs to somebody because they chose to ruin their own?

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Radiotherapy

During radiotherapy, concentrated waves of radiation are aimed at the tumour to try to shrink it. Small tumours can be treated this way instead of with surgery. Larger tumours can be prevented from growing bigger using radiotherapy.

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The radiotherapy can either be administered as beams of radiation directed at the tumour from outside the body, or by placing a small piece of radioactive material directly next to the tumour using a very thin tube, called a catheter.

40

Case Study: The Fight against Lung Cancer

The use of science and technology in diagnosis and treatment, government action

The use of science and technology in lung cancer treatment

Chemotherapy

During chemotherapy, patients are injected with many different drugs. These either shrink the tumour before surgery, prevent the cancer from reoccurring, or provide relief from the symptoms of lung cancer when surgery is not possible.

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Lung cancer patients are now more likely to be treated using a range of these strategies. For example, they might have surgery to remove the tumour and then have radiotherapy and chemotherapy to tackle any remaining cancerous cells.

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Genetic research

It is not yet possible to use genetics to treat lung cancer.

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However, scientists have been studying the genes of lung cancer sufferers in order to help doctors prescribe more effective treatments. For example, some chemotherapy drugs work better in lung cancer patients whose tumours have a certain genetic mutation.

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The reason for this is not clear. However, it does show that treatment can be more effective if it is prescribed for the individual, rather than on a ‘one size fits all’ basis. This idea of tailoring treatments to a person’s DNA is a growing field in medical research known as pharmacogenomics.

TASK: List the different ways in which science and technology is used in the treatment of lung cancer and give a one sentence summary.

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________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

41

Case Study: The Fight against Lung Cancer

The use of science and technology in diagnosis and treatment, government action

Prevention: the British government take action

The government was slow to respond to the evidence that cigarette smoking was linked to lung cancer. This evidence was first published in 1950. By 1985, smoking-related deaths cost the NHS £165 million a year. However, the government earned around £4 billion from the tobacco tax. There were thousands of jobs related to the tobacco industry in the UK. There was also an ethical issue: was it the government’s job to limit personal freedoms?

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However, as time passed, it became clear that the government needed to intervene. The death rate was too high – they would not normally ignore an epidemic of such magnitude.

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The table below shows some of the actions that the government took.

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42

Case Study: The Fight against Lung Cancer

The use of science and technology in diagnosis and treatment, government action

Prevention: the British government take action

TASK: Why were the government slow in responding to scientific evidence that smoking was harmful?

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___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Explain in 50 words the different actions in which the government have taken to prevent lung cancer.

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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HOT How successful do you think the government have been?

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____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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HOT: Some people argue that the smoking ban is an attack on personal freedoms, do you agree or disagree with this statement?

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______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Notes

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Notes