Changes in medicine 1920-48

Question 1

Who observed the need for a new magic bullet against septicaemia in WW1?

Answer 1

Alexander Fleming

Question 2

What did Alexander Fleming do whilst researching lysosome?

Answer 2

Made the modern rediscovery of penicillin

Question 3

When did Alexander Fleming make the modern rediscovery of penicillin?

Answer 3

1928

Question 4

Why did funding for Fleming’s research stop despite him publishing his findings?

Answer 4

• Production difficulties
• Penicillin was too slow to act
• It was ineffective when mixed with blood

Question 5

When did Fleming publish his findings?

Answer 5

1929

Question 6

What did Norman Heatley do?

Answer 6

Constructed equipment to cheaply purify penicillin and experimented on how to produce large volumes of it

Question 7

Who led the team at Oxford?

Answer 7

Howard Florey and Ernst Chain

Question 8

When was equipment constructed to cheaply purify penicillin?

Answer 8

1939

Question 9

When was penicillin tested on mice?

Answer 9

1940

Question 10

What was the result of testing penicillin on mice?

Answer 10

The dosed mice survived, though much more penicillin was needed for humans

Question 11

What happened to Albert Alexander in 1941?

Answer 11

He was treated with penicillin but they ran out. It was decided to only be use on children and not to patent it

Question 12

When did Florey go the US?

Answer 12

1941/2

Question 13

Why did Florey go to the US?

Answer 13

To mass produce penicillin because Britain was at war so there wasn’t enough funding or facilities

Question 14

Who advanced methods of growth and storage of penicillin?

Answer 14

The Us government, universities and companies

Question 15

When was penicillin tested in the North African Warzones?

Answer 15

1942

Question 16

Who received penicillin during the 1944 D-Day landings?

Answer 16

Allied casualties who had undergone major operations or had extensive wounds

Question 17

When did Fleming, Florey and Chain win a Nobel prize?

Answer 17

1945

Question 18

What did further research on penicillin develop?

Answer 18

Versions for use against streptomycin

Question 19

Why was there increased willingness to accept female medical practitioners during WW1?

Answer 19

There weren’t enough male recruits and there was an increased need for medical practitioners due to more men in the armed forces and more injured soldiers

Question 20

What was the RAMC (Role, Gender, Size, Locations, Employment conditions, History, Famous Members)?

Answer 20

• The Royal Army Medical Corps organised everything to do with injured soldiers.
• Men only
• Up to 13,000 officers and 154,000 lower ranks
• Ran everything from first aid points near the front lines to hospitals further back and in Britain (including St Thomas’ London)
• Regular, paid positions
• Predecessors from 17th century: RAMC name and structures from 1890s

Question 21

What was the VAD (Role, Gender, Size, Locations, Employment conditions, History, Famous Members)?

Answer 21

• The Voluntary Aid Detachment were nurses (and other roles)
• Mostly women (2/3 in 1914)
• 90,000 volunteers
• Worked in field hospitals and British hospitals
• By 1918, about 3/4 unpaid volunteers, rest (badly) paid positions in nursing and admin
• Set up by Red Cross in 1909, initially organised locally in Britain
• Vera Brittain, Agatha Christie, Sophia Duleep Singh

Question 22

What was the WAAC (Role, Gender, Size, Locations, Employment conditions, History, Famous Members)?

Answer 22

• The Women’s Army Auxiliary Corps were not nurses, but worked as cooks, drivers, mechanics and clerks
• Women only
• 50,000 volunteers
• Worked mostly near front lines
• Paid work in armed forces, but no possibility of being promoted to officer
• Set up in 1917 so as to “free up” men; closed down in 1921

Question 23

What was the FANY (Role, Gender, Size, Locations, Employment conditions, History, Famous Members)?

Answer 23

• The First Aid Nursing Yeomanry intended as delivering first aid (on horseback before WW1), in practice wider remit
• Women only
• Started with seven women and one ambulance; never very big
• Worked near front lines, first informally (without government approval) 1914-16, then officially 1916-18
• Self-funded or donations
• Set up in 1907; initially restricted to young women who owned horses
• Lilian Franklin (“the Boss”)

Question 24

What were the conflicts in training of female medical practitioners?

Answer 24

• Professionally trained nurses were suspicious/dismissive of quickly or barely trained nurse, whom they saw as eroding their professional standards.
• Where these volunteers were paid, professionally trained nurse resented that
• Where these volunteers were unpaid, trained nurses thought that their position as professionals was at risk
• Quickly trained nurse had much less respect for hierarchies and procedures, and often a much more emotional approach to their work/were more willing to invest in patients emotionally

Question 25

What were the conflicts in class of female medical practitioners?

Answer 25

• Some volunteers were extremely wealthy and powerful. These tended to look down on less wealthy and powerful people, who relied on wages for income.
• Those who relied on pay tended to reverse snobbery towards those who had “too much money”
• Culturally there was a clash between upper-class or middle-class volunteers and working-class nurses (for example some nurse had entered the profession in 1911, when women were barred from working in coal mines

Question 26

What were the conflict in gender of female medical practitioners?

Answer 26

• The Army and the War Office both wanted to maintain a clear gendered hierarchy, and did so by:
• Keeping women’s pay below men’s pay for the same job
• Trying to restrict women’s work to “feminine roles” e.g. telephone operators in WAAC, but this was increasingly hard to maintain as war went on

Question 27

What was women’s work as doctors like before WW1?

Answer 27

• Less than 1% of doctors were women
• Most practiced for GPs or in children’s/women’s hospitals

Question 28

What was women’s work as doctors like during WW1?

Answer 28

• Told to stay in Britain to replace male doctors (albeit in slowly increasing range of roles including surgery - c.50% of male doctors joined war)
• From 1916, some female doctors working for the RAMC in Malta (but on worse conditions than men e.g. did not become officers)
• Endell Street Military Hospital staffed only by women, set up in 1915 by Louisa Garret Anderson (Elizabeth’s daughter) and Flora Murray
• By end of war, about 20% of women doctors had worked in hospitals
• Many medical schools accepted female students (12 schools in London alone)

Question 29

What was women’s work as doctors like after WW1?

Answer 29

• Most medical schools stopping accepting female students (in London only the Royal Free Hospital [now UCL Hospital] did so)
• Very hard for female doctors to get jobs, irrespective of experience

Question 30

How was the second magic bullet developed?

Answer 30

In 1932 Gerhard Domagk tested Prontosil against streptococcus. In 1935 his daughter got ill form a pricked finger so he gave her prontosil and it worked.

Question 31

What did the Norway Campaign (April-June 1940) teach the British?

Answer 31

That blood transfusions needed to happen early - and the blood had to be provided in sufficient quantity - if it was to alleviate wound shock and prevent heart failure; this is turn, depended upon efficient logistics

Question 32

Where were FTUs set up?

Answer 32

Field Transfusion Units were set up near the front lines. To support them a Blood Transfusion and Surgical Laboratory was established behind the lines.

Question 33

What was the main problem with FTUs?

Answer 33

A shortage of blood. The Blood Supply Depot at Bristol worked hard to cope with the shortage

Question 34

What was the result of field trails of plasma-transfusion?

Answer 34

It was found to be successful in reducing wound shock and had no side-effects

Question 35

What lessons were applied in the Western Desert Campaign?

Answer 35

All medical staff, including nurses and orderlies, were given training in blood transfusion therapy and blood supplies and transfusion equipment were stored in all medical centres, not only specialist FTUs

Question 36

What was done by the end of the war?

Answer 36

FTUs were established in all theatres of war and volunteer donors provided them with a plentiful supply of blood and plasma for the “Blood Banks”. The blood was stored and transported to where it was needed by Mobile Refrigeration Units (MRUs). These blood supplies were crucial in saving lives as the FTUs worked closely with Casualty Clearing Stations (CCS) and Field Dressing Stations (FDS) to resuscitate soldiers.

Question 37

Where was the first British “Blood Bank” set up?

Answer 37

Ipswich, England

Question 38

When was the first British “Blood Bank” set up?

Answer 38

In 1937 during peacetime

Question 39

When was a basic panel of 5000 donors established with the Blood Transfusion Service (BTS)?

Answer 39

1939, as war seemed certain

Question 40

How many centres had been set up to collect blood by 1944?

Answer 40

Over 900

Question 41

When was the National Blood Service established?

Answer 41

1946

Question 42

How was Archibald McIndoe recommended as a plastic surgeon to the RAF?

Answer 42

By his cousin, Harold Gillies. He accepted on the condition that he remained a civilian despite strong pressure from the RAF to be commissioned

Question 43

What was used to treat burns?

Answer 43

Tannic acid

Question 44

What did McIndoe think of tannic acid?

Answer 44

That it did more harm than good

Question 45

What evidence was there that tannic acid did more harm than good?

Answer 45

Pilot Richard Hiliary arrived completely covered in coagulated acid, immobilising his fingers and toes and forcing his eyelids closed

Question 46

How did the airmen from the Atlantic help McIndoe to find a replacement for tannic acid?

Answer 46

They appeared to be in better shape than those on dry land. The salt water, it seemed, had benefitted them. They appeared to be in less pain, their burns were cleaner and easier to graft new skin onto. This is how McIndoe developed his idea of the “saline bath”. It was discovered that the saline solution needed to be slightly higher temperature than body heat and the salinity needed to be kept constant. McIndoe’s saline bath or “burns tank” is still used today and it placed the plastic surgeon at the forefront of burns treatment which used to be the responsibility of the general surgeon

Question 47

What were the problems with the saline bath?

Answer 47

Many hospitals couldn’t use it due to the special facilities required nor was it suited for war

Question 48

How did McIndoe pay considerable attention to the mental side of his patient’s recovery?

Answer 48

He went around East Grinstead speaking to pub owners to ensure that his patients were welcome and to make the “town that didn’t stare”. On 20th July 1941the “Guinea Pig Club” was founded, open to guinea pigs, doctors and friends

Question 49

How were female doctors treated between the wars?

Answer 49

As inferior to male doctors. Advancements made in WW1 were lost as gender stereotypes returned. There weren’t many women in the field as they were expected to marry and look after children

Question 50

Why did female doctors not play as important a role in WW2 as in WW1?

Answer 50

• It was difficult to travel across Europe due to Nazi pressures
• The government believed that women were unable to fill the necessary duties of an officer
• They were not allowed to join the RAMC - they were auxiliaries

Question 51

Why did female doctors not receive enough commemoration in WW2?

Answer 51

• They were less publicly visible of the front lines
• Expected to “simply get on”
• Gender stereotyped

Question 52

What was a “novel feature” of WW2?

Answer 52

The recruitment of female doctors into the army, although they were only admitted to the Auxiliary Territorial Service (ATS) or the BTS, not the RAMC

Question 53

What evidence is there that women did not accept the limitations in WW2?

Answer 53

The Medical Women’s Foundation (WMF) made requests to be admitted into the RAMC

Question 54

Why was nursing in WW2 very demanding?

Answer 54

• It was understaffed
• Emergency periods were common
• There were constant disease sufferers
• Most importantly the pressure to get soldiers fighting again
• Some nurses were awarded the Burma Star for their contribution to victory

Question 55

What did many nurses experience as a result of WW2?

Answer 55

Psychological problems which were rarely discussed. They were suffering from Post Traumatic Stress Disorder (PTSD)

Question 56

Why was the expanding role of government in Public Health pre-1940 a cause for the introduction of the NHS?

Answer 56

The Liberal government reforms introduced old age pensions, national insurance and schools having medical clinics. In the 1930s the government launched a major campaign to have children vaccinated against diphtheria. In 1938 the Emergency Medical Service was introduced and showed that government organisation could work well

Question 57

Why was the context of the 1930s a cause for the introduction of the NHS?

Answer 57

The Labour party became popular and opposition to Conservatives. The WSC and great depression led to mass unemployment, meaning that less insurance payments were being made. Government action was needed to decrease deaths and support the economy

Question 58

Why was the impact of WW2 a cause for the introduction of the NHS?

Answer 58

Many were in need including children and confidence in the government’s ability to protect its population needed addressing

Question 59

Why was the Beveridge Report a cause for the introduction of the NHS?

Answer 59

Published in 1942 by William Beveridge a lawyer and director of London School of Economics. 95% of the British public were aware of the report and >650,000 copies were sold. The cartoon called “The Five Giants” depicts Beveridge slaying the 5 key problems he identified in British society in order of significance: Want, Ignorance, Disease, Squalor and Idleness. Beveridge proposed large-scale social security changes

Question 61

Why was the 1945 election of a new Labour government a cause for the introduction of the NHS?

Answer 61

The Labour part won 48% of the votes and had a 393 seat majority. The National Health Service Act and the Nation Insurance Act were passed in 1946, they were paid for by taxes and extended social securities, provided care “from cradle to grave” and brought all aspects of medicine and care under the NHS and therefore the government

Question 62

What was the NHS?

Answer 62

A single, centralised British system, free at the point of entry to all

Question 63

Why did some doctors oppose the NHS?

Answer 63

They viewed it as socialist tyranny

Question 64

What 3 parts was the NHS organised into?

Answer 64

• Hospital were brought into one system and run by 14 regional boards
• Doctors, dentists, opticians and pharmacists were employed through individual contracts, GPs were central in referring patients to hospital and writing prescriptions
• Maternity clinics, vaccination programmes and school dental services were run by local authorities, led by medical officers

Question 65

When was the NHS launched?

Answer 65

5th July 1948