Medicine 4 Flashcards
Impact of WW1
- portable x-rays
- blood transfusions
- plastic surgery
Discovery of X-rays
1895 - Wilhelm Röntgen
How do X-rays work
- X- rays pass easily through soft flesh, less well through bone
- images produced by directing X-rays at body part in front of photographic plate
Problem with traditional X-rays in war
- located in hospitals miles from battlefields
- equipment involved glass tubes that were unreliable, often stopped working
Work of William Coolidge
- American scientist
- 1913 - invented more reliable X-ray tube: ‘Coolidge tube’
- widely used by end of war, still used today
Work of Marie Curie
- Polish scientist
- 1914 - mobile X-ray units: ambulances equipped with X-ray machines, could be easily transported across battlefield
- set up schools with Antoine Béclère to train radiologists
Discovery of blood groups
- 1900 - Karl Landsteiner
- discovered certain blood groups couldn’t be mixed together as blood would clot, blocking vessels
Result of Landsteiner’s discovery
Doctors could perform more successful blood transfusions, if donor’s blood group was same as patients
How did WW1 impact blood transfusions
- more serious wounds from gunshots + explosive shells so many soldiers died of blood loss - important to be able to store blood
- 1914 - doctors found sodium citrate stopped blood clotting, could be stored
- 1917 - first blood depot at Battle of Cambrai
When was British National Blood Transfusion Service established
1946
How did WW1 impact plastic urgery
- doctors in France + Germany worked on skin grafts before war
- Harold Gilles set up first plastic surgery unit for British Army during war
What did Harold Gilles develop
Pedicle tubes technique
What did Harold Gilles want to do
Reconstruct facial injuries so soldiers (and other people) could have normal appearance
How did pedicle tubes technique work
- skin partially cut from healthy part of body
- grown + reattached to damaged area to cover scarring
Harold Gilles’ work in WW2
- continued work with assistant - Archibald McIndoe
- many of McIndoe’s patients where pilots who had been trapped in burning aircraft
Who discovered penicillin
Alexander Fleming
What did Fleming discover first
Iysozyme
How did Fleming discover Iysozyme
- WW1 - noticed many men die of septic wounds caused by staphylococcal bacteria when working in army hospital
- 1922 - discovered antiseptic substance in tears (Iysozme)
Problem with Iysozme
Only worked on some germs
Fleming’s discovery of penicillin
- 1928
- cleaning old culture dishes he had been growing staphylococci in for past experiments
- found fungal spore had landed + grown in a dish
- saw colonies of staphylococci around mould stopped growing
- fungus identified as penicillium notatum, produced substance that killed bacteria - penicillin
Problem Fleming had with penicillin
- published findings in articles 1929-1931
- nobody willing to fund further research - hadn’t tested it on animals
What did Florey and Chain find way to do
Purify penicillin
How did Florey and Chain develop penicillin purification method
- 1938-1940 - Florey’s team in Oxford made breakthrough discovery
- Chain (on team) devised freeze-drying method part of process
How much penicillin needed to treat 1 patient
2000 litres
Who did Florey and Chain experiment on
Albert Alexander
Albert Alexander experiment
- used £25 from UK government
- dying of scepticemia, volunteered for penicillin testing
- began to recover, after 5 days penicillin ran out - he died
Why did Florey go to America
- knew penicillin could be vital to treating wounds of soldiers in WW2
- British chemical firms too busy making explosives to start mass production
When did US government take interest in penicillin
When America joined war in 1941
How did US government help production of penicillin
December 1941 - gave interest free loans to US companies to buy equipment for mass producing penicillin
British mass production of penicillin
- British businesses started in 1943
- sufficient for needs of military medics by 1944
What happened to price of penicillin after war
Fell, making it more accesible
What award were Fleming + Florey + Chain given
Nobel Prize - 1945
What enabled pharmaceutical companies to take off
Chemical companies starting to mass produce drugs + medicines
Drugs developed in booming pharmaceutical industry
- aspirin - 1899
- insulin - 1921
- sulphonamides - 1932
- penicillin
- AZT - 1987
Roles of pharmaceutical companies
- research
- development
- production
Development of AZT
- 1981 - AIDS identified, caused by HIV
- AZT developed to treat HIV
Problems faced by pharmaceutical industry
- thalidomide tragedy
- antibiotic resistance
Thalidomide tragedy
- 1950s - released without thorough testing
- sleeping pill but popular among pregnant women for morning sickness
- caused 10,000+ of babies to be born with under developed limbs
Consequences of thalidomide tragedy
- 1963 - government set up committee on safety of drugs
- drugs now have to go through vigorous clinical testing
Antibiotic resistance
When strain of bacteria adapts so isn’t can’t be killed by antibiotics
What causes antibiotic resistance
- doctors overprescribing
- patients overusing
Effect of antibiotic resistance
Around 25,000 people in EU die per year due to antibiotic resistance infection
First successful transplant
1905 - cornea of eye
First complete organ to be transplanted
Kidney
First successful heart transplant
- 1967
- South African surgeon Christiaan Barnard
- patient lived 18 days, died of pneumonia
Problems with transplants
Rejection
what is rejection in transplants
Immune system attacks transplant as if it were disease
How have transplants improved
Since 1970s, scientists have developed increasingly effective immunosuppressants - drugs that stop immune system attacking
Discovery of radiation
- 1896-1898
- Antoine Henri Becquerel
- Marie Curie
- Pierre Curie
Consequence of radiation discorvery
Radiotherapy could be developed to kill cancer cells
Development of lasers
- developed since 1950s
- widespread use in medicine since 1980s
Uses of lasers
- laser surgery
- correcting vision problems
- cancer treatment
- dentistry
When was keyhole surgery developed
1980s
What led to development of keyhole surgery
Advances in video technology
Process of keyhole surgery
- endoscope (camera) put through small cut, letting surgeon see inside body
- other instruments introduced through smaller cuts in skin
Uses of keyhole surgery
- investigating causes of pain/infertility
- vasectomies
- removing cysts
- removing appendix
- mending hernias
Benefits of keyhole surgery
- leaves patient with smaller scars
- allows patient to recover faster
- less risk of infection
What causes people to use alternative therapies
Distrust in modern medicine + technology
Alternative therapies
- acupuncture
- homeopathy
Acupuncture
Putting needles in specific part of skin to relieve pain
Homeopathy
Treatment using weak solutions of natural substances
Problems with alternative therapies
- not based on evidence to unlikely to be very effective
- some research has shown they do more harm than good
Poverty problems in Industrial towns
- slums
- overcrowded housing
- poor working long hours for low wages
- many couldn’t afford doctors/medicine
- many couldn’t afford 3 meals a day
- no unemployment benefits
- workhouses as last resort - poor conditions
- no pensions
Reports of effects of poverty
- Booth
- Rowntree
Booth’s report
- 1889 - Life and Labour of the People in London
- 30% Londoners live in severe poverty
- often impossible to find work
- wages too low to support family
Rowntree’s report
- owned York factory, didn’t believe problem as bad as London, did survery
- 1901 - Poverty a Study of Town Life
- 28% York people couldn’t afford basic food/housing
Effect of Boer War
- started 1899
- large scale army recruitment campaign
- found 40% volunteers physically unfit for military service
- 1904 - ‘physical deterioration of the people’ report linked poverty to poor physicality (diet, living conditions)
What led to Liberal social reforms
- Booth report
- Rowntree report
- newly elected David Lloyd George
Liberal social reforms
- free school meals act
- medical inspections act
- old age pensions act
- labour exchanges
- national insurance act
Free school meals act
- 1906
- paid for by local councils
- by 1914 - 14 million meals provided to poor children
Problems with free schools meals act
- only half local governments providing meals at time
- still poor diet when not at school
Medical inspections act
- 1907
- local education authorities gave free inspections to children whilst at school
Problems with medical inspections act
Didn’t provide treatment, parents would still have to pay
Old age pensions act
- 1908
- over 70 with no other income - 5 shillings a week
- 650,000 people claimed in first year
- first welfare scheme paid by national taxes
Problem with old aged pensions act
5 shillings a week was a tiny amount
Labour exchanges
- 1909
- unemployed could go to find work in area
- by 1913 - putting 3000 people into jobs per day
National insurance act
- 1911
- every worker paid into this
- if out of work - 7 shillings for up to 15 weeks
Problems with national insurance act
- 7 shillings a week not enough for family to survive on
- had to take eligibility test
Significance of Liberal social reforms
- changing attitude of government
- first attempt to improve living conditions and health - opposite of laissez-faire
How did war pressure public health improvements
- realised health problems with volunteers (40%)
- evacuations raised awareness of town/city problems compared to richer rural areas
How did WW1 affect housing
- after war, Lloyd George promised ‘homes fit for heroes’
- many new council houses build in 1920s/30s
How did WW2 affect housing
- bombing led to destruction
- after war - gov built 800,000 homes from 1945-51
Modern housing improvements
- 1946 New Towns Act - new towns near major cities
- 50s/60s - 900,000 slums demolished, 2 million rehoused
- 1961 ‘Homes for Today and Tomorrow’ report gave housing standards - heating, flushing toilet, enough space in/out
Beveridge report
- 1942
- government has duty to care for all citizens from ‘cradle to grave’
- should have system of grants + services for all citizens - welfare state
- people should have right to be free from 5 giants - ignorance, want, squalor, disease, idleness
- proposed national health service
- bestseller
Result of Beveridge report
- 1945 - Labour gov elected with promise of implementing his proposals
New national insurance act
- 1946
- supported anyone who couldn’t work due to sickness, pregnancy, unemployment, old age
- anyone could apply without taking eligibility test
When was NHS established
1948
How led to establishment of NHS after Beveridge
- Aneurin Bevan - Labour health minister
- negotiated compromise with doctors to treat patients with NHS + privately
- government nationalised hospitls, put them under local authority control
- treatment free for all patients
NHS formation pros
- government took control of hospitals in WW2 as Emergency Medical Service, successful
- hospitals guaranteed to receive government money, rather than relying on charities
NHS formation cons
- opposed by conservatives, thought cost would be huge
- doctors saw themselves as independent professionals, didn’t want to be controlled by government, thought they could lose income
- many doctors threatened to strike against NHS
Success of NHS
- more people could access healthcare
- number of doctors doubled 1948-1973 to keep up with demand
- contributed to life expectancy rise - 66-79 for men, 72-83 for women, 1951-2011
- today - free accessible care - A&E, maternity, surgery, dentistry, sexual health ect.
NHS challenges
- increase in life expectancy - more older people suffering with lifelong disease - diabetes, heart disease
- lifestyle choices straining NHS - smoking, obesity, alcohol leading to liver disease
- expensive modern treatments + medicines
- rising expectations of what NHS should offer
- consequently - rising cost of NHS - £116 billion in 2015/16 budget
Success of NHS today
2015 poll found 60% of people still satisfied with NHS
