Modern Medicine

Question 1

How did DNA give an insight into genetic conditions

Answer 1

In the 20th century new technology let scientists analyse human cells in greater detail. They found that every cell contained DNA. Codes controlling the genes of each person

Question 2

How did James Watson and Francis crick discover DNA

Answer 2

James Watson and Francis crick worked together on how the genetic codes of DNA are fitted together. They analysed X ray crystallography by Maurice Wilkins and Rosalind Franklin at king college hospitals and eventually worked out the double helix structure of DNA.
In 1990 James Watson led the human genome project and started identifying and mapping every gene in the human DNA

Question 3

What was the importance of DNA

Answer 3

By the end of the 20th century, it was also understood that some diseases, conditions or disorders are hereditary - which means they are passed from parents to children in genes. This has been proven for:
Down’s syndrome - the extra chromosome that causes this condition was discovered in 1958
cystic fibrosis - the gene that causes this condition was discovered in 1989
sickle cell anaemia - the genetic understanding of this disorder developed from the 1940s onwards
Knowledge of genetic conditions has improved diagnosis and treatment of them. Scientists can now produce a synthetic protein to replicate the work of a faulty gene and treat inherited conditions using techniques like gene therapy
Predicting whether individuals are at higher risk of developing some cancers

Question 4

What we’re the problems of DNA

Answer 4

There is not yet a cure or effective treatment for lost genetic conditions
Way of preventing most genetic diseases

Question 5

How did we discover that lifestyle factors can increase the risk of some disease

Answer 5

Understanding that our lifestyle has an impact on our health is not new. Doctors in medieval England advised rest, exercise and a good diet to remain healthy. However, since c.1900 there has been a greater understanding of how our lifestyle choices affect our health. Research has shown how specific aspects of our lifestyle cause health problems and illnesses.

Question 6

What are examples of lifestyle factors

Answer 6

Smoking has been shown to cause lung cancer
Obesity increased the chance of getting heart disease or diabetes
Drinking too much alcohol has been shown to cause liver disease
Overexposure to UV radiation can cause skin cancer

Question 7

How do blood tests allow doctors to diagnose more illnesses

Answer 7

Blood tests were first introduced to test blood groups before blood transfusions. Since then blood tests have been used to test for a range of disease
Blood tests can be used to check a patients cholesterol level. This can help diagnose their chance of suffering a heart attack or stroke
Blood tests can be used to check a patients DNA. This can help diagnose a genetic condition like cystic fibrosis or haemophilia
Some blood tests can be used to show whether a patient has a certain type of cancer including ovarian cancer, prostate cancer and breast cancer
Blood tests make diagnosis more accurate providing doctors with clearer info of what is wrong. This means they can be more confident when deciding how best to treat their patients

Question 8

How did medical scans allow doctors to see more of the body

Answer 8

The use of medical scans began in 1895 when Wilhelm röntgen discovered x rays. They pass easily through soft flesh but less well through bone. They also affect photographic film. These factors allowed simple X-ray images to be produced by directing X-rays at a body part in front of a photographic plate
Advances in computers allowed doctors to use ultrasound scanning-this uses high frequency sound waves which bounce off of the patients organs and other tissues to create an image of them on the computer

Question 9

How did medical scans allow doctors to see more of the body (2)

Answer 9

Computed tomography (CT or CAT) scans were invented in 1972 by Godfrey hounsfield. They use X-rays and a computer to make detailed images of parts of the patients body
Magnetic resonance imaging (MRI) scans were initially invented in 1970s but became widely used in the 1980s. These use extremely powerful radio waves and magnetic fields to construct images
Improvements in technology like medical scans have given doctors a much more detailed picture of what’s going on inside their patients body. This has enabled them to intervene much earlier before the disease has become too advanced. Early treatment is generally mor en effective and has a higher chance of success

Question 10

How do patients monitor their own bodies

Answer 10

Since around 1900 devices have been introduced to allow doctors and patients to monitor the body
Blood pressure monitors were invented and developed in the 1880s and 1890s. They let doctors and patients see whether disease, lifestyle factors or medicines are causing high blood pressure which can cause damage to the heart

Question 11

How do patients monitor their own bodies (2)

Answer 11

Blood sugar monitors were introduced in the mid 20th century. They allow those with diabetes to make sure their blood sugar is at the right level.

Question 12

How did Fleming discover penicillin

Answer 12

Alexander Fleming saw many soldiers die of septic wounds caused by staphylococcal bacteria when he was working in an army hospital during the First World War
Searching for a cure he identified the antiseptic substance in tears lysozyme in 1922 but this only worked on some germs
One day in 1928 he came to clean up some old culture dishes on which he had been growing staphylococci for his experiments. By chance a fungal spores had landed and grown on one of the dishes

Question 13

How did Fleming discover penicillin (2)

Answer 13

What caught Flemings eye was that the colonies of staphylococci around the mould had stopped growing. The fungus was identified as penicillin. Fleming published his findings in articles between 1929 and 1931. However nobody was willing to find further research so he was unable to take his work further. The industrial production of penicillin still needed to be developed

Question 14

How did Florey and chain find a way to purify penicillin

Answer 14

Since it’s a natural produce penicillin needs to be purified. A breakthrough was made by Howard Floreys team in Oxford between 1938 to 1940. Ernst chain a member of the team devised the freeze drying technique which was an important part of the purification proces
At first Florey and chain didn’t have the resources to produce penicillin in large amounts. They made penicillin for the first clinical trial by growing it in every container they could find in the lab.

Question 15

How did Florey take penicillin to America for mass production

Answer 15

In December 1941 the us government began to give out grants to businesses that manufactured penicillin
By 1943 British businesses had also started mass producing penicillin. Mass production was sufficient for the needs of the military medics in 1944
After the war the cost of penicillin fell making it more accessible for general use
Fleming, Florey and chain were awarded nobel prize in 1945

Question 16

What was the importance in penicillin

Answer 16

Today penicillin is used to treat a range of bacterial infections including chest infections and skin infections
Other antibiotics were discovered after 1945 including treatments for lung infections, acne and bacterial meningitis

Question 17

How did Paul Ehrlic discover the first magic bullet-Salvarsan 606 to treat disease

Answer 17

Antibodies were identified as a natural defence mechanism of the body against germs. It was known that antibodies only attacked specific microbes- so they were nicknamed magic bullets. In 1889 Paul Ehrlich set out to find chemicals that could act as synthetic antibodies
First Ehrlic discovered dyes that could kill the malaria and sleeping sickness germs
In 1905 the bacterium that causes the STD syphilis was identified

Question 18

How did Paul Ehrlic discover the first magic bullet-Salvarsan 6060 to treat disease

Answer 18

3) Ehrlic and his team decided to search for an arsenic compound that was a magic bullet for syphilis. They hoped it would target the bacteria without poisoning the rest of the body
4)over 600 compounds were tried but none seemed to work
5)in 1909 Sahachiro Hata joined the team. He rechecked the results and saw that compound number 606 actually appeared to work. It was first used on a human in 1911 under the trade name Salvarsan 606

Question 19

How did Gerhard Domagk discover the second magic bullet-prontosil to treat disease

Answer 19

In 1932 Gerhard Domagk found that a red dye prontosil stopped the streptococcus microbe from multiplying in mice-without being poisonous to the mice. Streptococcus caused blood poisoning which was often fatal and could be contracted from minor wounds. Many surgeons contracted it after cutting themselves in the operating theatre
In 1935 Domagks daughter pricked herself with a needle and caught the disease. Afraid she would die, Domagk gave her a large dose of prontosil. The girl turned bright red but recovered

Question 20

How did Gerhard Domagk discover the second magic bullet prontosil to treat disease (2)

Answer 20

3) the active ingredient of prontosil was identified as a sulphonamide. A whole group of drugs based on sulphonamides followed including M&B 693 which worked on pneumonia without turning you a strange colour
4) sadly more serious side effects were discovered. Sulphonamide drugs can damage the liver and kidneys
The discovery of magic bullets showed that synthetic targeted treatments for specific disease were possible. Since Paul Ehrlichs first discovery a huge pharmaceutical industry has grown, dedicated to the research and production of new treatments

Question 21

What are the treatments that had been introduced to fight cancer

Answer 21

1)the first successful treatment against cancer that didn’t involve surgery was radiotherapy introduced after the discovery of radiation in 1896-98 by antoine henri becquerel, Marie curie and Pierre curie. Radiotherapy involves killing cancer cells using targeted X-rays and gamma rays
2)chemotherapy is the treatment of cancer using drugs. It was discovered in WWII when doctors found that nitrogen mustard could be used to reduce cancer tumours. Other drugs were later discovered including a compound in folic acid that blocks the growth of cancer cells

Question 22

What is the importance of cancer treatments

Answer 22

Since the late 1990s targeted therapy has been used to fight cancer. This uses drugs to prevent cancer from spreading

Question 23

How did blood transfusions solve the problem of blood loss

Answer 23

The idea of blood transfusions was known from the 17th century but they were rarely successful since the blood of the recipient was often clotted. Blood also clotted is it was stored outside the body
1) in 1900 Karl Landsteiner discovered blood groups. Certain blood groups can’t be mixed as the blood will clot clogging the blood vessels. He found that transfusions were safe as long as the patients blood matched the bloods donor

Question 24

How did blood transfusions solve the problem of blood loss (2)

Answer 24

2) in 1914 during WW1 doctors found that sodium citrate stopped blood clotting so it could be stored outside the body. In 1917 this discovery was vital when the first blood bank was set up at the battle of cambrai
3)In 1946 the British National blood transfusion service was established
Patients always suffer some blood loss during surgery. If a lot of blood is lost this can be fatal. Blood transfusions helped to prevent this caused of death by allowing surgeons to replace any blood lost during surgery

Question 25

How were transplants made more successful

Answer 25

1) in 1905 the first successful transplant of the cornea of the eye was performed. During the First World War surgeons developed techniques for skin transplantations
2) the first complete organ to be successfully transplanted was the kidney. Livers, lungs, pancreas and bone marrow can now also be transplanted
3) the first successful heart transplant was carried out be South African surgeon Christiaan Barnard in 1967. The patient only survived for 18 days- he died of pneumonia

Question 26

What was the problem of transplants

Answer 26

The problem for transplants is rejection. The immune system attacks the implant as if it were a virus
The success of early transplant operations was limited because doctors lacked effective immunosuppressants-drugs that stop the immune system attacking
Since the 1970s researched have developed increasingly effective immunosuppressants making transplants safer and more likely to be successful

Question 27

How did key hole surgery and robot assisted surgery increase precision

Answer 27

Keyhole surgery is a technique developed in the 1980s which makes surgery less invasive -it leaves patients with smaller scars and allows them to recover more quickly
An endoscope is out through a small cut letting the surgeon see inside the body. Other surgical instruments are then introduced through even smaller cuts in the skin
Keyhole surgery is useful for investigating the causes of pain or infertility. It’s also used for vasectomies removing cysts or the appendix mending hernias and other minor operations

Question 28

How did keyhole surgery and robot assisted surgery increase precision

Answer 28

Robot assisted surgery also improved precision
The first surgical robot was introduced in 1985 but robot assisted surgery only became widely used after 2000 with the launch of the da Vinci system
Robot assisted surgery allows surgeons to make smaller cuts. This mean less scarring, less infection and quicker healing from wounds. These new type of surgery made it safer for patients by limiting the possibility of infection and blood loss as well as reducing the shock and trauma of surgery

Question 29

How was access to healthcare limited before the NHS

Answer 29

At the start of the 20th century access to healthcare was severely limited. This was particularly the case for poor people who couldn’t afford to go to the doctor and buy medicine
This meant that peoples health was poor. For example in 1901 there were 140 infant deaths for every 1000 births- today it’s less than 5. When the Boer war broke out in 1899 army officers found that 40% of volunteers were physically unfit for military service
In 1911 the liberal government introduced the national insurance act which gave some workers health insurance to pay for medical attention. But WW1 drained Britain’s resources and several economic slumps in the 1920s and 1930s meant the government couldn’t expand healthcare provision

Question 30

How was the NHS established

Answer 30

In 1945 the Labour Party was elected with a mandate to implement beveridges proposals. In 1942 Lilian beveridge published a report which called for government provision of social security. They founded the NHS in 1948
Aneurin Bevan was the minister for health who introduced the national health service. Bevan wanted the NHS to be free at the point of use-he set up a system of compulsory national insurance to pay for it

Question 31

How was the NHS established (2)

Answer 31

Bevan wooed doctors and dentists with a fixed payment for each registered patient. They were also allowed to continue treating private free paying patient. By 1948 neatly all hospitals and 92% of doctors had joined the NHS
The founding of the NHS showed that government intervention could make a positive impact on peoples health. However it took a change in public attitudes to make it happen

Question 32

How did the NHS improve access to healthcare

Answer 32

The NHS increased the number of people with access to healthcare-the number of doctors doubled between 1948 and 1973 to keep up with demand
Today the NHS provides a range of health services most of which are free and accessible to everyone. They include accident and Emergancy care, maternity care and major surgery as well as pharmacies, dentists, mental health services, sexual health services and general practitioners.
However the NHS has encountered some problems in providing access to care. The 1980s black report suggested the NHS hadn’t improved the health of the very poorest. Patients also had to suffer long waiting times during the 1990s.

Question 33

How did vaccination campaigns set up by the government eradicate diphtheria

Answer 33

Since 1900 the government has launched several national vaccination programmes to prevent people from catching deadly diseases. These have been successful in reducing the number of deaths from such diseases
For example diphtheria was a major killer disease- in 1940 there were over 60,000 cases of the disease and over 3000 deaths
After fears that wartime conditions could lead to the spread of disease the government started a vaccination campaign in 1940
The government ran publicity campaigns using poster, newspaper advertisements and radio broadcasts
The campaign was a success-by 1957 the number of diphtheria cases has dropped to just 38 with only 6 deaths

Question 34

How did vaccination campaigns set up by the government eradicate polio

Answer 34

Polio is an infection that can attack the digestive system, bloodstream and nervous system. The disease can cause paralysis and particularly affects children
In the late 1940s and early 1950s Britain suffered a series of polio epidemics- the disease made over 30,000 children disabled between 1947 and 1958.
The first vaccine was introduced in Britain in 1956 alongside a national campaign aiming to vaccinate every person under the age of 40
The campaign was successful with the disease all but eradicated by the late 1970s. In the period 1985-2002 only 40 polio cases were reported in britain

Question 35

How did lifestyle campaigns aim to improve people health

Answer 35

In the 20th century scientists showed a link between peoples lifestyle choices and their health. In government ran several campaigns to make people aware of the danger and to change their lifestyles
In 1952 a great smog caused by coal fires resulted in 4000 deaths in London. It showed the dangers of air pollution which can cause breathing conditions like asthma and bronchitis. The government passed laws in the hope of limiting air pollution
An increase in less active lifestyle led to an increase in obesity. In 2009 the government launched the Change4Life campaign with the aim of improving diets and promoting daily exercise

Question 36

How did lifestyle campaigns aim to improve peoples health (2)

Answer 36

Excessive alcohol intake has been linked to several diseases most notably liver cirrhosis. Alcohol intake rose between 1950 to 2004 but has since fallen. This may be due to the governments Drinkaware campaign launched in 2004. The Drinkaware logo appears on many alcohol advertisements
These campaigns mark a big shift in the governments approach from the foundation of the NHS and an even bigger shift from the laissez faire attitudes of the 19th century when people thought the government shouldn’t intervene at all in public health. Not only is the government trying to treat and vaccination against known diseases it’s now intervening in peoples lives in order to prevent them from getting particular illnesses in the first place

Question 37

What happened before government campaigns fought against lung cancer

Answer 37

Lung cancer was a rare disease in 1900 but became common by the 1940s. Today 20% of all cancer deaths in the UK are due to lung cancer. Approximately 43,500 people are diagnosed every year
Scientists have estimated that around 90% of lung cancer cases can be linked to tobacco smoking. The popularity of smoking increased in the First World War particularly amongst soldiers. Smoking soon became popular among women too. In 1950 the link between smoking and lung cancer was proven by Richard Doll and Austin Bradford Hill

Question 38

How did advancements in science and technology make it easier to diagnose and tread lung cancer

Answer 38

Chest X-rays are the first means of diagnosing lung cancer. The X-rays can’t show whether the patient definitely has cancer but can show if there’s anything on the lung there shouldn’t be
CT scans can be used to give a more detailed image of the lungs
Doctors can now use bronchoscopy to diagnose lung cancer. This involves putting a thin tube into the lungs to take a sample of suspected cells. It requires a local anaesthetic to numb the throat
Lung cancer can be treated using surgery like removing the affected lung
Modern treatments like radiotherapy and chemotherapy are also used to treat lung cancer. Radiotherapy involves directing radiation at the lungs. Lung cancer chemotherapy uses a combination of several drugs which are normally injected directly into the bloodstream

Question 39

How have government campaigns reduced smoking

Answer 39

In 1962 the royal college of physicians recommended a ban of tobacco advertising. Shortly afterwards in 1965 cigarettes adverts were banned from TV. In 1971 tobacco companies were forced to put a health warning on cigarette packets
In recent years the government has put a ban on smoking in public places. This was introduced in scotland in 2006 and in England and Wales in 2007
Recent government campaigns have focused on helping people to give up smoking and on discouraging smoking in cars, homes and in front of children

Question 40

How have government campaigns reduced smoking (2)

Answer 40

In March 2015 parliament passed a law requiring all cigarette companies to use plain packaging on boxes of cigarettes
These measures have contributed to a decline in smoking. The percentage of men who smoke cigarettes has fallen from 65% in 1948 to around 20% in 2010 and for women it dropped from 41% to 20% in the same period
Lung cancer prevention is a good example of an area of health where the government has been increasingly active as the large number of television campaigns and pieces of legislations show that the government is now taking health seriously which is in contrast to its attitude in 1900