4. The Modern Period c1900-Present

Main feature of the Modern Period?

Time of rapid change.

Key factors of change?

Factors:

• Government intervention.

• War.

• Industry.

• Science & Technology.

• Greater understanding - causes and prevention.

What did the government do to allow rapid progress?

Laissez-faire ideas ceased, links between germs, DNA and lifestyle = action needed, implemented campaigns and laws.

How did war contribute to rapid medical progress?

New injuries due to new weapons gave greater practice to surgeons, after WW2 ppl used to gov helping them be healthy and fit.

How did industry enable rapid developments?

Large profits could be made, drug companies emerge, gov funding allows new techniques to be developed.

How did science and technology make advanced discoveries possible?

Greater co-operation global research called "Big Science", led to greater understanding of DNA and lifestyle benefits, technology aided improvement.

Name believed causes of disease.

Causes:

• Lifestyle.

• Genetic factors.

• Environmental exposure.

Better ways of diagnosis.

What mostly changed about causes of disease?

Shift from infectious diseases (contagious) to chronic diseases (lifestyle).

What does smoking cause?

Lung and mouth cancer, heart disease, high blood pressure, gum disease, tooth decay. Biggest cause of preventable diseases.

What does being overweight or having a poor diet cause?

Type 2 diabetes (too much sugar), heart disease (too much fat). Not enough nutrients lead to health problems.

What problems does alcohol abuse cause to health?

Liver disease and kidney damage.

What problems does drug taking cause other than addiction?

Needles spread disease.

How are people aware of dangers of unprotected sex?

Spread STDs, STIs, HIV, AIDS.

What impact did diagnostic imaging (pictures to diagnose) have?

Allowed doctors to look inside the body without invasive surgery.

What are some of the imaging tools?

X-rays: locate fractures, shrapnel. (used in WW1, locate bullets.)

CT & MRI Scans: 3D images of internal body & tumors.

Ultrasounds / Endoscopes: safely monitor organs,

pregnancies, and internal systems using sound or cameras.

What impact did testing and monitoring tools have?

Precise scientific data, instead of guessing.

What are some of the testing and monitoring tools?

Blood Tests: identify infections and illnesses chemically.

Blood Pressure Monitors / ECGs: To track heart health and prevent strokes.

Blood Sugar Monitors: manage diabetes at home.

What was discovered to cause disease other than microbes?

Genetics.

What did the 1953 DNA structure discovery reveal?

Proved DNA was in every human cell and that human characteristics and defects are inherited.

Whose work led to the 1953 structure discovery?

Francis Crick and James Watson, mapped double helix structure.

Who did they then work with to photograph DNA?

Relied on X-ray technology, worked with Rosalind Franklin.

What did Rosalind Franklin do?

Developed technique to photograph DNA, first person to use X-rays to do so.

Impact of the 1953 DNA structure discovery?

Greater understanding of hereditary conditions, directly led to Human Genome Project in 2003.

Limitations of the 1953 DNA structure discovery?

No immediate improvements after 1953, genes recognised but cannot be altered or treated.

Examples of hereditary conditions?

Down's syndrome, cystic fibrosis, certain cancers.

What was the Human Genome Project?

International project, successfully mapped and sequenced all human DNA for the first time.

When did it start and was completed?

Start - 1990.

Completed - 2003.

Funded by global governments and charities.

How did the complete map help?

Vital to understand causes of genetic diseases, look for mistakes or mismatches in DNA of ppl suffering from hereditary diseases.

What genes did scientists identify for what genetic disorders?

Down's Syndrome, Parkinson's disease, diabetes, Alzheimer's disease, cystic fibrosis, breast cancer.

What impact did the identifcation of certain genetic disorders have?

Predict and screen ppl at risk, preventative measures taken place. (e.g. mascetomy for ppl with higher risk of breast cancer.)

Factors that allowed international research to happen?

Factors:

• "Big Science" - teamwork.

• Technology.

• Communication - data and the internet.

Importance of DNA discovery?

Importance:

• future developments in medicine.

• treatment - gene therapy for sickle cell anemia. (no cure for Down's Sydrome or cancer.)

• prevention - mascetomy or parents choose to abort embryos with high risk of Down's syndrome.

Name treatments of disease.

Treatments:

• Antibiotics - magic bullets, penicillin.

• Improvements in surgical treatments - keyhole, micro, robotic surgery, anaesthetic injections.

• Organ transplants.

• Blood transfusions.

• Dialysis.

• Gene therapy.

How did Robert Koch's work (in industrial period) allow the invention of antibiotics?

Ehrlich, worked with Koch, if certain dyes stain certain bacteria, perhaps certain chemicals could kill them.

Why were antibiotics called "Magic Bullets"?

Chemicals would kill the bacteria only and not healthy cells.

What was the first effective "Magic Bullet"?

Salvarsan 606. (606th attempt in making one.)

What disease can Salvarsan 606 treat?

Syphilis.

Why was Salvarsan 606 so important but what was its limitation?

First treatment of disease using chemicals, but used arsenic (poisonous).

What was the second "Magic Bullet"?

Prontosil. (A red dye.)

What did Prontosil cure?

Killed bacteria that caused blood poisoning.

What did the Pasteur Institute find?

Active ingredient inside Prontosil, chemical called sulphonamide.

What did the discovery of sulphonamides lead to?

Mass production of cheap "sulpha-drugs" to cure multiple bacterial diseases.

What other diseases did sulphonamides treat?

Pneumonia, scarlet fever. Puerperal fever (childbed fever) mortality rates - 20% to 5%.

What was Penicillin?

Most important and first natural antibiotic.

Who discovered Penicillin and when?

Alexander Fleming in 1928.

How did Fleming accidentally discover Penicillin?

Left dirty petri dish out, went on holiday, natural airborne fungus landed on dish, Fleming later saw developed mould killed surrounding bacteria. (Accidental.)

What did Fleming do with this information?

Published in medical journal one year later.

Limitation of Fleming?

Could not purify it, mixed with blood, ineffective, assumed didn't work on humans, no immediate impact on treatment.

How did Florey and Chain develop Fleming's discoveries into treatment for humans?

Extracted pure penicillin from mould in Oxford, which was very rare (one in a million, needed a lot of mould), ran multiple tests.

What was their first test?

Tested on mice, effective, but can't produce Penicillin in large quantities. (Tried their best to grow on equipment like bathtub.)

How did they prove Penicillin was effective on humans?

Used on policeman with blood poisoning, effective at first, but ran out so patient died. Still proved it to be effective on humans.

How did Penicillin help the Allies in WW2?

US and UK gov funded millions into factories to mass produce injections (infection) and powders (open wounds) for war.

How many doses were ready for D-Day in 1944?

2.3 million doses, enough to treat all Allied casualties.

Impact of Penicillin during WW2?

Saved around 15% Allied soldiers.

How did Penicillin help the Allies win WW2?

Saved those from fatal infection, soldiers recovered faster from operations than opposition, advantage in manpower.

Limitation of antibiotics?

Bacteria like superbug MRSA resistant to antibiotics.

How was Penicillin used after the war?

NHS made Pencillin free for all, important "wonder-drug" to treat and prevent illness.

Changes to treatment in Modern Period?

Changes:

• "Cure all" medcines replaced by chemical drugs like aspirin.

• New anitbiotics used.

• New custom drugs target specific health (genetic) conditions.

• Pills and injections mass produced.

What did modern surgical treatments solve?

Solved three previous major problems in surgery - pain, infection and bloodloss.

What is keyhole surgery and what is its benefit?

Tiny cameras and small cuts, less pain and faster healing.

What is microsurgery and what is it used for?

Microscopes, nerve endings and blood vessels reattached, helped transplants develop.

First successful kidney transplant?

1956.

What is robotic surgery used for in the modern age?

Highly precise operations like brain surgery.

Types of anaesthetic?

Modern anaesthetics - injection in vein, patient unconscious.

Local anaesthetics - injected and numbs specific part, can stay awake. Minor surgeries.

How did X-rays improve treatment and surgery in the modern era? (Radiotherapy)

Target and shrink tumours, treat cancer. X-rays not just for diagnosis.

What breakthrough made modern blood transfusions successful?

Karl Landsteiner discovered the three main blood groups (A, B, and O) by 1901. (WW1 sodium citrate prevent blood clotting.)

Give two examples of modern medical machines and their functions.

Dialysis - clean blood until transplant available.

Heart-lung bypass - pumped oxygenated blood around body during heart operations.

What is gene therapy and how is it used in modern medicine?

Normal genes put in patient suffering from genetic diseases (e.g. cystic fibrosis).

How did robotics improve prosthetic limbs in the modern era?

Advanced prosthetics connected to nerves, patient can control their movement with mind.

How did modern treatment change the number of deaths from infectious diseases?

1900 - 25%.

Now - 1%.

Antibiotics andd vaccines highly successful.

How did modern medicine affect life expectancy compared to 1900?

1900 - ~50 years.

Now - ~80 years.

Limitations to modern treatment?

Limitations:

• New diseases and strains (e.g. MRSA) appearing.

• Some still use herbal remedies and acupuncture.

• No cure for cancer or heart disease - lifestyle factors cannot be cured.

Name preventions of disease.

Preventions: Government

• Vaccination campaigns.

• Gov legislation - Clean Air Acts of 1956 & 1968.

• Smoking ban inside public buildings.

• Limiting car emissions.

• Lifestyle campaigns - against smoking, drinking, unprotected sex and drugs.

• Regular health checks.

What are the two types of government campaigns?

Vaccination and lifetsyle campaigns.

What was the first vaccination campaign?

Against diptheria in 1942. (Over 3000 children died a year before, after, cases died out.)

Another examples of vaccinations?

Polio - vaccines made part of routine life, no cases since 1984 (UK).

HPV - still used today, against STIs causing long term risk of cervical cancer.

Limitations to vaccination campaigns?

Limitations:

• Parents can decline vaccine offers, causing potential illness.

• Flu viruses change each year, new vaccines required.

What are the three main lifestyle factors targeted by modern government health campaigns?

Smoking, diet/obesity, and alcohol intake.

What anti-smoking campaign encouraged people to stop smoking?

"Stoptober" - for a month.

What was the Change4life campaign's "5 a day" message?

Eat at least 5 portions of fruits and vegetables a day.

What independent charity was set up in 2004 to reduce alcohol harm?

Drinkaware, educates the public on daily unit limits and health risks of binge drinking.

What is examples of governments abandoning the "laissez-faire" attitude?

Examples:

• 2014 Ebola outbreak - quarantines and travellers tracking enforced.

• Covid-19 - quarantines, vaccinations and travel restrictions.

What major anti-smoking law was passed for public places?

2007 indoor smoking ban.

What triggered the Clean Air Act in 1956?

The Great Smog of London killed thousands in a few days to respiratory issues in 1952.

When were the Clean Air Acts enforced?

1956, then renewed in 1968.

What other recent legislation did the government enforce to reduce air pollution?

Taxing cars that cause more pollution. (ULEZ - Ultra Low Emission Zone, modern example.)

What were the problems with healthcare before the establishment of the NHS?

National Health Insurance (1911) - only for workers, not for families, elderly or unemployed.

When was the NHS established and by who?

July 1948 by Aneurin Bevan (Minister of Health).

What was the aim of the NHS?

Free healthcare funded by taxation available to everyone regardless of wealth.

What report laid the foundation of the NHS?

The Beveridge Report in 1942.

What did the Beveridge report identify?

"Five Giants" - Want, Disease, Ignorance, Squalor, Idleness.

How many hospitals and GPs are the NHS responsible for?

Over 2500 in UK.

What was early opposition to the NHS?

Many doctors opposed, feared becoming state employees and losing high private incomes.

What were the early problems with the NHS?

Problems: Early

• Shortages of hospitals, staff and funds - large waiting times and delays.

• Surging demand - millions of working class flooded to hospitals at once.

Why did Britain face shortages of funds after establishing the NHS?

Little money after WW2.

Why were NHS hospitals spread unequally in 1948?

Most hospitals were in South East England, poorer areas like North England had little.

What physical condition were NHS hospitals in when founded in 1948?

Old (Victorian), war-damaged, and desperately needing modernisation.

What were the improvements made in the 1960s?

Improvements:

• More hospitals built.

• Quality Care Commission.

• GPs Charter.

What was the Quality Care Commission?

Monitored hospital quality.

What was the GPs Charter and how did it make GPs more willing to work for the NHS?

Gave incentives to keeping up with medical research and GPs to work in group practices together.