Medicine Unit 5 - Advances in Medicine, Surgery and Public Health, 1920-48 Flashcards
(23 cards)
1
Q
Fleming’s Discovery
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- Realized a new treatment was needed for infections e.g. septicemia & gangrene due to ineffectiveness of antibiotics
- Returned to work after WW1, in London
- 1922 - discovered the enzyme lysosome - found in tears & fluids + kills microorganisms - harmless microorganisms
- 1928 - became Professor of Bacteriology at St. Mary’s Hospital Medical school
- Studied staphylococcus cultures - went on holiday and one became contaminated w/mould
- Noticed staphylococcus culture had been destroyed in the area around the mold
2
Q
Was the Discovery of Penicillin a Breakthrough?
A
- Fleming grew the mould in pure culture - could kill various microorganisms that caused disease
- Identified mould of penicillium genus & named it penicillin - was an antibiotic using bacteria to attack other bacteria
- Not really a new discovery - known in Middle Ages that mould was effective against infection & used by Lister in 1871
- 1929 - Fleming published his research of penicillin in the British Journal of Experimental Pathology
- Few realized the importance because it was difficult to produce & tests saw it was slow & ineffective when mixed w/blood
- Fleming failed to get funding to continue his research
3
Q
The Second Magic Bullet
A
- 1932 - German scientist, Gerhard Domagk tested Prontosil - based on the bright red chemical compound used to dye wool & leather
- Found the chemical could be used to kill streptococcus infections in mise
- Domagk first used it on his 6-year-old daughter instead of amputation - completely cured her
- Published his lab results & tests in a British hospital that Prontosil could cure puerperal fever
- Key ingredient is sulphonamide - other forms used to cure pneumonia, scarlet fever & meningitis
4
Q
Further Penicillin Research by Florey & Chain
A
- No progress by Fleming because a chemist was needed to purify the mould
- 1939 - team at Oxford hospital led by Howard Florey & Ernst Chain followed up on Fleming’s research
- Used biochemist Norman Wheatley to construct equipment cheaply to purify
- 1940 - tested penicillin on mic and found that mice with penicillin lived longer while fighting streptococcus than the mice without
- Exciting result but 500L of mould would be needed to test on a human
- Heatley experimented with/containers to find the best way to produce large quantities of mould
- Employed six ‘Penicillin Girls’ to be responsible for the culture
- 1941 - team thought they had purified enough of the penicillin mould to test on a human
5
Q
Treatment using penicillin
A
- 1941 - First patient treated - Albert Alexander
- Given penicillin to recover from septicemia but team ran out of penicillin
- Collected his urine to reuse but died due to a lack of penicillin to treat
- Treatment showed potential to save lives and how large quantities had to be manufactured
- Team used penicillin only on children due to smaller doses & were treated successfully
- Florey refused a patent so everyone could mass-produce it
6
Q
Mass production
A
- Florey knew funding was needed but funding was short in 1939 UK due to the war
- Florey decided to apply to companies in the US - impressed scientists & 35 institutions became involved in the project - Included university chemistry departments, government agencies, research foundations & pharmaceutical companies
- Work led to advances in growing & storing penicillin
- Large amounts of funding by the US in December 1941 when they entered the war
7
Q
Importance of penicillin
A
- 1943 - Florey went to North Africa and used penicillin to treat injured soldiers
- Cleaning wounds 7 using penicillin was effective
- Results of tests were very convincing & mass production was improving
- 1944 - enough penicillin for all Allied casualties at D-Day
- Penicillin given by injection - powder mixed w/sterile saline before injection & syringes had to be sterilized before reused
8
Q
Nobel prize
A
- 1945 - Nobel Prize for Medicine jointly awarded to Fleming, Florey & Chain (Heatley was dead)
- Estimated penicillin saved at least 200 million lives since its first use in 1942
- Success lead to further research - showed bacteria could kill other bacteria
- Lead to discovery of the drug streptomycin to treat tuberculosis
- 1000 British & Americans, 39 labs, over $20 million
- 1955 - synthetic version of penicillin produced
9
Q
Impact of War on Hospitals in Britain
A
- Had to deal with/many injuries - both abroad soldiers & civilians due to bombings
- Important to co-ordinate voluntary or charity hospitals w/ones ran by town councils & to have enough ambulances & doctors where bombing was expected
- The Emergency Medical Service created in 1939
- London plans drawn up before war broke out - plans to divide an area of 65km into 10 sections & to establish first aid & casualty sorting centers in the danger areas - provide basic treatment so casualties could be transported to better-equipped hospitals
- bombing put pressure on hospitals e.g. staff used water & sand to put out signal flares for bombing
10
Q
Role of Women
A
- 1931 - 10% of 30,000 doctors were women - still difficult to find jobs 7 ,most likely GPs
- Many med schools discouraged women due to men not wanting women, the belief women were delicate or waste of resources if women retired for their families
- Male doctors also paid more than female doctors - problem in the 1920s & 1930s because me thought women would have better jobs if they were cheaper - led to hospitals paying the same for bth sexes
- Opportunities opened up in WW2 - increased from 2000 to 2900 female medical students from 1938-1946 - impact was less than WW1 because less male doctors called for war
- Many women doctors worked within Emergency Medical Service - set up by government to co-ordinate hospitals
- Nurses needed to examine children before evacuation
- Medical services helped by voluntary organizations e.g. Red Cross so ambulances could focus on urgent cases
11
Q
Nurses in war zones
A
- Many nurses served abroad e.g. FANY, VAD, QAIMNS & TANS (Territorial Army Nursing Service)
- 1938 - 500 QAIMNS working in military hospitals abroad
- Matrons often ‘requested’ suitable trained nurses to join QAIMNS - nurses interviewed at War Office & given sealed packet in event of war
- British & American forces prepared to invade France in 1944 - QAIMNS had physical & military training including self-defense, how to climb a rope ladder to ship, jumping boat-to-boat & moving through barbed wire
- By 1945 - QAIMNS served in China, Egypt, Iceland & Italy
- Recruitment so successful that only newly qualified nurses could join in 1943 - also helped keep nurses in Britain
12
Q
Plastic surgery
A
- 1920 - Gillies & T.P Kilner published Plastic Surgery of the Face based upon their experiences of treating facial injuries during WW1
- Gillies travelled giving lectures & teaching new techniques - importance of his work recognized when he was knighted in 1930
- Gillies also set up a private practice
- 1930 - relative Archibald McIndoe came from New Zealand to UK & joined Gillies to specialize in plastic surgery & became an RAF consultant in 1938
13
Q
The Problem of burns
A
- Only 4 fully experienced plastic surgeons in Britain when war broke out
- Surgeons headed up 4 separate plastic surgery units - McIndoe had the Blond McIndoe Research Centre based in West Sussex
- Pilots often suffered from terrible burns - caused muscle & nerve damage + disfigurement to appearance
- Usual treatment was chemical coating for the burn but shrank tissue around the burn & tightened it, hence less movement
- McIndoe banned chemical treatment & placed patients in saline baths instead
14
Q
Skin Grafts
A
- Layer of skin taken from an undamaged part of the body & transplanted to the damaged area - tissue needs a good blood supply for the graft to grow
- 1916 - Ukrainian surgeon Vladimir Filatov developed pedicle skin grafts to grow flaps of skin similar to Gillies pedicle tube
- Fixative developed methods of grafts & transplants for eyes - some patients could retain sight
15
Q
The Guinea Pig Club
A
- McIndoe’s patients were the ‘Guinea Pig club’ because new techniques in treatment were trial & error
- Some patients had over 30 operations
- Emphasis on keeping a positive mood - patients encouraged to wear uniforms, walk around, barrel of bear kept & patients smoked
- Many patients suffered psychological problems due to fear of rejection from society
- Neville & Elaine Blond helped by arranging local families to welcome pilots into their homes
- Members welcomed to local shops & pubs - East Grinstead became known as the village ‘where no one stared’ + McIndoe arranged visits by famous people & dancers for men to talk to women
16
Q
Impact of The War on Other Developments in Medicine
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- Cushing’s brain surgery work followed by British surgeon Wylie McKissock - led a neurosurgery unit dealing with/brain injuries
- Dwight Harken developed a way to remove bullets & shrapnel from the heart, done 130 times w/o a death
- Blood transfusion developed during the war - 50 bottles collected in 1938 due to fear of war w/Germany - largest stock in London + Army Blood Supply Depot set up in Bristol + 4 large blood banks for civilians & 8 regional centers in 1940
- 700,000 donors gave blood during the war - blood plasma used as a substitute for whole blood + rhesus blood group system discovered in 1939
- Work on tetanus developed to a vaccine - 17,000 wounded from Dunkirk in 1940 didn’t develop tetanus with the vaccine
- PTSD - attempted electric shock treatment & others treated at home or in asylums - 18 psychiatric hospitals set up in WW2 w/servicemen for mental health problems
17
Q
The Beveridge Report - 1942
A
- Identified 5 key problems called the ‘giant evils:
- Want - problems of poverty & not enough money or food
- Disease
- Ignorance - lack of education leads to worse jobs or to develop a better understanding of society
- Squalor - living in dirty or unhygienic conditions
- Idleness - unemployment leads to depression or alcoholism or crime
- Felt the state had a duty to help & protect people and people had a responsibility for themselves
- Beveridge Report was a best seller - 95% heard of it & many supported it
- 1945 - Labour government elected under new PM Clement Attlee - announced a welfare state would be set up & paid for by National Insurance contributions
- National Insurance Act 1946 provided old age pensions, maternity benefits & payments to sick & unemployed
18
Q
The National Health Service
A
- Brought all aspects of medicine & care into one organization under the government’s control & paid for through taxes
- Officially set up by National health Service Act, 1946
- Care began during pregnancy and continues throughout life
19
Q
Aneurin Bevan
A
- Work of setting up the NHS was done by Minister of Health - Aneurin Bevan
- 1929 - Member of Parliament & as an MP continued to work to improve lives of the poor & became Minister of Health in 1945
- Faced opposition from doctors who didn’t like being employed by NHS instead of private practice - many would lose money - 40,000 medical practitioners disapproved whilst 5,000 approved
- Bevan paid GPs according to number of patients seen & they could continue private practices & work for NHS
- Campaign encouraging people to come to the NHS put pressure on doctors - 90% enrolled in 1948 when it came to fruition
- NHS had three parts - Hospital services brought into a single system w/14 regional boards - GP wrote prescriptions - everything free at delivery but paid through taxes
20
Q
National Health Service services
A
- Surgery
- Blood transfusion
- Ambulance transport
- Pregnancy care
- Health visit to check on new babies
- Vaccination programmes
- Dental treatment
- Sight checks & spectacles
- Care for elderly
- Care for disabled
- Help on mental health issues
- Accident and emergency care
- Treatment and medication
- Access to a GP
- Reference to hospital consultant
- Diagnostic checks e.g. x-rays & blood tests
21
Q
Impact of the NHS
A
- Created a welfare state where government helped at every stage of life
- Developments in surgery, medicine & prevention increased life expectancy dramatically in late 20th century
- Life expectancy for men went from 51 in 1901 to 58 in 1930 to 66 in 1950 & for women from 55 to 62 to 70
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