Changes in Medicine, c1845-c1945Revision Guide

Part 1: Exam questionsPaper 2, Part B (25 marks in total)

Focus: change over time…

a) Source comprehension (3 marks)b) Explanation of key features (7 marks)c) Change over time (15 marks)

a) 3 marks Give 3 detailed examples from the source – you don’t need to quote the source. Just tell the examiner what you have learnt from the source itself.

b) 7 marks A key feature is a CAUSE, EVENT, RESULT of something. In this question you are to write 2 PEE paragraphs and then link your PEE paragraphs together (just think of your structure for an 8 mark question in paper 1)

c) 15 marks In this question you are to write 2 or more PEEL paragraphs about change over time. You will also need to write a conclusion that will have a reasoned judgement about change

Question (a)3 marks

1 mark 2 marks 3 marksI give 1 example I give 2 examples I give 3 examples

Question (b)7 marks

1-2 marks 3-4 marks 5-6 marks 7 marksI have made simple POINTS in my answer about the key features.

I have made a clear PEE paragraph about the key features. The evidence will show the 5W’s clearly and the explanation of the key features.

I have made 2 clear PEE paragraph about the key features. The evidence will show the 5W’s clearly and the explanation of the key features.

I have linked both my PEE paragraphs together in my conclusion.

Question (c)15 marks

1-4 marks 5-8 marks 9-12 marks 13-15 marksI have made a clear PEE paragraph about change. The evidence will show the 5W’s clearly and

I have made 2 clear PEE paragraph about change. The evidence will show the 5W’s clearly and

I have made 2 or more PEEL paragraph about change. The evidence will show

My conclusion has a reasoned judgement about the change in the investigation

the explanation of why things have changed.

the explanation of why things have changed.

the 5W’s clearly and the explanation of why things have changed and linking these paragraphs together.

Part 2: ContentB2 Changes in medicine, c1845-c1945

i. Medical knowledge and understanding in the mid nineteenth century

ii. Changes in surgery and in understanding the causes of diseaseiii. Changes in hospital treatment and the role of women in medicineiv. Developments in public health provisionv. The importance of the two world wars in bringing about change

i. Lack of understanding of causes of disease. Dangers in surgery. Attitudes to women and medicine, nursing and public health provision. Problems in public health.

ii. Anaesthetics and antiseptics: the work of Simpson and Lister, early opposition, impact of surgery in the nineteenth century. The battle against germs: work of Pasteur, Lister, Koch, Ehrlich, Fleming, Florey and Chain. Importance of penicillin.

iii. Florence Nightingale and Scutari. Changes and improvements in nursing. Elizabeth Garrett and the progress of women in medicine. Improvements in hospitals. Work of Lister. Influence of the two world wars on the role of women in medicine.

iv. Impact of cholera. The work of Chadwick and Snow and public health reform in the nineteenth century: The Public Health Acts of 1848 and 1875 and their impact. Liberal measures 1906-11.

v. Importance of the First World War for medicine, surgery, X-rays, blood transfusion and fighting infection. Importance of Second World War for the development of penicillin, treatment of burns and skin grafts, blood transfusion and public health.

B2 Changes in medicine, c1845-c1945Medical knowledge and understanding in the mid nineteenth century

Lack of understanding of causes of disease. Dangers in surgery. Attitudes to women and medicine, nursing and public health provision. Problems in public health.

Lack of understanding of causes of disease

Medicine before 1800’s:• There was little progress in

medicine between 1750-1800.• No one at this time knew what

caused illness…• Some people believed that

illness was caused by MIASMA – a poisonous cloud containing germs.

• Others believed God was punishing them.

Dangers in surgery

• 80% of surgeries resulted in death• The most common surgeries were:

• Caesarean sections• Amputations• Removal of kidney stones

• The main issues were:• Blood loss• Pain and Shock• Infection

• Doctors did not perform surgeries in clean environments; some used the

These were probably the most common surgeries as patients would have died without them anyway.

same equipment between patients without cleaning them and they did not clean their clothes between operations.

Attitudes to women and medicine, nursing and public health provision

• Women had no place in medicine – they were only involved as mothers or ‘wise women’

• To become a doctor you needed to go to University. Women were not allowed to study at University, and even secondary education for women was uncommon.

• There were some women, who became doctors, despite the law! Such as Elizabeth Blackwell, Elizabeth Garrett and Sophia Jexblake.

• It wasn’t until 1876 that women were given the same rights to university education as men. This meant that women were now legally allowed to train as doctors.

• Nurses were NOT respected women: Nurses in the 1800s (before Nightingale changed people’s attitudes) were often dirty or drunk.

• Nursing did not require any training and was badly paid.• Nurses frequently had reputations for being drunks and causing the deaths of

patients

Problems in public health

• Public health was appalling – then conditions in towns meant that disease and illness spread easily…

• Conditions in the 19th Century towns:

B2 Changes in medicine, c1845-c1945

Changes in surgery and in understanding the causes of disease

Anaesthetics and antiseptics: the work of Simpson and Lister, early opposition, impact of surgery in the nineteenth century. The battle against germs: work of Pasteur, Lister, Koch, Ehrlich, Fleming, Florey and Chain. Importance of penicillin.

Anaesthetics and antiseptics: the work of Lister and Simpson

Joseph Lister James SimpsonAntiseptics AnaestheticsAfter Pasteur published his GERM THEORY, Lister experimented with Carbolic acid and discovered an effective antiseptic in 1867.

Discovered the effective anaesthetic, Chloroform in 1847.

He experimented with ether (another anaesthetic) and hydrochloric acid and discovered chloroform.

Who was Lister?Lister was born in 1827 and died in 1912. He was a Professor of Surgery at Glasgow University, and believed that washing your

Who was Simpson?James Simpson was born in 1811 Edinburgh. Studying medicine at 15, Simpson watched many operations and wondered if there was

hands before operations helped stop the spread of infection. In 1865, Lister read about the work done by Louis Pasteur on Germs. Lister believed that it was microbes carried in the air that caused diseases to be spread in wards and believed that if the wounds were thoroughly cleaned, infections could be prevented.Lister was one of the outstanding surgeons of the nineteenth century. He had researched gangrene and infection, and had a keen interest in the application of science to medicine. That was why he knew all about Pasteur’s work on germ theory, which helped to spark the idea for his own discovery.He experimented with using carbolic in treating people who had compound fractures where the bone breaks through the skin. Infection often developed in these open wounds. Lister applied carbolic acid to the wound and used bandages soaked in carbolic. He found that the wounds healed and did not develop gangrene

How did Lister help to change surgery?Despite opposition, Lister’s methods marked a turning point in surgery. In 1877 he moved to London to train young surgeons. Then came a link to another great name in medical history. In 1878 Robert Koch discovered the bacterium which caused septicaemia (blood poisoning). This gave a great boost to Lister's ideas.

Aseptic surgeryBy the late 1890s Lister’s antiseptic methods (which killed germs on the wound) developed into aseptic surgery, which meant removing all possible germs from the operating theatre. To ensure absolute cleanliness:

Operating theatres and hospitals were rigorously cleaned.

a drug that would put people to sleep without harming them. He passed his exams for the Royal College of Surgeons and in 1836 became a doctor at an Edinburgh hospital. In 1840 he became Professor of midwifery at Edinburgh.

He reorganised the teaching of the subjects, and made it an essential part of every medical student’s training. Over the years he became more and more concerned about the suffering endured by women during childbirth.

How did he discover Chloroform?Simpson started his own experiments. He decided to use Ether as a base and mix it with other substances. He tried a mixture of Hydrochloric Acid and Ether (later to be called CHLOROFORM). At dinner one night he sniffed it in from of the family and immediately passed out. On November 4th 1847 he conducted an experiment to test the usefulness of chloroform.

Why is it important?Within fourteen days Simpson completed 50 successful operations using Chloroform. It was first given by a sponge soaked in the liquid pressed to the patient’s nose. Later special inhalers were developed. In 1852 Queen Victoria used it during the birth of Prince Leopold and it soon became completely accepted. Twenty years after it was first tired it was used throughout Europe and in 1866 Simpson was knighted. He died in 1870. Chloroform remained the chief method of anaesthesia well into the Twentieth Century.

From 1887 all instruments were steam-sterilised.

Surgeons abandoned operating in their ordinary clothes and wore surgical gowns and face masks.

In 1894, sterilised rubber gloves were used for the first time. For, however well surgeons ’hands were scrubbed, they could still hold bacteria in the folds of skin and under the nails.

“Infection” “Pain and Shock”

The battle against germs

Louis Pasteur Robert Koch Paul Ehrlich Alexander Fleming

Howard Florey and Ernst Chain

December 27, 1822 – September 28, 1895) was a French chemist

and microbiologist renowned for his discoveries of the

principles of vaccination,

microbial fermentation and

pasteurization.

Robert Koch was born in 1843. Koch worked on anthrax

and tuberculosis (TB) and he further

developed the work of Louis Pasteur.

German physician and scientist who

worked in the fields of hematology,

immunology, and antimicrobial

chemotherapy.He invented a way to

identify different bacteria

Scottish biologist, pharmacologist and botanist. His best-known discovery is Penicillin (from the mould Penicillium

notatum) in 1928, for which he shared the Nobel Prize in 1945

with Florey and Chain.

Florey was born in Australia and Chain

in Germany, and they worked

together at Oxford University doing research into the

production of penicillin. In 1945, Florey and Chain

shared a Nobel Prize with Alexander

Fleming.

Pasteur and germ theory

Pasteur was the first to suggest that germs cause disease. Micro-organisms had been seen through 18th century microscopes, but scientists thought they were caused by disease and appeared because of illness. This was the theory of spontaneous generation. Instead of blaming the microbes, people looked for noxious gases called miasmas.

Louis Pasteur was employed in 1857 to find the explanation for the souring of sugar beet used in fermenting industrial alcohol. His answer was to blame germs in the air. Pasteur proved there were germs in the air by sterilising some water and keeping in a flask that didn’t allow airborne particles to enter. This stayed sterile – but sterilised water kept in an open flask bred micro-organisms again.

Robert Koch

A German scientist Robert Koch began the process of linking diseases to the microbe that caused them. Koch developed a solid medium to grow cultures and dying techniques to colour microbes, which he viewed through high-powered microscopes.

Hearing of Koch’s work, Pasteur came out of retirement in 1877 and started to compete in the race to find new microbes and combat them. Pasteur looked for cures to anthrax and chicken cholera. Both he and Koch worked with large teams of scientist in the Franco-German competition for national prestige. Pasteur’s theory was a huge turning point for medicine. His theory allowed others to build on his work and identify microbes and ways to combat them.

Paul Ehrlich and Magic Bullets

Paul Ehrlich made an important breakthrough in drugs. He called the antibodies produced naturally by the body ‘magic bullets’ as they fought specific germs without harming the rest of the body.

At first, he tried to extract them to cure ill patients, but they did not always work. So he began to look for synthetic chemical ‘magic bullets’ to cure disease. As part of Koch’s team, he had used dyes to stain microbes. After 1899, he tried to see if the dyes would kill the germs. In this, he was helped by advances in the German chemical industry, which was producing synthetic dyes. Although he found dyes that attacked malaria and sleeping sickness germs, he had only limited success at first.

In 1906, Ehrlich began to search for a chemical ‘magical bullet’ to cure syphilis. In 1909, after Ehlich’s team had tested over 600 dyes, Sahachiro Hata joined the team. He retested the dyes and found that dye 606 worked – this became known as Salvarsan 606. After testing it on hundreds of animals deliberately infected with syphilis, it was first tried on a

human in 1911. However, there was much opposition to this discovery – it was difficult and painful to inject and some feared it would encourage promiscuity.

Alexander Fleming and Penicillin

Fleming had become interested in how to deal with wounds that became infected. He noted that the antiseptics used were not very effective. In 1928, he began work on staphylococci. One day, by chance, he noticed that mould was growing on some Petri dishes. He noticed no germs were growing near the mould. He grew more of it and found it killed many deadly germs. A colleague identified the mould as belonging to the penicillium family. Although he tried to purify the ‘mould juice’, the necessary chemical skills were unavailable. After Fleming had tested the mould on animals, and showed it did no harm, he tried it on a colleague’s eye infection. Again, it worked, and did not harm body tissues. This was a big improvement on chemical ‘magic bullets’. Fleming wrote up his research and called the ‘mould juice’ penicillin. He did not try to make pure penicillin.

Florey and Chain and Penicillin

Howard Florey and Ernst Chain took the next important steps with penicillin. In 1938 they decided to study germ-killing substances. They came across Fleming’s article and tried to produce pure penicillin. Penicillin was successfully tested on a human for the first time in 1940. At first, the patient improved but, when the supplies were used up, he died. Florey and Chain did not have the resources to manufacture large quantities of the drug. When war broke out in 1939, Florey pointed out to the British government how the drug could cure infections in deep wounds. The government were too involved in making explosives to provide resources. Florey approached US chemical firms and after Pearl Harbour in 1941 he was given financial help. Mass production of penicillin began in Britain in 1943. By 1944, there was enough penicillin to treat all wounded Allied forces in Europe. After the war, even better methods of mass production led to reduced costs. Soon penicillin was used to treat a whole range of diseases.

Importance of penicillin

The discovery, development and subsequent use of penicillin can be considered to be one of the most important breakthroughs in medical history.

Penicillin prevents a large number of germs from growing. As it is an organic substance it can be used on, or in, the human body. This meant that for the first time something was available that could, potentially, prevent the decay of the body or infection from germs whilst operating.

The immediate impact of the discovery is clear. The drug was developed quickly in the War years by the American government. By developing the drug so readily and so quickly the US Governemtn prevented many soliers from having war wounds becoming infected: the drug therefore saved a lot of lives and, it could be argued, played a role in helping to win the war for the Allies.

B2 Changes in medicine, c1845-c1945Changes in hospital treatment and the role of women in medicine

Florence Nightingale and Scutari. Changes and improvements in nursing. Elizabeth Garrett and the progress of women in medicine. Improvements in hospitals. Work of Lister. Influence of the two world wars on the role of women in medicine.

Florence Nightingale and Scutari and changes and improvements in nursing.

Florence Nightingale (1820-1910): During the Industrial Revolution, the poorer classes often relied on informal midwives and ‘wise-women’. The first signs of change came in nursing following the work of Florence Nightingale during the Crimean War. During her time there the death rate in Scutari fell from 43% to 2%. She believed disease was caused by miasma and emphasised cleanliness and fresh air. Her work was reported in British newspapers.

Mary Seacole also played an important part in improving nursing care during the war. However, probably because she was a black woman from Jamaica, she was not given much credit and was not allowed to work as a nurse in England after her return.

As a result of these developments nursing started to become a respectable medical profession. In 1859 Florence Nightingale’s book Notes on Nursing was published and a public fund was launched to raise money for a proper nursing school. The Nightingale

School of Nursing was based at St.Thomas’ Hospital, London. Other training schools followed. By 1900 there were 64,000 trained nurses. Florence Nightingale also wrote over 200 books about hospital design and organisation.

The impact of Florence Nightingale: Florence Nightingale’s work had far greater impact in the long run. She was not a hands-on nurse but a great organiser, convinced that her life’s work was to improve conditions in hospitals and training of nurses for the good of the patients. Those skills and beliefs were visible in the Crimea where she concentrated on improving hygiene and cleanliness. She continued to focus on these aspects of care throughout her life. One surprising thing about her was that she paid little attention to Pasteur’s germ theory when it appeared in the decade after the CrimeanWar. Like Chadwick, she had been brought up in the early 1800s when miasma (bad air) was the main theory about what caused disease. She continued to associate disease with dirt and this is why she concentrated on improving:

sanitation in hospitals – clean water supplies, good drains and sewers, toilet facilities, total cleanliness

ventilation in hospitals to make sure patients got fresh, clean air to breathe food supplies, clothing and washing facilities for patients.

As a result her nursing schools concentrated on training nurses in very practical skills. She did not let doctors teach nurses about germ theory because she felt that such ideas would simply get in the way of nurses’ more important task – keeping patients and wards clean.

Elizabeth Garrett and the progress of women in medicine.

Elizabeth Garrett Anderson (1836-1917): Inspired by Elizabeth Blackwell, the first woman in the USA to qualify as a doctor. Repeatedly turned away by medical schools, she worked as a nurse while attending lectures for doctors, until she was forced to stop. Turned away by medical schools, which refused to accept a woman. Needed a certificate from one of the three medical organisations to become a doctor – in 1865 she was accepted by the Society of Apothecaries. Set up a medical practice in London. Still wanted a medical degree so she learned French and gained the qualification at Paris University. In 1876 an Act of Parliament allowed women to enter the medical profession. She was the first woman to qualify as a doctor in Britain.

Improvements in hospitals

How did Nightingale help to change surgery and hospitals?The improvements in hospital buildings and sanitation could not have come about without improved engineering techniques and the new ideas about public health.Changes in surgery increased the numbers of complex operations and so surgeons required better-trained nurses to assist them. And, despite Nightingale’s downgrading of germ theory, it had a very significant impact on all aspects of medicine, including surgery, and so in turn affected the ways that nurses carried out their work.

How did Lister help to change surgery and hospitals?Despite opposition, Lister’s methods marked a turning point in surgery. In 1877 he moved to London to train young surgeons. Then came a link to another great name in medical history. In 1878 Robert Koch discovered the bacterium which caused septicaemia (blood poisoning). This gave a great boost to Lister's ideas.

OppositionFor many centuries surgeons had lived with the idea that many of their patients would die. When Lister said he achieved good results, their first reaction was disbelief. For many the next reaction was to feel defensive, that Lister was criticising them for letting patients down.

Despite anaesthetics, surgeons were still convinced that speed was essential in an operation – often because of the problem of bleeding. It seemed that Lister’s antiseptic methods just slowed operations down.

Lister's carbolic spray, which soaked the operating theatre, seemed very extreme. It cracked the surgeon’s skin and made everything smell. The new precautions caused extra work, and made operations more expensive and less pleasant for the surgeons. Aseptic surgery

By the late 1890s Lister’s antiseptic methods (which killed germs on the wound) developed into aseptic surgery, which meant removing all possible germs from the operating theatre. To ensure absolute cleanliness:

Operating theatres and hospitals were rigorously cleaned. From 1887 all instruments were steam-sterilised. Surgeons abandoned operating in their ordinary clothes and wore surgical gowns and

face masks. In 1894, sterilised rubber gloves were used for the first time. For, however well

surgeons ’hands were scrubbed, they could still hold bacteria in the folds of skin and under the nails.

B2 Changes in medicine, c1845-c1945

Developments in public health provisionImpact of cholera. The work of Chadwick and Snow and public health reform in the nineteenth century: The Public Health Acts of 1848 and 1875 and their impact. Liberal measures 1906-11.

During the late 1700s and the first half of C19th, conditions in British towns became worse than ever.

Houses were built as close together as possible as more people crowded into factory towns to work.

Towns could not cope with the need to provide people with water and sewage disposal facilities.

In these squalid conditions, diseases spread easily and rapidly. The conditions were so bad that many people’s health may have even become worse

than ever before. The Battle to Improving Public Health Some thought that the government should force local councils to clean up their

towns.

However, many believed that the government shouldn’t interfere – this attitude is called laissez-faire.

They believed the government should allow each local area to control its own affairs. This meant that local ratepayers made all the decisions. Local ratepayers didn’t want

the government to force them to pay for improvements to their towns.

Edwin Chadwick In 1842 he was asked by the government to report on the living conditions and

health of the poor. Chadwick concluded that poverty was caused by ill health which was caused by the

terrible conditions in which people lived. He said that ratepayers can cut their taxes and save money in the long-term by

looking after the poor and to spend money improving their health. In his “Report on the Sanitary Conditions of the Labouring Population” he said

industrial towns should:o Organise drainage and refuse collectiono Provide a pure water supplyo Appoint a Medical Officer of Health

For over 30 years an argument went on about the need for town councils or the government to take action. Towns such as Liverpool and Manchester did start to build sewage and water-supply systems.

1848 Public Health Act The government did nothing at first about Chadwick’s recommendations. However, in 1848 there was another outbreak of cholera, this put pressure on the

government to do something. Parliament reluctantly agreed to pass Public Health Act.

Although it was not compulsory. The government set up a Board of Health to encourage, but not to force, local authorities to improve conditions.

They gave local authorities money to make improvements in their areas if they wanted to and had the support of local ratepayers.

Only a few local authorities took any new measures. By 1872 only 50 Medical Officers of Health had been appointed. The Board of Health was abandoned in 1854.

1853 John Snow• In 1854 John Snow proved that there was a link between cholera and water

supply. He used research, observation and door-to-door interviews to build a detailed map of a cholera epidemic in Broad Street.

• Nearly all the deaths had taken place within a short distance of the water pump.

• Near to the pump, there was a brewery and none of the people there had cholera. The brewery had its own water pump, and the men had been given free beer. They didn’t use the Broad Street Pump at all.

• After collecting evidence, John Snow removed the handle from the Broad Street pump.

• There were no more deaths. It later came to light that a cesspool near to the pump had a cracked lining which allowed the contents to contaminate the drinking water.

• Snow put pressure on water companies to clean up their water supplies.

1858 Great Stink• For years human waste made its way from the latrines in London into the River

Thames.• In 1858 the hot weather caused a ‘great stink’. The putrid smell was right under

Parliament’s nose.• Parliament considered moving and had to coat their curtains with a deodorant to

get rid of the smell.• The Great Stink prompted Parliament to sort out London’s sewage and drainage

system and to clean up the River Thames.• Within a year Sir Joseph Bazalgette had begun to build an extensive system of

sewers and drains that are still in operation today.

1867 Second Reform Act• Working class men were given the right to vote.• For the first time, it wasn’t just the ratepayers who got a say in improving public

health.• MPs were forced to improve the living conditions of the poor.

1875 Second Public Health ActUnlike the 1848 Public Health Act, the 1975 Public Health Act actually forced local authorities to introduce the following measures:• Provision of clean water• Proper drainage and sewage• The appointment of a Medical Officer of Health

But why was the act introduced?Factor Explanation

Scientific Developments

In 1861 Louis Pasteur published his germ theory which proved the link between dirt and disease. With scientific proof, people were more willing to pay taxes to cover the costs of public health reforms.

New Voters Working-class men were given the vote in 1867. MPs were more likely to take notice of the victims of poor public health.

Statistics The government published statistics of where death rates were highest and what people died of. The statistics shamed some unhealthy towns into action.

Cholera Outbreaks

When cholera returned in 1865 and the link between disease and dirty water had been proven by John Snow, ratepayers were finally prepared to take action.

Weakening of Laissez Faire

The government saw it could no longer leave public health measures to individuals or councils, and realised that they had to take action.

The Public Health Act of 1875 was very effective. By 1900 most British towns had built effective hygiene and water systems.

Result of the Public Health Act of 1875• Improved the standards of housing• Stopped the pollution of rivers from which people got water• Shortened working hours in factories for women and children• Made it illegal to add ingredients that made food unhealthy• Made education compulsory

B2 Changes in medicine, c1845-c1945The importance of the two world wars in bringing about change

Importance of the First World War for medicine, surgery, X-rays, blood transfusion and fighting infection. Importance of Second World War for the development of penicillin, treatment of burns and skin grafts, blood transfusion and public health.

What Medical Progress Did the First World War Bring About? Surgeons had the opportunity to experiment with new techniques. Surgeons

developed techniques to repair broken bones, and perform skin grafts – plastic surgery.

Soldiers promised good housing when they returned. This helped to get rid of unhealthy slum housing.

Surgery of the eye, ear, nose and throat all improved rapidly. Brain surgery also advanced.

The Development of X-rays X-rays were first discovered 20 years before the war. Hospitals installed X-ray machines, but it was the First World War which confirmed

their importance. More were manufactured to meet demand and they were installed in hospitals along

the Western Front. X-rays immediately improved the success rate of surgeons in removing deeply lodged

bullets and shrapnel which would otherwise have caused fatal infections.

Blood Transfusions:

In the renaissance, Harvey proved blood circulates and this encouraged experiment with transfusions.

It sometimes worked and sometimes failed. Scientists didn’t know about different blood groups.

Blood groups were discovered in 1901 by Karl Landsteiner. The discovery made transfusions successful.

During the First World War vast amounts of blood was needed. On-the-spot donors were impractical. Many soldiers bled to death in the trenches before blood could get to them.

The search began for a better method of storage and transfusion. Doctors discovered how blood can be bottled, packed in ice and stored where it was needed. This discovery helped to save many lives.

Skin Grafts:

• Plastic surgery prior to the World Wars were limited by pain and the danger of infection.

• The terrible injuries of both World Wars led to a rapid improvement in

techniques, especially the use of skin grafts.• In World War One the injuries were mostly from bullet and shell damage.

Surgeons carried out over 11,000 plastic surgery operations, increasing their experience and learning from each other.

• In World War Two there were many more burns cases in tanks and aeroplanes.

• Archibald McIndoe alone carried out 4000 operations on burns cases.

The Discovery and Development of Penicillin

1 Fleming discovered mould killed germs. Writes articles but publishes them in book with an obscure name.

2 Chain and Florey begin research in Oxford after reading an article by Fleming. They experiment with mice.

3 Penicillin is first tested on a human being in Oxford.4 U.S. and Britain fund production of penicillin.5 Enough penicillin is produced to treat all the allied forces wounded in the D-Day invasion of Europe. How Was Penicillin Discovered? The discovery of penicillin is a great example of a chance finding helping science. One day in 1928 Fleming came to clean up some old culture dishes he had been

growing bacteria for his experiments on. By chance, a fungal spore had landed and grown on one of the dishes.

He noticed that colonies of bacteria around the mould had stopped growing. The fungus was identified and the substance given the name penicillin. It produced a substance that killed bacteria.

Fleming was unable to take his work further. The industrial production of penicillin still needed work. How Was Penicillin Developed? In the 1930s two Oxford scientists, Florey and Chain, became interested in Fleming’s

1929 paper. In 1939 they gathered a skilled research team and three days after the outbreak of the

Second World War Florey asked the British Government to fund the team’s research into penicillin.

British chemical firms were too busy making explosives to start mass production – so Florey went to US.

America helped to mass produce penicillin, the casualties of the Second World War added to the urgency.

By 1944 mass production was sufficient for the needs of the military medics. Fleming, Florey and Chain were awarded the Nobel Prize in 1945.

Factors Leading to the Development of Penicillin

Government – British government funded Florey’s research, U.S. government funded

mass production. Technology – microscopes and bacteria growing mediums. Scientific experiment – testing on mice. Individuals – Florey and Chain were skilled scientists supported by a skilled team of

researchers. War – the growing casualties of World War Two added to the urgency to mass produce

penicillin. Chance – Alexander Fleming discovered penicillin by chance in 1928.

Impact of the Second World War

Blood transfusion –blood could be stored for longer, civilians donated blood. Diet – rationing improved some people’s diet, government encouraged healthy eating. Drugs – penicillin was developed as the first antibiotic. Poverty – evacuation took children out of urban areas. Highlighted contrast between

rich and poor. Surgery – developments in the use of skin grafts and treatment of burns. Hygiene – government posters education people about health and hygiene.

The National Health Service

Influence of WW2 WW2 broke down social distinctions and brought people together. The raising of armies made powerful people take notice of the health problems of the

poor. Evacuation of children increased awareness of how disadvantaged many people were. After the Second World War people looked for improvements in society. Such

feelings led to the 1945 victory for the Labour Party.

Introduction of the NHS Sir William Beveridge published his famous Beveridge Report in 1942. In it he called

for the state provision of social security “from the cradle to the grave”. The report became a bestseller.

Aneurin Bevan was the Labour Minister for Health who introduced the National Health Service.

National Insurance was introduced to pay for the NHS. Doctors and dentists were wooed with a fixed payment for each patient. They were also allowed to continue treating private fee-paying patients.

The NHS Still Has A Few Problems… Governments have reduced how much of the NHS is free – charging for prescriptions

and dental health. Long waiting lists and doubts about the quality of treatment have led to paying for

treatment outside NHS. Longer life expectancies have meant more need for care of the elderly and increased

costs for the NHS.