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Medicine in the 20th and 21st centuries

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Magic bullets and antibiotics

  • Ehrlich and Hata’s compound 606 work identified an anti-syphilis drug in 1909; Salvarsan was marketed in 1910. Domagk and colleagues investigated Prontosil in the early 1930s, publishing in 1935. These targeted chemical treatments were distinct from penicillin’s later development.
  • Fleming observed penicillin’s effect in 1928 and published in 1929. The Oxford team, including Florey, Chain and Heatley, developed extraction and testing; wartime British and US industrial cooperation enabled mass production in the 1940s. Discovery, development and distribution are separate stages.
  • Antibiotic resistance concerns resistant microorganisms and their spread, not patients becoming immune to drugs. MRSA means methicillin-resistant Staphylococcus aureus; resistance to some drugs does not mean resistance to every treatment.

Discovery is one stage of development

Discovery is one stage of developmentStagePenicillin exampleObservationFleming’s 1928 antibacterial findingDevelopmentOxford purification and testingProductionBritish and US industrial cooperationLater limitsResistance and continuing research

The NHS and the state

  • Beveridge’s 1942 report and earlier debates informed reform. The 1946 NHS Act established the England and Wales framework; Scotland and Northern Ireland had separate legislation. The launch was 5 July 1948, with Bevan central within Attlee’s government.
  • The service aimed to provide comprehensive care according to need, funded largely through taxation and free at use. Later charges, resource constraints and different national arrangements mean this principle should not be restated as every service being permanently free to everyone in all circumstances.

Proposal, law and service are distinct

Proposal, law and service are distinctDate or principleNHS development1942Beveridge proposals within a widerdebate1946England and Wales legislation5 July 1948Launch of the serviceCare according toneedTax-funded aim; later charges anddifferences

Modern surgery and technology

  • X-rays originated in 1895, before this century. Landsteiner’s ABO work, transfusion systems, Gillies’s and McIndoe’s reconstructive surgery, transplantation and later minimally invasive techniques developed through research and teams. Successful kidney transplantation in 1954 preceded the first human-to-human heart transplant in 1967; tissue matching and better control of rejection improved later outcomes.

Genetics and lifestyle

  • DNA was known before 1953, when Watson and Crick’s double-helical model appeared alongside King’s research papers. Franklin and Gosling’s diffraction work and Wilkins and colleagues were important parts of the evidence. Do not reduce this to an isolated discovery by two people.
  • The Human Genome Project ended in 2003 with a major reference sequence, not an exhaustive account of every human variant or a cure for every inherited condition. Difficult sequence gaps were addressed by later projects.
  • Doll and Hill’s 1950 study reported a smoking/lung-cancer association; further evidence established causation. Public-health responses included campaigns, taxation and smoke-free rules, introduced on different dates across UK nations. In England the major enclosed-premises rules began in July 2007.
  • NICE, established in 1999, develops guidance and appraises clinical and cost-effectiveness evidence. It does not individually dictate every treatment across all UK services. Behaviour, social conditions, environment and genetics interact in health; lifestyle should not become an explanation that blames all illness on personal choices.

A timeline does not mean every problem is solved

A timeline does not mean every problem is solvedDateLandmark1953DNA double-helix model published1954Successful kidney transplantation1967First human-to-human heart transplant2003Human Genome Project concludes

Slides

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Practice questions

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  1. 1.In what year did the NHS begin?

    Easy
    • A1948
    • B1918
    • C1900
    • D1965

  2. 2.Which Health Minister played a central role in establishing the NHS in England and Wales?

    Easy
    • AWinston Churchill
    • BFlorence Nightingale
    • CEdward Jenner
    • DAneurin Bevan

  3. 3.What did Fleming discover?

    Easy
    • AX-rays
    • Banaesthetic
    • Cpenicillin
    • Dvaccination

  4. 4.Which drug emerged from Ehrlich and Hata’s research on syphilis?

    Easy
    • Achloroform
    • BSalvarsan 606
    • Cpenicillin
    • Dvaccination

  5. 5.Who led the team performing the first human-to-human heart transplant in 1967?

    Easy
    • AChristiaan Barnard
    • BHarold Gillies
    • CFleming
    • DBevan

  6. 6.Who developed penicillin into a usable drug?

    Easy
    • AFleming alone
    • BPasteur
    • CKoch
    • Dthe Oxford team including Florey, Chain and Heatley

  7. 7.Why was penicillin mass-produced during WWII?

    Easy
    • Afor plants
    • Bfor fun
    • Cto treat wounded soldiers
    • Dfor sale to doctors only

  8. 8.What did the Beveridge Report do?

    Easy
    • Abanned smoking
    • Bproposed a welfare state including health care
    • Cended the war
    • Ddiscovered DNA

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