Medicine in the
20th Century
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The 20th century
We have seen that the 150 years up to 1900 were ones
of rapid change or revolution. The world was a vastly
different place to that of 1750. Yet the revolutions did not
stop there.
If anything, they accelerated after 1900. The 20th century
saw the invention of the motor car, which was to transform
people’s lives. Two world wars led to millions of deaths and
many more injured. Humans began exploring space and
landed on the moon. The invention of computers
revolutionized the way people worked and affected most
aspects of life. The balance of power in the world changed
with many countries gaining independence from their
colonial masters.
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Ordinary people began to have electricity and sanitation
in their homes. Telephones, radios and televisions,
vacuum cleaners and washing machines became
available to most households. Foreign travel became an
expectation of many.
Needless to say, with improvements in the standard of
living, education, public health and diet, as well as the
development of a free national health service, people’s
health improved dramatically. Progress in science and
technology led to the invention of a whole host of new
machinery for diagnosing disease and treating it.
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Prevention of disease became a key reason for the rise in
the average life expectancy from 47 to 75 years. By the
end of the 20th century the high proportion of elderly
people in Britain was putting a strain on health services
and the economy.
As we go through this unit, note down examples of how the
factors of war, science and technology, government,
individuals, communications, chance and education have
all helped to transform medicine and health in the 20th
century.
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World War I
Between 1914 and 1918 a totally new type of war ripped
Europe apart. Huge quantities of mass produced weapons
caused unprecedented death rates and horrendous
injuries. Instead of men fighting one to one, a machine gun
could obliterate hundreds in a few moments.
This war cemetery in
Belgium, one of
hundreds, contains the
graves of 11,000 soldiers
who fell at the Battle of
Passchendale in 1917,
and commemorates the
names of 33,000 other
men whose bodies were
never found.
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How World War I affected medicine
Surgery
The huge number of casualties meant that
surgeons and doctors gained a wealth of
experience. Practice led to improvements in
mending broken bones, grafting skin and all
types of surgery.
These surgeons were used to working
in clean, well equipped hospitals.
Suddenly they were trying to operate in
dirty conditions just behind the front line
or in a field hospital, often without the
supplies they needed. This led to them
having to improvize, much like Paré
had done, resulting in new discoveries.
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The experience
gained in the war
led to these
surgeons
specializing in
different forms of
surgery after the
war.
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Infection
Many soldiers died not from the bullets themselves,
but from the dirt which the bullets carried deep into the
body. Doctors were used by now to antiseptic
techniques but could not apply this to stopping
infection inside the body.
Conditions in the trenches were
appalling, often with soldiers
standing knee-deep in filthy water.
Even small wounds turned septic
and many soldiers developed gas
gangrene, where the infection of
dead flesh produced a foul-smelling
gas.
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Doctors experimented to find new ways of treating
infection, by cutting away infected flesh and using saline
solutions. Though their progress was not great, their
knowledge and techniques did improve and helped in
the long-term understanding of infection.
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New Technology
a) X-rays
X-ray machines were in use in many hospitals by the
end of the 19th century. During the First World War,
however, they were used constantly at the Front to help
surgeons locate shrapnel and bullets in their patients.
They became very adept at using this technique and
saved many soldiers because of it. The importance of Xrays had become very apparent and machines and
images were improved after the war.
How might X-rays have helped Galen?
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b) Blood transfusion
In 1901 scientists discovered that humans have different
blood groups, and this explained why 19th century attempts
at blood transfusion often failed. However, blood could still
only be taken from a donor present at the transfusion as
doctors had no way of storing or transporting the blood
without it clotting.
In the trenches, huge quantities of blood were needed for the
injured soldiers, and doctors had to find a way of storing blood
and taking to wherever it was needed.
Many experiments resulted in the discovery that plasma (the
liquid) could be separated from the corpuscles (minute
particles). The blood cells could now be packed in ice and
diluted with a warm saline solution when needed. This not
only helped soldiers in but saved many civilians afterwards.
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Activities
Draw a spider diagram to show the benefits the World War
I brought to medicine.
Indicate whether these benefits were realized in the short
or long-term.
Can you think of any ways in which World War I hindered
the progress of medicine?
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Combating infection
Whilst World War I generally benefited medicine, it also
interrupted a very important research programme into
fighting infection. Research had been going on for years to
find a chemical compound which would kill bacteria in the
body.
If you think back to Robert Koch, you will remember he
found a way of staining bacteria to identify them. One of his
research team, Paul Ehrlich, decided to take this idea
further. He believed that perhaps a chemical compound
could be used not only to stain the bacteria causing an
infection, but which would kill them (and only them) as well.
Ehrlich said this would be like a ‘magic bullet’, shooting the
bacteria, but not harming the patient.
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Magic bullets
For years Ehrlich was unsuccessful, but he still believed it
was possible. He had observed how the body produces antibodies to attack the specific bacteria causing an infection,
and wanted to find a chemical which would work in the same
way.
In 1909 he was proved right.
He and his team had tried 605
varieties of an arsenic
compound to cure syphilis, a
common venereal disease.
The 606th one killed the
syphilis bacteria. They had
discovered the first magic
bullet. They called it Salvarsan Salvarsan 606 injecting kit c. 1920.
606.
Explain what Salvarsan 606 was. Why was it so important?
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Ehrlich’s discovery was a major step in the progress of
medicine, though Salvarsan 606 needed to be improved
upon because it could kill the patient as well as the infection
because it was made from arsenic.
After World War I research into magic bullets resumed.
The number of men who had died because of infection in
the trenches made it all the more necessary. There was
little success, however, and most doctors had to rely on
old, and usually hopeless, treatments.
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In 1932, however, Gerhard Domagk found the second
magic bullet after years of methodical research. This was a
red dye called Prontosil. He injected mice with a lethal dose
of a streptococcal infection. He then injected them with
Prontosil which cured them. Soon he had the chance to try
it out on a human, his own daughter, who was seriously ill
with the same streptococcal infection. Having no other
cure, he injected her with Prontosil and she recovered.
Scientists now set about trying to find which component
of Prontosil made it a magic bullet.
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With the aid of the new, hugely powerful electron
microscopes which had been in use since the early
1930s, scientists at the Pasteur Institute in Paris
found that the active ingredient was a
sulphonamide which came from coal tar.
The discovery of sulphonamides led to drug
companies developing drugs which cured gonorrhoea,
pneumonia, meningitis and scarlet fever. One area
which showed particular improvement was maternal
mortality: the number of mothers dying following post
natal infection was slashed from 20% to 4.7%.
Explain in your own words why the
discovery of sulphonamides was important.
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Alexander Fleming and the discovery of penicillin
Alexander Fleming had worked on wounds and infections
during World War I and spent years researching the body’s
natural defences against infection.
In 1928, chance helped the scientific
search for anti-bacterial drugs, as it had
helped Pasteur. Fleming returned from
holiday to find that mould had grown on
the cultures in some of the petri dishes in
his laboratory. He noticed that in one dish
the staphylococci cells had disappeared
around the edges of the mould. He
realised that the mould had killed the
bacteria. He identified the mould as
penicillium, which had probably blown in
through the open window.
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This plaque
commemorating
Fleming’s
achievement is at St
Mary’s Hospital,
London.
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The development of penicillin
Fleming had made the important discovery that penicillin
would attack certain forms of bacteria, but he did not have
the resources to research whether or not it could be used
to fight infection.
This was to become the work of two Oxford scientists,
Howard Florey and Ernst Chain and their assistants. They
sought funding for the project from the British government
just after the outbreak of World War II.
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Florey and Chain used thousands of milk bottles in which to
grow just enough penicillium (the mould which produces
penicillin) to experiment with. They injected eight mice with
lethal organisms and then injected four of them with
penicillin.
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Now penicillin had to be tried on a human patient. It took
months to collect enough penicillium to treat one person.
In early 1941 they had an ideal patient – a policeman who
was dying from staphylococcal septicaemia. They had
nothing to lose. There was so little penicillin that they had
to recycle it from the patient’s urine.
In three to four days the man was recovering well and his
fever had gone, but then on the fifth day they ran out of
penicillin. The policeman’s fever returned and soon he was
dead. There was no doubt in Florey and Chain’s minds that
penicillin worked, if only enough could be produced.
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Florey could get no help from British drugs companies to
find a way to increase production. They were too
preoccupied with producing other items for the war.
Florey looked to the USA. The USA had joined the war in
December 1941 and feared heavy casualties. It gave four
drugs companies $80 million to mass-produce penicillin.
By 1945 the US army used 2 million doses a month. This
was the first antibiotic.
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Activities
Explain in your own words how penicillin was
discovered.
What event helped Florey obtain funding for the
development of penicillin?
Whom do you regard as more important in the story of
penicillin – Fleming or Florey? Explain why.
Using your previous notes, draw a flow diagram
showing the development of antibiotics from Pasteur to
Florey, including Koch, Ehrlich, Fleming and Domagk.
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The effects of World War II on medicine
We have already seen the effect the USA entering World War
II had on the development of penicillin. There were other
effects too.
Hospitals had to be prepared to cope with high numbers of
injured civilians in bombing raids. Health care was generally
improved.
Diet for many people improved because of the rationing of
fats and sugars. The government encouraged people to ‘Dig
for Victory’ – grow lots of fresh vegetables.
The government promoted healthy living, including basic
hygiene and immunisation against diphtheria – all part of a
campaign to have a healthy nation able to stand up to Hitler.
Surgical techniques and blood transfusions improved
because of practice.
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Infant mortality
Today, when a woman has a baby it is expected to be
born fit and well and live to adulthood. In pregnancy the
mother will have had access to nutritious food, been
advised against smoking and drinking, will have had
access to good medical care and her unborn baby will
have been scanned and monitored for any problems.
Before the 20th century the picture was very different.
Many babies were lost in pregnancy or were stillborn. In
1899 more than 16% of babies born alive died before the
age of one. More died before their fifth birthday.
The turning point came in the early 20th century following
some of the worst infant mortality rates ever. In the next
forty years there were dramatic improvements.
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19
70
19
50
19
30
19
10
18
90
18
70
180
160
140
120
100
80
60
40
20
0
18
50
No. of deaths under 1
year per 1,000 live births
When did infant mortality decrease?
Year
A series of measures were taken,
including education, medical
services and regulations governing
housing and public health.
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Nearly 40% of
men
volunteering for
the Boer War in
1899 were found
to be unfit. The
government
realized it had to
try to improve
people’s health.
During which
decades was the
greatest
improvement
seen?
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Between 1902 and 1930 the government passed laws
which introduced the following measures:
1902 Midwives had to be qualified
1906 Cheap school meals to be given to children
1907 Medical inspections to be made in schools
1907 Health visitors to be informed of all births
1909
be
1918
1919
Building regulations – back-to-back houses to
banned
Ante-natal and post-natal clinics to be set up
New houses to be built for the working classes
1930 Slum housing to be cleared
List the measures which would improve infant
mortality in (a) the short-term and (b) the long-term.
Which three measures do you think would have the
greatest effect on infants’ wellbeing?
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Other reasons for a decrease in infant mortality:
In the 19th century it was common for women to have more
than 10 children. Wider availability of contraception resulted
in fewer pregnancies and births. This meant that mothers
were healthier and, with less mouths to feed, were more
able to provide for the children they had.
Child and health care was taught to girls in schools.
Schools for mothers were set up from 1907 to promote
breast feeding, hygiene, and good parenting.
Women were encouraged to stay at home when they
married, to look after their husband and children and keep a
clean house. (They were, however, encouraged into
factories and other places of work during both world wars.)
Vaccinations became available against TB and diphtheria.
How might the measures taken to reduce infant mortality
alter the average life expectancy rates? Explain why.
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The National Health Service
The government measures taken to reduce infant mortality
were very effective. During World War II health services had
been expanded to cope with civilian casualties and the first
antibiotics were increasing life expectancy. Yet the poorer
people in society could not afford basic medical care or the
government’s health insurance scheme.
The scheme helped those in work but not the elderly, the
young, the long-term sick or the unemployed. During the
peaks of the economic depression of the 1920s and 1930s
nearly three million were unemployed. In the worst affected
areas infant mortality was rising again.
During the war ideas were evolving about widening the
health care system to reach all people.
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In 1942 William Beveridge, a civil servant, advised the
government about his ideas for setting up a welfare state,
including a free national health service, which was to give
benefits “from the cradle to the grave” for all. Two years
later the Beveridge Report was the basis for the
government’s proposals for a new health service.
The plans were finally passed by the new post war Labour
government in 1946, after extensive discussions between
the minister for health, Aneurin Bevan, and the medical
profession. Two years later the National Health Service
began. This was to be available free to everyone in the
nation. It was also to cover every aspect of health care.
Local authority hospitals were nationalized, health centres
were set up and doctors and services were more evenly
distributed across the country.
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Medical
aids
Training of
doctors
and nurses
Hospitals and
ambulance
service
Dentistry
Vaccination
programmes
Medical
research
What the
NHS
provides
Eye tests
Consultants
Medicines
Surgery
Maternity care
GPs, surgeries,
health clinics,
district nurses.
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The effect of the National Health Service on people’s
health was dramatic. For the first time ever, everyone had
the right to free health care. Before the NHS many could
not afford to visit the doctor, let alone buy medicines or
have regular treatment.
Yet, despite this, there was some fierce opposition to the NHS:
The British Medical Association (BMA) said doctors did not
want to be told what to do by the NHS.
Local authorities objected to the nationalization of their
hospitals.
MPs claimed it would all cost too much money and it would
encourage people to expect ‘something for nothing’.
Bevan, however, was not to be dissuaded and, promising
good salaries and other benefits to consultants and doctors,
he got his way.
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Problems of the NHS
By the end of the 20th century, however, the NHS was
facing one financial crisis after another. Successive
governments had spent more and more on the NHS yet it
seemed to get further into debt.
Prescription charges, introduced in the 1950s, rose steeply.
Charges were introduced for dental treatment and eye tests.
Some regions refused to use certain drugs on people
because they could not afford them. Unable to pay for the
necessary staff, many beds remained empty while the waiting
lists grew longer.
Yet, even so, anyone could be treated free when needed
regardless of their ability to pay or whether they had
insurance. The NHS remained, arguably, the best and fairest
system in the world.
Why do you think it costs so much more to run
the NHS today than in 1948, in real terms?
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There are two major reasons why the NHS costs so
much more to run by the end of the 20th century.
Firstly, the provision of free health care for all resulted in
people being healthier and living much longer. Instead of
living to 66 in 1948, the average woman could expect to
live to 78 by the 1980s. The NHS, quite simply, had many
more people to look after, and of an age where they
needed increasing amounts of treatment, such as
cataract operations or hip replacements. Retired people
do not pay the National Insurance contributions needed
to fund the cost of their care.
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Secondly, developments in science and technology
resulted in a far greater range of treatments being offered,
many of which were extremely complex and expensive. By
the end of the century organ transplants, ultrasound scans,
open heart surgery and laser treatments were just a few
examples of everyday services offered.
In many ways the NHS became a victim of its own success.
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What diseases kill people today?
As we have seen, medicine and health progressed
dramatically during the 20th century. Because of
vaccination, old diseases such as smallpox or diphtheria
no longer were a threat. Other illnesses became treatable
with antibiotics. Previously incurable conditions can be
treated with the latest surgical techniques.
There are, however, diseases which kill people today
which were not known in earlier times.
As you read through the next slide, note down the
three examples given of modern killer diseases
and which people are affected.
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One modern killer is cancer, which despite extensive
research, still kills huge numbers of people, usually in
later years. It is often caused by poor diet or smoking.
Poor diet (fatty, refined foods) and smoking also contribute
to heart disease which account for many deaths, again in
older people. It tends not to affect people in poorer
countries.
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AIDS is a completely different type of disease. It is
caused by a virus, called HIV, and is spread via body
fluids. It is most commonly caught through sexual
activity or by drug addicts using infected needles.
Government campaigns in the 1980s preventing AIDS
were reasonably successful in Britain, although by the
end of the 20th century the number of cases continued
to rise. In many poorer parts of the world, especially
parts of Africa, India, Thailand and Russia, AIDS is a
huge problem, with millions of people infected.
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Activities
1) Why do you think cancer and heart disease did not
affect people to the same extent earlier in history?
2) What part have governments played in the controlling
of the spread of AIDS in this country and elsewhere in the
world?
3) What part have improved communications played in
the spread of AIDS?
4) These three diseases are major killers. Does this mean
that medicine is no longer progressing? Explain your
answer.
5) What factors do you think have caused the huge
strides made in surgery in the 20th century?
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20th century public health
Today, even the poorest families can expect to have
access to running water, a flushing toilet and a bath or
shower. We can expect waste water and sewage to be
taken away and to have our refuse collected each week
and the streets to be cleaned. Those who can afford to,
pay council tax to pay for most of these services for
everyone.
Building regulations insist on dwellings being built with
good insulation, damp proofing, bathrooms and heating,
as well as adequate fire protection.
Laws now govern pollution and air quality.
This is a very different picture of public health to that of 1900.
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Public health in 1900
In 1900 many people still used outside privies and had no
bathroom. Vast areas of back-to-back housing contained
overcrowded working class families where diseases spread
rapidly. Lack of building regulations in the previous century
meant many houses were damp or unsafe. Factories
pumped foul pollution into the atmosphere and rivers
without breaking any laws.
The poor state of people’s health in 1900 spurred 20th-century
governments to act. Some of the measures taken to improve
health are shown on the next slide.
As you go through them, try to decide which actions
would be the most effective. How did government
intervention in the 20th century differ from that of the
previous century?
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Improvements in Public Health
1909
Back-to-back houses were banned. This was
just one of the building regulations introduced.
1919
A Housing Act obliged local authorities to build
250,000 new homes for poorer people. This was
prompted by the government’s promise to improve living
conditions for those working class men who had fought in
World War I – ‘ Homes for Heroes’.
1930
Start of a five-year slum clearance programme. Nearly
three-quarters of a million new homes replaced slum
housing.
The Clean Air Act designated ‘smokeless’ zones in
urban areas. Only smokeless fuels could be used for
heating. Factory pollution was strictly controlled.
1956
2000
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Petrol containing lead was banned following fears
this would have on future health.
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