Development of modern health care
We have come a long way in health care. However, it no doubt hasn't always been this way. It has taken a lot of determination from various persons to break through stubborn scientists refusing to accept the truth. Some discoveries really worth mentioning:
The germ theory of disease
The issue: People all over the world get ill because of infectious disease. Either because they ignore of don’t know about the basic rules of hygiene.
The science behind the issues: We now know infectious diseases are caused by small organisms, called germs. The germs are attacked by the immune system, defending the body. But is the defending system works to slow the patient can die.
What this tells us about science and society: People have always known about infectious disease but only since the 19th century we’ve started to understand what causes them. This shows that science isn’t only about having data but also about how you work with these data and what patterns you see.
Since doctors got involved in delivering babies women got serious infections after giving birth. They vomited, had terrible pain and death would follow within five days. Charles White and Oliver Wendell both tried to convince people that doctors and nurses spread the disease from patient to patient. But the person who proved this theory was Philipp Semmelweis. He had two delivery rooms; one staffed by midwifes and one by medical students. He found that the students carried the cause of childbed fever on their hands from the autopsy to the delivering room.
He let the students wash their hands and in 2 months the number of childbed fever decreased. But no-one would believe his theory because other doctors didn’t want to accept that they caused the illness. Semmelweis couldn’t handle the rejection and died in a mental asylum at the age of 47. But only hand-washing didn’t completely eliminate all the risks. This changed for a great deal when in the Second World War antibiotics became widely available.
While Semmelweis was trying to convince the people of his theory, in Britain another disease was developing. Between 1830 and 1840 there were a few severe cholera outbreaks. People with cholera have bad stomach pains, watery diarrhoea and vomit as well. It was most common by poor people who lived in bad hygienic circumstances. People thought it was caused by miasma, ‘bad air’. John Snow was a doctor at this time in Newcastle. He was very interested in cholera and observed carefully what was happening. He found it was reproduced in a patient’s body and was spread by vomit and diarrhoea. People didn’t believe him but he wasn’t the only person to come up with a theory about cholera. At the time of the next cholera outbreak he started to collect lots of data and found that almost all sick people got their water from the same pump. He had the pump removed and the epidemic was stopped.
Louis Pasteur found that fermentation was caused by a kind of yeast cells. At that time people thought living things could arise from death things. He wanted to prove this was wrong but found it was easier to show that there was no evidence that it did happen. He claimed microbes could cause disease and proved this right with an experiment with caterpillars. Later Koch, a German doctor, started to study microbes more closely. On agar jelly he cultured them and stained them with dyes. In this way he discovered eleven diseases and made the germ theory universally accepted.
Germs reproduce them selves in the body and can have harmful or less harmful effects. Most bacteria are harmless or beneficial. Bad bacteria invade a healthy cell and reproduce themselves until the cell bursts open and releases the bacteria to invade other cells.
There are several ways for diseases to spread: via living creatures, the skin, coughing and food.
In the time of Semmelweis it was hard to convince the public that he was right. But even now this happens. In the 1980’s a comparable situation occurred with ulcers. People thought you got them from having stress for a long time but it turned out that is was caused by a bacterium.
The better understanding of the germ theory of disease leads already to policies to limit infection. This was done by the improvement of hygiene and closed sewers and the development of a better diet for children. This greatly cut down the deaths of infections long before vaccinations and antibiotics were available.
The body can defend itself against bacteria and viruses which want to invade. The white blood cells make this possible because some white cells attack and destroy the germs and others produce antibodies which destroy the bacteria. The antibodies also remain in the body for months after the infection this makes you immune for that disease and the immune system becomes more alert. The immune system is much weaker when you suffer from malnutrition.
TB (tuberculosis) comes in many forms and can spread easily. This makes it a dangerous disease the most common way of spreading is by saliva or by drinking infected milk. TB mostly affects the respiratory system. Improving living standards is the best way to control the disease.
Immunisation: for along time it was known that when you had had the smallpox you would not get them again. This was discovered by Jenner because the girls who milked the cows, were infected by a mild form of the disease never got the smallpox. This shows that when you once were infected with a mild form of a disease you wouldn't get infected with a more dangerous form of the disease. You are immune.
Pasteur and chicken cholera
Pasteur was infecting chickens with chicken cholera trying to find a vaccine against the disease. The infected chickens died. By mistake they used an injection which had been left standing for several weeks after a holiday. These chickens got ill but recovered. Once they were recovered they became immune for the fresh injection.
It takes years to make a vaccine because every bacterium reacts different. With Influenza (flu) for example it is very difficult to make a vaccine because the virus changes (mutates) every year. Vaccinations don't have to be used when enough people are immune for the disease they can’t spread the disease. Vaccinations sometimes have side effects mostly they clear up quickly. But sometimes they cause life-long damage. Once autism was related to the MMR vaccination because a few children who were given the vaccine MMR showed symptoms of autism fortunately this was coincidence
Medicines to treat disease
The issue: most people welcome the idea of new drugs, and better treatments for the sick. The demand is always greater than the service can provide. Another growing issue is the fact that the antibiotics are beginning to fail, more and more bacteria develop resistance.
Plants provide most of the drugs used in traditional medicine. In the pharmaceutical industry chemist develop new medicine everyday. While in Africa people have known a medicine against malaria for hundreds of years. IN 1922 insulin was tested successfully and was used against diabetes all over the world
In the 19th century Paul Ehrlich showed that selective dyes could be used to classify blood cells. This was the start of his search to ‘magic bullets’. He thought it might be possible to inject dyes into a patient which would kill microbes but leave the healthy parts unharmed. At last in 1909 the magic bullet was found, he could kill the bacterium which caused syphilis. This was the beginning of chemotherapy.
The discovery of antibiotics
Alexander Fleming was examining some Petri dishes in which were growing colonies of bacteria which cause boils and sore throats. He noticed that one of the dishes had a mould, he was surprised to see that the colonies growing near the mould were dying. It looked as if the mould were producing a substance which killed the bacteria. The substance he found could kill bacteria that cause human diseases, this was later called penicillin. At that time he didn’t see the importance of his discovery. With in time bacteria develop resistance against antibiotics. This is why drugs have to be developed over and over again. First they sort out which drugs are needed and develop them with computers. Then they are manufactured and tested. This is done on tissue and organs this is called in-vitro testing. In-vivo testing begins on animals and later on people who volunteer.
In most countries there are rules for this testing.
- The people who carry out the research must be competent to do so.
- A certificate of designation is only granted to scientific institutions where the places for keeping animal meet the necessary high standards.
- The benefits of the research should outweigh any possible distress to animals.
What is ethics: ethics is a branch of philosophy concerned how we should decide what is morally wrong and what is morally right. Ethical questions aren’t easy to be answered. Ethics can not be proved, first of all you have to think of the consequences before taking a decision in which is wrong and right. People who believe that consequences alone are enough to let us decide what is right and wrong are called consequntialists, a wide spread form of consequntialism is known as ultilariaism which means most actions lead to pleasure and/ or displeasure.
When animal studies have been approved clinical trails of the drug can begin on humans. The best form of clinical trail is the double blind study. People can volunteer for this test. Out of all the people participating half will get the medicine and half will receive a placebo. Only one person knows who was given the drug and who was given the placebo, this makes it a fair test with reliable results. Ethics committees decide if it’s safe for volunteers to participate.
TB on the rise
The last years TB outbreaks are a huge problem especially for people who are infected with HIV. HIV weakens the immune system. TB bacteria are resistant against the anti-TB drugs. The best way to cure TB is by
- Political commitment
- Microscopy services to detect the TB bacteria in samples of saliva
- Drug supplies
- A drug regime which has proved effective
- Monitoring of patients to observe and record patients following the full course and taking the correct doses of drugs.
The changes in a virus are the results of mutations in the viruses’ genetic code. This makes it much more difficult to develop drugs which kill bacteria and viruses.
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