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For centuries, people considered the heart to be the source of vitality and innate heat, as well as the seat of intelligence. In 1628, William Harvey published his “Anatomical Studies on the Motion of the Heart and Blood in Animals”. He established that blood circulates round the body and passes through the lungs, where it is revitalised. From his experiments and the evidence of what he could see and feel, he developed his theories. In this regard, Harvey was one of the first scientists in the medical field. Until the Elizabethan era, people had relatively healthy teeth. By 1750, however, all levels of society became consumers of refined sugar. Bacteria that colonize the dental surface convert fermentable sugar into an acidic film that attacks tooth enamel. This led to a serious decline in the nation’s dental health. In 1770, William Addis, whilst in Newgate prison, originated a design for a ’mouth broom’ (toothbrush) that he would mass-produce once he had served his sentence and was released. When effectively applied, brushing can control dental hygiene. Addis is credited with being the ‘father’ of dental hygiene for the British public, and the toothbrush has become one of life’s essential, personal care items. Protection and recovery from disease, particularly world-wide epidemics such as smallpox, were helped by revolutionary new medical advances such as vaccination (Jenner), sterile surgery and antiseptics (Lister). Since their adoption, millions of lives across the world have been saved. Thousands of years ago, the smallpox virus emerged and began causing illness and the deaths of millions. Edward Jenner was a country doctor who was the pioneer of the world’s first vaccine—a safe smallpox vaccine. After an extensive international vaccination programme, this ancient human scourge has been eradicated. Jenner was hailed as the ‘father’ of immunology and it is said that his vision has saved more lives than the work of any other human being. Vaccination has become a highly effective method of preventing a host of infectious diseases. We cannot develop the specific immunity necessary to protect us from a specific pathogen unless we are either infected with it or vaccinated against it. A desperate search for a SARS-CoV-2 vaccine has now been realized. Coincidentally, research workers at the Jenner Institute, in Oxford, have been involved in one of its developments. Vaccines are probably the most successful medical intervention in history. It is concerning, therefore, that ‘anti-vaxxers’ promote, on social-media, misinformation about vaccinations, resulting in vaccination hesitancy and growing numbers of unprotected children. For instance, in England, in 2020, take up for the measles, mumps and rubella (MMR) vaccine is below the level needed to provide widespread (herd) immunity in the community. Charlatans also use social media to peddle well-meaning but useless remedies and therapies for a variety of ailments. Britain survived two horrific world wars unconquered, with its democratic institutions intact. However, such victories were achieved at the expense of enormous human and economic sacrifices. Our compassion for those in distress and suffering, after military action in a previous century, was reflected in pioneering new nursing methods. Like most women of her time, Florence Nightingale was denied tertiary education and deterred from entering a profession. During the Crimean War, in the 1850s, she ministered to those soldiers suffering from battle injuries, as well as typhus, cholera and dysentery. Compassionate by nature, she was immortalised as the “Lady with the Lamp”. She kept meticulous records about the deaths of soldiers and their causes. Being a gifted statistician and a champion of data-visualisation, she was able to present these novel methods of communication, to the Royal Commission on the Health of the Army, to show that most of the mortalities were from preventable diseases, poor nutrition and/or unsatisfactory hospital conditions. Upon her return home from Crimea, she turned her attention to nursing and sanitary concepts in British hospitals, setting up a training school for nurses. Having the attention of Queen Victoria and eminent members of the Cabinet, she helped bring about a seismic shift in the UK’s sanitation and public health programmes. Florence was the first woman to receive the Order of Merit. During Victoria’s reign, medical care was reshaped, and changes implemented to bring the health of the nation into the modern age. For instance, Joseph Lister observed that some patients, particularly those with open wounds, underwent an operation successfully, only to die from a post-operative infection, known as ‘ward fever’. He believed that infection was invading externally. Many surgeons wore dirty aprons; did not wash their hands before operations and used unclean surgical instruments. Recovering patients might be placed on bed linen stained with blood and other bodily fluids from previous patients. Lister reasoned that the way to stop post-operative infections was to prevent germs entering the wound. Applying a dilute solution of carbolic acid (phenol) he experimented with the soaking of dressings, the washing of hands, and the dipping of surgical instruments. Over a 4-year period, his antiseptic procedures brought about a significant reduction in mortality rates. As many of his techniques were adopted by other surgeons, he became known as the ‘father of antiseptic surgery’. Refinements to his techniques led to sterile surgical procedures with which we are more familiar, and the saving of an incalculable number of lives. During WWI, Alexander Fleming served as a practising bacteriologist studying wound infections. He demonstrated that the direct use of strong antibiotics on deep wounds often did more harm than good. He was convinced that antibiotic agents should only be used if they acted in a way that is complementary with the body’s natural defence agents. By a chance observation, he discovered that a certain mould culture prevented the growth of staphylococci. He named the active substance ‘penicillin’ but was unable to isolate it in adequate quantities. A multi-skilled team at Oxford University, led by Florey and co-worker, Chain, improved the extraction and purification process making clinical trials possible. Because of its military importance, further upscaling took place in America. By D-Day, enough penicillin was available to treat troops suffering from bacterial infections. It became known as the ‘miracle or wonder drug’. It proved to be the most efficacious life-saving drug in the world, making possible the treatment of a wide range of previously untreatable bacterial infections, saving millions of lives. In 1945, Fleming, Florey and Chain jointly were awarded the Nobel Prize in Physiology or Medicine. For infertile couples, we want to give the gift of parenthood. After a decade of collaborative studies into in vitro fertilization (IVF), co-workers Patrick Steptoe, Robert Edwards and Jean Purdy facilitated the child of the century, the first ‘test tube baby’, Louise Brown, who celebrated her 40th birthday in 2018. Her artificial conception, outside the womb, was a momentous achievement, sometimes equated with other major firsts in medicine, such as the application of vaccinations (Jenner) and the discovery of penicillin (Fleming). It was associated with a moment of national pride, demonstrating the country’s excellence in medical research and innovation. Initially, Edwards and Steptoe faced a backlash from religious groups, the media and even parts of the scientific community. The two co-workers argued that assisted reproductive technology merely ‘gives nature a nudge in the right direction’. Ultimately, they succeeded in bringing about a change in moral attitudes to IVF, after which millions of infertile couples across the world were able to harness IVF as their last chance at parenthood. Because Nobel prizes are not awarded posthumously, and Steptoe died in 1988, only Edwards received the Nobel award in Physiology or Medicine, in 2010.
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- Life Sciences Leading to Health Care, Dental Hygiene, Disease Control, Hospital Sanitation and IVF. Great British Physicians and Nurses
- Chapter 9