Modern treatment of disease

Model answer

In the 1980s there was no effective treatment; the first drug, AZT, approved in 1987, had only a limited effect. From 1996 combination antiretroviral therapy controlled the virus, so by the 2010s HIV had become a long-term, manageable condition and people on treatment could expect a near-normal life.

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At the time, Fleming's discovery had very little significance. In September 1928, at St Mary's Hospital in London, he noticed that a mould had contaminated a plate of staphylococcus bacteria and killed those around it. He grew the mould, named the substance penicillin and published his findings in 1929. However, he could not purify it or make enough of it, he did not test it on infected animals, and he thought it would not last long enough in the body to cure infection. He went back to other work, his paper attracted little attention, and for more than ten years penicillin was not used to treat anyone.

In the longer term, though, the discovery was hugely significant because it was the essential starting point. Ernst Chain found Fleming's paper in about 1938, and he and Howard Florey's team at Oxford purified penicillin, showed in 1940 that it cured infected mice, and first used it on a patient in 1941. During the Second World War American drug companies mass-produced it, so by D-Day in 1944 there was enough to treat Allied casualties. Penicillin was the first antibiotic: it cured killers such as pneumonia, septicaemia and meningitis, made surgery far safer and, after 1948, was available free on the NHS. It also began the search for other antibiotics, such as streptomycin for TB.

The discovery is still significant today because of Fleming's own warning in 1945 that misuse would create resistant bacteria, a problem seen in superbugs such as MRSA. Overall, Fleming's discovery was the beginning of the antibiotic age, but its significance depended on the work of Florey and Chain and on wartime mass production.

Model answer

One similarity is that both were new diseases which doctors did not understand and could not cure. When the Black Death reached England in 1348, physicians blamed God, bad air (miasma), the alignment of the planets or an imbalance of the four humours, and their remedies, such as bleeding, herbs and prayer, were useless; perhaps a third to a half of the population died. Its real cause, a bacterium spread by rat fleas, was not discovered until the 1890s. Similarly, when AIDS appeared in the early 1980s - the first British death was in 1982 - doctors did not know what caused it. The virus, HIV, was identified in 1983-84, but there was no effective treatment until AZT in 1987, and even that had only a limited effect until combination therapy arrived in 1996. In both cases medicine was helpless at first.

A second similarity is that, because the diseases were frightening and not understood, both led to people interpreting them as punishments and blaming particular groups, while the authorities concentrated on prevention. In 1348-49 many believed the plague was God's punishment for sin; flagellants, who whipped themselves to show repentance, reached London in 1349, and in Europe Jews were blamed and attacked. In the 1980s some newspapers called AIDS a 'gay plague' and some religious figures described it as a punishment, so gay men and drug users faced prejudice. In both cases the authorities, unable to cure, tried to stop the spread: Edward III ordered the streets of London to be cleaned in 1349, and in 1986-87 the government's 'Don't Die of Ignorance' campaign sent a leaflet to every household urging people to protect themselves.

Model answer

Individuals have played a vital role in the treatment of disease, both in encouraging and in holding back progress. However, I will argue that individuals were rarely the main factor on their own: their ideas only led to progress when science and technology, government, war and communication allowed them to.

The influence of one individual is clearest in the Middle Ages, but it slowed progress. Galen's theory of the four humours and his idea of treating illness with opposites dominated medicine for more than a thousand years. Physicians trained at universities learned his books, and because his belief in a creator fitted Christian teaching, the Church supported his ideas. As a result, medieval doctors continued to bleed and purge patients, and no one seriously challenged him. Even when Vesalius showed in 1543 that Galen's anatomy contained errors, and Harvey proved in 1628 that the blood circulates, treatment hardly changed, because individuals alone could not overturn established ideas.

From the eighteenth century, individuals began to make real breakthroughs. Edward Jenner noticed that milkmaids who caught cowpox did not catch smallpox, tested his idea on James Phipps in 1796 and published his results in 1798. In the nineteenth century Louis Pasteur proved germ theory in 1861, and Robert Koch identified the bacteria that cause TB and cholera. Paul Ehrlich's Salvarsan 606 of 1909 was the first magic bullet, and in 1928 Alexander Fleming discovered penicillin. Without these individuals' insight and determination, these advances might have come much later.

However, almost all of them depended on other factors. Jenner's vaccine only reached the whole population because Parliament gave him grants of 10,000 pounds in 1802 and 20,000 pounds in 1807 and made vaccination compulsory in 1853. Pasteur and Koch relied on improved microscopes and on government funding encouraged by rivalry between France and Germany; both led teams, and it was Pasteur's assistant Chamberland whose mistake revealed weakened vaccines. Fleming's discovery was partly chance and he could not develop it. It took Florey, Chain and Heatley's team at Oxford, then the Second World War and American government money, to mass-produce penicillin. Fleming's paper was only noticed because Chain read it, which shows the importance of communication.

In the modern period the role of lone individuals has become smaller still. New drugs are developed by large teams in pharmaceutical companies, tested under government regulation introduced after thalidomide, and paid for by the NHS, created by Aneurin Bevan in 1948 but funded by the state. The COVID-19 vaccines of 2020 were the work of large teams, backed by billions of pounds of government money.

In conclusion, individuals have been very important: they provided the ideas behind almost every major breakthrough, and Galen's influence shows that they could also block progress. But they were not the main factor, because their ideas only led to better treatment when science and technology made them possible and government, war and industry provided the money and organisation to use them. The most important developments, such as penicillin, came when individuals and these factors worked together.