Banner image: 2021 lectern sign carrying the message ‘Stay At Home. Protect the NHS, Save Lives’, as used in the Science Museum Group. © The Board of Trustees of the Science Museum.
GPs have witnessed many changes in society and their impact on the nation's health. The tools they use record these challenges, from pandemics to drug epidemics.
Over the past two centuries, our nation's health has significantly changed. Throughout, GPs have played a vital role, from the early days of vaccination in the 19th century to the current COVID-19 outbreak. GPs have worked tirelessly under challenging circumstances to improve the nation's health.
GPs face societal challenges like evolving attitudes towards pregnancy, past pandemics, and social stigma. Many people still misunderstand HIV.
On the frontline: pandemics and epidemics
Within the archives, there are delicate small blades that demonstrate how GPs have been involved with vaccination and public health since the beginning of the profession. While public health officials primarily provided vaccinations at designated locations, many doctors also administered vaccinations. Influential writers like R.W. Allen included guidance on vaccination practices in his 1919 book specifically aimed at helping doctors.
These efforts had a revolutionary effect on public health. From 1915 to 1945, infectious disease was the leading cause of death for young and middle-aged people of both sexes. With the introduction of childhood vaccination programmes and schemes, these deaths dramatically plummeted. Diseases such as diphtheria, mumps and rubella virtually disappeared in the second half of the twentieth century.
Now more than ever, vaccinations are present in the public eye. COVID-19 saw GPs and other health professionals working under immense pressure to treat the infectious disease, and vaccines proved a crucial part of that challenge. Despite some working in hospitals or remotely, GPs like Gavin Francis still rely on their doctor's bag to treat patients outside the surgery. The supplies of PPE, tests, and tools within the bag are essential in uncertain and daunting situations.
To learn more about this, visit the RCGP’s COVID-19 collections or read Gavin Francis’ account of a Day as an Emergency GP during April 2020 from the Wellcome Collection’s website.
Listen to the collection
Doctor's practices have adapted to societal changes, including the pandemic. Kate Cabot discusses how her practice introduced new tools for treating patients.
Object in focus: case cards
Care and conversation skills are as important as any tool in the doctor's bag. Four doctors created these cards, which serve as a reminder of the necessary care in specific situations when treating patients. These cards were designed as a training tool for exams and can be carried in a doctor's bag to use as a prompt during their rounds. Many doctors find them helpful and use them frequently.
Cards that outline HIV and intravenous drug use, for example, remind doctors that patients are not treated in a vacuum but within society with all the social stigma that entails. For a long time, HIV has been stigmatised and misunderstood, with the weight of that often falling on the global ethnic majority and LGBT communities. These cards were made in the 2000s and note that, with effective treatment, the life expectancy of someone with HIV is often the same as those without the disease.
However, HIV continues to be misunderstood, with two-thirds of people believing HIV always goes on to develop into AIDs. Similarly, only 38% of the public know that people on effective HIV treatment can not transmit the virus to their partners.
To learn about public attitudes towards HIV and AIDS, refer to the National AIDS Trust and Fast-Track Cities London's report on HIV: Public Knowledge and Attitudes from July 2021.
You can read about one GP's experience tackling and treating HIV and her review of the Channel 4 drama: It's a Sin here.
Travel pharmacy
The doctor's travel pharmacy is a tool that has been crucial throughout the years. When away from the surgery, it is vital to be adequately prepared. As Dr K Harden of Glasgow warned in his notes in 1966, returning to the surgery during an emergency can be far too time-consuming. Instead, GPs carried their ampoules and, crucially, their travel pharmacy, such as this one.
Since the 1970s, the Drug and Therapeutics Bulletin has published its guide on the necessary medicine for a doctor to carry. These changing medications indicate changing attitudes, for example, growing understanding and awareness of mental health. Sedatives that were common in the mid-twentieth century had become less common due to increased awareness of how to treat mental health. New medicines to treat challenges that had become more common filled the doctor's bag, such as Naloxone to treat opioid overdose.
Snapshots from the archives
Doctors have been at the forefront of social challenges such as infectious diseases. These stories from the archive show how much things have advanced regarding certain conditions like diphtheria. Meanwhile, challenges such as vaccine scepticism seem like a modern problem, but have roots far back into the nineteenth century.
"The use of antiseptic treatment in surgery, which we owe to Lord Lister, has greatly improved the safety of operations. It has significantly reduced the risk to life, especially in abdominal surgery. In the past, removing tumours caused by ovarian disease was considered too dangerous due to the high fatality rate. However, the risk has been significantly reduced over the last decade or so. Nowadays, it is safe to operate in every case.
"I had a very dear relative who was the subject of this disorder and ultimately succumbed. It's because, in her case, an operation was not considered permissible. I have no doubt that had the antiseptic treatment been known, then her life would have been saved. The anti-vaccination craze was in full vigour before I left the practice, and I had an unfortunate experience with its methods and was the victim of the misplaced zeal of some of that fraternity."
"There was a "fever hospital" for infectious diseases, which was most helpful and needed a visit on most days. The most common illnesses treated there were diphtheria, scarlatina, and measles. Though diphtheria antitoxin was used in treatment, no immunisations were available for anything other than smallpox. I always carried a set of tracheotomy instruments in my bag, but fortunately, I never had to use them."
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