The History of Health Care

Ancient Times

• Prevention of injury from predators

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• Illness/disease caused by supernatural spirits

Ancient Times

• Herbs and plants were used as medicine�examples:
• Digitalis from foxglove plants
• Then, leaves were chewed to strengthen & slow heart
• Now, administered by pills, IV, or injections

Ancient Times

• Herbs and plants were used as medicine�examples:
• Quinine from bark of cinchona tree
• Controls fever and muscle spasms
• Used to treat malaria

Ancient Times

• Herbs and plants were used as medicine�examples:
• Belladonna and atropine from poisonous nightshade plant
• relieves muscle spasms especially GI
• Morphine from opium poppy
• relieves severe pain

Egyptians

• Earliest to keep accurate health records
• Superstitious
• Called upon gods
• Identified certain �diseases
• Pharaohs kept many �specialists

Egyptians

• Priests were the doctors

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• Temples were places of worship, medical schools, and hospitals

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• Only the priests could read the medical knowledge from the god Thoth

Egyptians

• Magicians were also healers

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• Believed demons caused disease

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• Prescriptions were written on papyrus

Egyptians

• Embalming
• Done by special priests (NOT the doctor priests)
• Advanced the knowledge of anatomy
• Strong antiseptics used to prevent decay
• Gauze similar to today’s surgical gauze

Egyptians

• Research on mummies has revealed the existence of diseases

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• Arthritis
• Kidney stones
• Arteriosclerosis

Egyptians

• Some medical practices still used today
• Enemas
• Circumcision (4000 BC) preceded marriage
• Closing wounds
• Setting fractures

Egyptians

• Eye of Horus
• 5000 years ago
• Magic eye
• amulet to guard against disease, suffering, and evil
• History: Horus lost vision in attack by Seth; mother (Isis) called on Thoth for help; eye restored
• Evolved into modern day R_x sign

Jewish Medicine

• Avoided medical practice
• Concentrated on health rules concerning food, cleanliness, and quarantine
• Moses: pre-Hippocratic medical practice
• banned quackery (God was the only physician)
• enforced Day of Rest

Babylonians: 2000 b.c.

• Lived in squalor, drank filthy water and poor personal hygiene.
• The ruler of Babylon established a legal code for medical practice. This set fees for services and established rules of conduct.
• Physicians hands cut off, if patient died (nobility)

India/Hindus (1500 b.c.)

• Diseases were malaria, dysentery, typhoid, cholera, leprosy, smallpox.
• World’s first nurses and hospitals.
• Used Anesthesia
• Contributed Surgery
• Performed cataract and plastic surgeries
• Used approximately 120 surgical instruments.
• Walled sewers & underground water pipes.

Chinese

• Highly developed center of medical learning and as a result the Chinese belief in evil spirits as the cause of illness gradually changed.
• Father of Chinese Medicine: emperor had documents of Herbal medicines some of which are still used today.
• Acupuncture was used to drive out evil demons.

Greeks: approximately 2000 b.c.

• Belief in Apollo, The Sun God, taught medicine to a centaur who taught others.
• Asklepios: Greek God of Healing(1250b.c.) used massage, bathing and exercise in treating patients.
• Used the magical powers of large yellow nonpoisonous snakes

Greeks cont’

• Snakes licked wounds while patients slept.
• Asklepious applied salves
• The medical caduceus symbolizes the past use of snakes as treatments.

Greek Medicine

• First to study causes of diseases
• Research helped eliminate superstitions
• Sanitary practices were associated with the spread of disease

Aristotle

• Contemporary of Hippocrates…
• Philosopher and scientific genius
• Tutor of Alexander the Great
• Brought together botany, biology and medicine

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Aristotle

His findings were based on animal dissection, because human dissection was illegal where he lived.

In Alexandria, Egypt human dissection was legal, therefore, students studied in Alexandria which was the center for learning and home of a famous medical school

Greek Medicine

• Hippocrates
• no dissection, only observations
• took careful notes of signs/symptoms of diseases
• disease was not caused by supernatural forces
• Father of Medicine
• wrote standards of ethics which is the basis for today’s medical ethics

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Greeks cont’

• HIPPOCRATES (b.460 b.c.)
• Founder of Scientific Medicine
• Organized method of gaining medical knowledge through observation.
• Disease was a result of natural causes
• Examining a patient’s environment
• Stressed diet and cleanliness
• Disease traced by listening to the chest

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• Father of Medicine: due to his accomplishments- prognostics, fractures, surgery, and code of behavior which became the HIPPOCRATIC OATH

Greek Medicine

• Aesculapius
• staff and serpent symbol of medicine
• temples built in his honor because the first true clinics and hospitals

Claudius Galen

• Prescribed diets, massage, exercise and drugs to treat patients.
• His viewpoints were unchallenged until the 16^th Century

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Claudius Galen

• Physician from Asia Minor
• Professed to the teachings of Hippocrates however ignored the theory of observation. He believed that illness and disease was a result of an unbalance in “humors”.
• Believed that the body was regulated by the “four fluids” …blood, phlegm, black bile and yellow bile.

Romans

• Made almost no contributions to medicine, BUT…
• Established superior methods of sanitation and water supply.
• Laws to maintain public health and clean streets. Built aqueducts, pure water systems and underground sewer systems.

Romans

• Despite these efforts..the pandemic (occurring at the same time in different places) bubonic plague afflicted many.
• It spread from China through trade routes to Egypt, North Africa, Syria, and into Europe.
• It infected all the known world.

Roman Medicine

• Learned from the Greeks and developed a sanitation system
• Aqueducts and sewers
• Public baths
• Beginning of public health

Roman Medicine

• First to organize medical care
• Army medicine
• Room in doctors’ house became first hospital
• Public hygiene
• flood control
• solid construction of homes

Dark Ages (400-800 A.D.) and �Middle Ages (800-1400 A.D.)

• Medicine practiced only in convents and monasteries

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• custodial care

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• life and death in God’s hands

5^th to 16^th Century

• No progress was made in medical knowledge or practice
• Blend of Pagan magic and herbalism

• Anglo Saxons in Britain believed that illness was caused by “nine venoms”
• Worms
• Elves
• Witches

Illness treated

with charms, herbs and incantations

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In the 6^th century, epidemics of smallpox, dysentery, typhus and plague were prevalent due to filth and total absence of sanitation.

MEDIEVAL MEDICAL HX

• The Church didn’t foster medical science
• 391 AD: Religious fanatic mob burned the great library in Alexandria

• The use of exorcisms and holy relics were to cure the sick. The belief that illness was due to punishment for sins. Priests again became healers

Arabs Medical Knowledge

• Moslem Arab Empire extended from Spain to India
• Medicine began a revival due to Arabs curiosity
• Learned much about epidemics
• Four major teaching centers

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The Arab’s major medical contribution was chemistry and pharmacology.

Rhazes The Arab Hippocrates based diagnosis of disease upon observation .

Wrote over 150 books/ medical encyclopedia

His major contribution was distinguishing smallpox and measles.

• Rhazes
• (ad 865- c.925)
• was credited with using animal gut sutures.

MEDIEVAL MEDICAL HX

• The major surgical instrument was the cautery, which was a red hot iron used to burn out poison. This was VERY painful, disfiguring and often fatal

• By 850 AD and outstanding medical school was in Salerno. By the 12^th century it had highly organized curriculum upon which students were examined and issued degrees to become the first “true doctors”

• Medieval European surgeon’s practice was limited to nobility, high clergy and wealthy merchants. Other patients were treated by ignorant barber/surgeons.

• Typhus was flourishing due to the custom of wearing the same underclothing which was infested with fleas.

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• Tuberculosis flourished due to poverty and food shortages.

Dark Ages (400-800 A.D.) and �Middle Ages (800-1400 A.D.)

• Terrible epidemics
• Bubonic plague (Black Death)
• Small pox
• Diphtheria
• Syphilis
• Measles
• Typhonid fever
• Tuberculosis

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• Two of the greatest Medieval diseases were leprosy and bubonic plague, probably brought by the Roman soldiers. Leprosy was one of the few diseases recognized as being a result of sins against God.

Bubonic Plaque

Black Death

• The “Black Death” is bubonic plague. It killed many lepers. Black death was a term used to describe the dark mottle appearance of the corpse due to hemorrhages beneath the skin.
• It was caused by a bacillus which grew in fleas of infected black rats. The disease was devastating.

• Signs and Symptoms of bubonic plague were:
• Headache, shivering, vomiting, abdominal pain, and delirium.
• Boils on the joints.
• If left untreated death could occur in 5 days

• Pneumonic Plague affected the lungs and caused death in 3 days.
• Septicemic Plague which was caused by the direct injection of the bacillus into the bloodstream by infected fleas. Death occurred in as little as 24 hours.

MEDIEVAL MEDICAL HX

• Estimated that 1/3 of Europe’s population died from Bubonic Plague
• There were 4 additional outbreaks before the end of the 14^th century
• Black death was enough to motivate additional learning in medicine

Dark Ages (400 –800 A.D.) and Middle Ages (800-1400 A. D.)

• Crusaders spread disease
• Cities became common
• Special officers to deal with sanitary problems
• Realization that diseases are contagious
• Quarantine laws passed

Renaissance Medicine� (1350-1650 A.D.)

• Universities and medical schools for research
• Dissection
• Book publishing

16^th & 17^th Century

• Leonardo da Vinci
• anatomy of the body
• Anton van Leeuwekhoek (1676)
• invented microscope
• observed microorganisms

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16^th & 17^th Century

• William Harvey
• circulation of blood
• Gabriele Fallopian
• discovered fallopian tube
• Bartholomew Eustachus
• discovered the eustachian tube
• Some quackery

18^th Century

• Edward Jenner 1796
• smallpox vaccination

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• Joseph Priestly
• discovered oxygen

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18^th Century

• Benjamin Franklin
• invented bifocals
• found that colds could be passed from person to person
• Laennec
• invented the stethoscope

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19^th & 20^th Century

• Inez Semmelweiss
• identified the cause of puerperal fever which led to the importance of hand washing
• Louis Pasteur (1860 –1895)
• discovered that microorganisms cause disease (germ theory of communicable disease)

19^th & 20^th Century

• Joseph Lister
• first doctor to use antiseptic during surgery
• Ernest von Bergman
• developed asepsis
• Robert Koch
• Father of Microbiology
• identified germ causing TB

19^th & 20^th Century

• Wilhelm Roentgen
• discovered X-rays
• Paul Ehrlick
• discovered effect of medicine on disease causing microorganisms
• Anesthesia discovered
• nitrous oxide, ether, chloroform

19^th & 20^th Century

• Alexander Fleming
• discovered penicillin
• Jonas Salk
• discovered that a killed polio virus would cause immunity to polio
• Alfred Sabin
• discovered that a live virus provided more effective immunity

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1900 to 1945

• Acute infectious diseases (diphtheria, TB, rheumatic fever)
• No antibiotics, DDT for mosquitoes, rest for TB, water sanitation to help stop spread of typhoid fever, diphtheria vaccination
• Hospitals were places to die
• Most doctors were general practitioners

1945 to 1975

• Immunization common
• antibiotic cures
• safer surgery
• Transplants
• increased lifespan
• chronic degenerative diseases

1945 to 1975

• new health hazards
• obesity
• neuroses
• lung cancer
• hypertension
• disintegrating families
• greatly increasing medical costs