History 5 – History of Medicine – From the Ancient Period in the other parts of the World, up to Pre-Hispanic, Hispanic, American, and Contemporary Development of Medicine in the Philippines

Medical Practices in the Ancient World

A. Mesopotamia

3,000 BCE

Found evidence—a seal of Sumerian physician--some tablets/”book” on obstetrics--medicine is essentially magical --physicians are known as A-zu (“he who knows water”)

1,950 BCE--Code of Hammurabi prescribes fees and severe penalties for malpractice

669-626 BCE

--King Ashurbanipal’s period--though medicines were magical, empirical approaches were somewhat present--over 300 drugs mentioned from plants, trees, herbs, roots, seeds, juices, mineral

substances, etc.—as a whole, 500 of mineral origins --with specifics:

a. drugs for cardiac ailmentsb. emollient enemas to reduce inflammation—certain measures were of such

positive therapeutic valuesc. massage to ease gastric paind. dietary regimentatione. rest and quiet

--astrology interwoven with prognosis of disease but diagnosis was more empirical—all tablets giving remedies are preceded by succinct descriptions of symptoms --available records show that Assyrians and Babylonians suffered from psychiatric, gastrointestinal, ophthalmic, biliary, cardiac and orthopedic disorders --physicians form a separate class of the priests, surgeons and veterinarians --Hepatoscopy (examination of an animal liver to forecast the course of human disease) was widely used but some were efficacious --demonology and magical practice prevalent --incantations used and effective for psychotherapy

B. Egypt

--Physicians spent years of arduous training at temple schools in the arts of interrogation, inspection by palpitation (examining the body by touch)—but physicians constituted a special caste.

Sources:1. Smith Papyrus –oldest

a. a copy of text written around 2,500 BCE includes surgical advice such as the use of compression to stop bleeding and there were sections on diseases of the eye and the heart and other internal organs

b. surgical treatise that deals systematically and rationally with the diagnosis and treatment of 48 cases—splinting, stitching and bandaging are mentioned but not of scalpel

c. devoted to treatment of wounds and bruisesd. study of human anatomy not developed despite the practice of

embalming of the dead since embalmers were not physicians2. Ebers Papyrus

a. dating from about 1,500 BCEb. contains about 900 recipes and prescriptions and deals with medicine

in general but with spells and incantations usedc. Egyptian Pharmacopoeia highly specific—remedy and dosage were

indicated for each disease d. Remedies applied in rational fashione. Used drugs like castor oil (cathartic), olive oil, opium and saffron,

tannic acid (from acacia nuts) for burnsf. Includes laxatives like figs, dates, also castor oil

3. Other papyri contain textbooks on gynecology, pediatrics4. hermetic books strictly adhered to 5. idea of demonic possession as basis for pathology6. weather and ingestion of noxious substances also recognized as etiological

factors7. Diagnosis comparatively advanced

a. pulse was felt at several places suggesting the idea of circulation of the blood

b. heart regarded as vital organ (where the Ka—soul is residing)c. respiration considered as important functiond. hand served as “thermometer” and changes in body temperature notede. idea of auscultation

8. Hygiene fairly advanced9. Prescriptions for diet and cleanliness formed due to religion (head shaved and

wigs used)10. Many parasitic and infectious diseases that plague modern Egypt were found

in the time of the Pharaoha. Schistosoma eggs were discovered in the kidneys of mummies

b. Tuberculosis of the spine maybe seen in the mummies dating back to 3,400 BCE

11. Other diseases such as:a. that of the eye were frequentb. Rheumatoid arthritis extremely commonc. Arteriosclerosis encountered during the 21st dynasty (1,000 BCE)d. Dental caries raree. No evidence of syphilis or rickets

12. Egyptians were excellent physicians13. There was medical specialization14. Earlier Egyptian medicine were empirical and less magical than that of later

dynasties15. Recorded ancient physicians:

a. Sekhet’ Enanach (circa 3,000 BCE)b. Imhotep (circa 2,975 BCE), grand vizier to King Zoser and a noted

architect, astrologer

C. China

1. Chinese medicine first attributed to Emperor Shen Nung (2,700 BCE)a. reported to be the first to compile herbals with over 100 remediesb. also credited with inventing acupuncture

2. Nei Ching (Book of Medicine) attributed to Emperor Huang (2,698-2,599 BCE)—oldest and greatest medical work in China; also known as Huang Di Nei Ching

3. Shang Han Za Bing Lun (Treatise of Febrile and other Diseases)

*Canon of Medicine (Nei Ching)a. --Earliest and most comprehensive medical classic from both the theoretical

and clinical standpoints—compiled around the 3rd Century BCEb. –A compilation of treatises by different authors at different timesc. –Consists of 18 volumes, half of which are entitled Su Wen (Questions and Answers) and the rest Zhen Jing (Laws on Acupuncture), renamed Ling Shu in the 17th Century CE)d. –This collection,, based on rudimentary materialism, stressed the fundamental theories of Chinese traditional medicine—discussed the maintenance of health, clinical symptoms, prescriptions, acupuncture and moxibustion.e. –In the unique traditional Chinese system medical sciences, the visceral organs theory and that of channels and collaterals are important branches dealing with physiological and pathological problemsf. –In a chapter entitled “Treatise on the Channels and Collaterals” in Su Wen, which states that food and drink ingested are absorbed by the stomach and other organs of the digestive system. The “lighter elements” extracted from the food and water are then distributed to the liver, while the heavier elements into the blood, which transport them to the lungs and to all parts of the body including the skin, hair and visceral organs.

g. –The Su Wen also contains a passage to the effect that the heart is the main organ for blood circulation and blood flow is constant and circulative.h. –In anatomy, a chapter on Acupuncture titled Jing Shui says:

“The method to use in examining a human body of average stature is to take measurement and feel the pulse, if there is life. For a dead body, do an autopsy. The stiffness and size of every organ, contents of the digestive system, length of the blood vessel and the purity of the blood may be indicated in figures.

i. –Another chapter entitled “Gastroenteric Study” gives the length of thedigestive tract and every section of it from pharynx to the rectum.

j. –As for diagnostics, the contributors to the laws of medicine summarize diagnostic knowledge from the time of the celebrated physician Bian Que (a pioneer in medical examination and pulse feeling) of the 5th Century CE). These contributors’ discussion on pulse feeling mentioned feeling the temporal arteries on the head and arterior tibial arteries of the legs besides feeling the radial artery in the wrist.k. –The ancient medicine work deals with 311 diseases in 44 categories, including various fevers, sunstroke, malaria, cough, asthma, diarrhea, parasitic diseases, nephritic ecteric hepatitis, diabetes, mumps, various gastroenteric ailments, epistaxis and blood in the feces, hematuria, hematemesis and other hemorrhages as well as pectoral angina, rheumatic arthritis, neurasthenia, mental diseases, epilepsy, leprosy, boils, hemorrhoids, thrombo-endarteritis, cervical and tubercular lymphadenitis, esophageal tumors and a number of gynopathies as well as otolaryngologic, opthalmologic and dental diseases.l. --Dealing with tubercular lymphadenitis, it points out that ‘the disease apparent in the cervical region on the armpit, has its root in the viscera.”m. –In therapeutics, this brilliant medical text attaches great implication to the “treatment of potential diseases, is in modern term, preventive medicine.n. –another feature is Nei Jing’s refutation of the superstitions—“It is meaningless to talk about medical science to those who adhere to their belief in the supernatural.”o. –It also discusses specifically a variety of treatments, including oral administration of drugs, diet, surgical intervention, moxibustion, acupuncture, massage and tapping of fluids.p. –A detailed account of treating ascites by abdominal paracentesis is done “by inserting a needle into the abdomen at a point called guanyuan (10 cm below the umbilical), inducing the fluid with a stylet until certain amount was released. The abdominal region was then tightly bandaged to avoid the patient’s feeling suffocated due to the change in abdominal pressure.q. –Another chapter titled “Carbuncles” teaches that advanced thrombo-endarteritis can be treated by amputation of the blood vessel affected as an emergency measure to prevent spread to the arm or leg.

3. Treatise on Febrile and other Diseases

Written by Zhang Zhongjing early in the 3rd Century, was later re-edited

and divided into two separate books: Shang Han Lun (Treatise on Febrile Diseases) and Jin Qui Yao Lue (Jin Qui Collection of Prescriptions)—systematically summarizes contemporary knowledge in diagnosing and treating the acute fevers and other disorders.a. –In diagnostics, Zhang proposed “four methods”—examination, auscultation,

inquiry and pulse feeling.b. –He classified the acute fevers into six groups, named after channels and took

the typical symptoms of each group as basis for dialectical diagnosis.c. –He suggested the rudimentary concept of the “eight keys” in diagnostics and

was summed up as yin and yang, external and internal factors, fever and cold, deficiency and excess.

d. Thus, combining a variety of theories that appeared after the 3rd Century BCE when the Nei Jing was compiled and the pathogenic theories of the “channels and collaterals’ in the one hand, plus the “four methods” and the “eight keys””—the author produced a general system of therapeutical methods now known as the “eight therapies.”

e. There are inductions of prescription for disorders over the surface of muscles, induction of vomiting for sluggish digestion, hiccups, over secretion in the trachea and similar illness, purgative measures for ascites due to intestinal obstructions, mild treatment for ailments at a medium depth of the organs, warming measures for the effects of cold, purification for fevers, tonics for ailments arising from weakness and dissolution for stagnation, swelling, etc.

f. The treatment contains more than 100 prescriptions plus acupuncture, moxibustion, scalding, local warming, administration of drugs by rubbing over the affected region (tapping), use of suppositories, baths, foot baths, injecting water or air into the ears and the sublingual administration of drugs.

g. Other works on Medicine are: Shen Nong Ben Cao Jing (Shen Nong’s Materia Medica)—China’s earliest systematic pharmacological discourses and Nan Jing (Classics on Difficulty).

h. To these were added medical encyclopedia and works on hygiene, nursing, massage, surgery and treatment, forensic medicine, veterinary medicine, etc.

D. India

The Great Periods of Ayurvedic Medicine:1. Vedic (up to 800 BCE)2. Brahmanic (800 BCE to 1,000 CE)3. Mongol/Delhi Sultanate (1,000 CE)

1. Vedic Period (also Vedantic Medicine—1,500 to +-1,000 BCE)a. First great Hindu Physician—Charaka (1,000 BCE) or (maybe early

Christian Era?)b. Some empirico-rational elements evident (surgery, drugs, hygiene)

were present.c. Atharva Veda had medical concepts in the form of metrical passages.d. Presence of many practices for disease treatment and charms against

demonic possessions.e. In here, chief conditions like fever (takman), cough, consumption,

diarrhea, dropsy, abscesses, seizure, tumors and skin diseases (including leprosy) and presents some herbs for treatment.

f. Started humoral theory in Pathology attributed to the imbalance of the primary constituent elements of the body—caused by: heredity, poison, accident, over-eating and karma or retribution, climate.

g. Thorough diagnosis involved palpitation, auscultation, inspection, taste and smell.

h. Treatment included medicinal plants, blood-letting, cupping, leeches, emetics, purges and enemas.

i. Despite slight knowledge in anatomy, paradoxically, surgery was well-advanced and operations included—repair of anal fistula and hernia, lithotomy, tonsillectomy, extraction of fetus, amputations, excision of tumors and rhinoplasty (practiced by caste of potters to those punished by nose amputation as punishment for adultery—as prescribed from the Manava Dharma Shastra or the Law of Manu or the Manu Smrti).

j. Hygiene highly important.k. Code of Manu or the Manu Smrti prescribed diet, ablutions, removal

of excreta. 2. Brahmanic Period a. Represents the best in Indian medicine characterized by good medical

education and the presence of fine hospitalsb. Susruta (500 CE) prescribed over a hundred surgical instrument and listed 760

medical plants; with writings on malaria, plague, small pox and tuberculosis—also with relation between rats and plague; mosquito and malaria.

c. Aside from advancement in surgery and dentistry (tooth extraction); Susruta also mentioned about 1,120 diseases (also Charaka) like Phthisis—pulmonary tuberculosis.

d. Taught practitioners of fracture treatment, tumor extraction and extraction of urinary bladder stone, caesarian operation.

e. Wrote descriptive works on malaria, tuberculosis, diabetes.f. Advancement in pharmacopeia: Cannabis sativa/Indian hemp/marijuana.

--Datura and Hyocyamus/henbane for anesthesia; Rauwolfia serpentina as source of tranquilizer; anti-venoms and poison antidotes.--The extensive material medica composed mostly of vegetable drugs from indigenous plants.(1) Charaka knew 500 medicinal plants and Susruta knew 760.(2) Sources from animals include milk, bones, gallstones and minerals like sulfur, arsenic, lead, copper sulfate, gold and also cardamom and cinnamon.

g. Also diagnosis involved palpitation, auscultation, inspection, taste and smell.h. As a whole, the Hindus believed that the body contains three elementary substances which are microscopic representatives of three divine universal

forces: spirit/air, phlegm and bile and health depends on the proper/normal balance of these three.i. He gave the seven primary constituents of the body: blood, flesh, fat, bone, marrow, chyle and semen.j. He included also hygiene, diet, water therapy, use of condiments for skin,

teeth and eyewashes.

k. Surgical operations also include excision of tumors, incision and draining of abscesses, punctures to release fluid in the abdomen, extraction of foreign bodies, repair of anal fistulas, splinting of fractures, amputations, stitching of wounds—using, as case needs, part of the 20 sharp and 101 blunt instruments of different descriptions—all made of steel, using alcohol as agent of narcosis during operations; bleeding control by hot oils and tar.l. Examples of exceptional/goal operations:

(1) Lateral lithotomy—removal of vesicular calculus/bladder stone;(2) Plastic surgery by skin or tissue grafting;(3) Cataract operation by couching lens displacement for improved

vision.m. Time of good medical education and fine hospitals.

C. Mongol or Delhi Sultanate Period (from 1,000 CE)—Arabic tradition, maybe due to the rise of Muslim Sultanates.

E. Greece

1. Three Major Stages of Greek Medicine a. Pre-Hippocratic period

--of the Minoan civilization from the island of Crete characterized by a high stage of sanitation.

b. Classic period of Hippocratic tradition --classic period of Greek medicine started around 6th Century BCE.

(1) Empedocles (c. 490-430 BCE) --a possible Pythagorean—freed two cities of pestilence by draining

the swamps and by fumigation; --set forth the view that the universe is composed of four elements—

fire, air, earth, water—that led to the doctrine of the four bodily humors:: blood, phlegm, choler or yellow bile and melancholy or black bile—whose maintenance of health was held to depend upon the harmony of the four humors.

(2) Anaxagoras of Croton (c. 500 BCE)--dissected animals and provided a description of the optic nerve

and the auditory tubes;--saw the brain as the seat of the senses and the intellect and

regarded disease as a disharmony of the body elements.

(3) Herophilus (c. 300 BCE)—“The Father of Anatomy”--distinguished between arteries and veins; discovered and named

the duodenum and the prostate gland; discovered the hyoid bone; described the female anatomy; named the many parts of the brain which he regarded as the seat of intelligence; recognized the difference between the motor and sensory nerves; studied the structure of the eye, the liver, the pancreas and the salivary glands;--recognized the importance of the pulse for diagnosis;--a celebrated surgeon who invented the embryotome and improving the operation of cataract.

(4) Erasistratus (c. 300-260 BCE)—“Father of Physiology”--anatomy and the function of the brain; --was interested in the processes of respiration, the muscular action, nutrition and secretion;--his work on the heart and the vascular system was outstanding and led to the development of the ‘pneumatic theory of blood flow’--rejected the humoral theory of Hippocrates and substituted plethora or excess of blood as the cause of a disease;*-invention of catheter is attributed to either Herophilus or Erasistratus;--believed that venesection lowered the resistance of the patient--discouraged the excessive use of drugs;--prescribed vapor baths, rest, diet, and exercise;--aware of the wavelike progress of the pulse;--practiced ligation of bleeding arteries.

(5) Alcmaeon (c. 5th Century BCE)—from the Greek colony of Crotona--a biologist who also identified the brain as the physiological seat

of the senses.(6) Aristotle (c. 330 BCE)

--the first great biologist;--laid the foundations of comparative anatomy and embryology and suggested evolution;--was important due to his belief that the scientific methods which consist of careful observation, experimentation, and study of cause and effect could lead to greater scientific knowledge.

(7) Asclepius (c. 1200 BCE)—(semi-divine)--probably a person who performed many miracles of healing and

may have been the father of Podeleirus and Machaon; both military surgeons mentioned in Iliad and Odyssey of Homer (c. 1000

BCE).(8) Hippocrates (may be born 460 BCE)—“Father of Medicine”

--may have been “several men” of the same name or may have been the author of only some or none of the books that make up

the Hippocratic Collection (Corpus Hippocraticum);

--may have taught and practiced medicine in Cos and in other parts of Greece including Athens and that he died in an advanced age;--the works attributed to him mark the stage in Western medicine where disease was coming to be regarded as a natural rather than a supernatural phenomenon and doctors were encouraged to look for physical causes of illness;--the true genius of Hippocrates is shown in the Aphorisms and Prognostics containing pithy summaries of vast clinical experiences that inspired countless commentaries until well into the 18th Century;--of unusual also is the Hippocratic work Fractures, Dislocations and Wounds;--known also were 70 books extant that were written either by him or by his other students and followers that stressed important principles like:

a. the physician should work not for personal gain but for love of humanity and should be sober, industrious, clean, discreet and modest;

b. disease should be studied by meticulous observation, making use of sight, taste, touch, hearing and smell in order to diagnose properly and cases should be carefully recorded and studied to establish a prognosis;

c. disease is often the result of environmental forces such as diet, climate and occupation;

d. physician should emphasize a simple treatment supplemented with careful diet and surgical intervention when necessary.*(A physician’s conduct is summarized in the Hippocratic oath which was sworn to the newly graduate physicians to this day.)

--Corpus Hippocraticum marks a revolutionary point in the development of medicine. The treaties On Air, Water, and Places is the first work on

physiotherapy, balneology (science of baths) and climate in relation to health;--on the Prognostics are described the symptoms of approaching

death that are still called Hippocratica;--the treaties on Epidemics relates to the first 4 clinical case

histories;--“The Healing Power of Nature” could often lead to spontaneous

recoveries;--bloodletting was performed infrequently;--diet, rest, fresh air, massage, and baths were an important part of

treatment;

--as for drugs, the principle of similia similibus, though not exclusively, was employed;

--purgatives were usually mild; hot drinks used as sudorifics (perspirants) and vegetable juices as diuretics;--Hippocratic pharmacopeia also included emetic, astringents and

such narcotics as belladonna, mandragora and opium;--may be unaware of the pulse and the knowledge of anatomy and

physiology sketchy but the principle of direct clinical observation, together with logical

approach to disease, made possible the development of a valuable medical system.

*Hippocratic Oath—Physician swears:a. to impart medical knowledge, even for free;b. bound by ethical concepts;c. to the best of one’s ability;d. but not to cause or give harm by giving harmful drugs,

even if asked;e. nor to induce abortion;f. nor do mischief, even under temptation;g. to be discreet regarding patients and their cases and

sickness.

3. Graeco-Roman and may be Hellenistic.

F. Rome

In Alexandria (Hellenistic Culture), Herophilus and Erasistratus influenced practitioners in anatomy and physiology. Their followers were divided into many contending sects. The most notable were the empiricists who based their doctrine on experience gained by trial and error; they also excelled in surgery and pharmacology.

A royal student of empiricism, Mithradates IV, King of Pontius, developed the concept of inducing tolerance of poisons by the gradual administration of increasing dosages.

1. Asclepiades of Bithynea (1st Century BCE)--credited with establishing Greek medicine in Rome;--opposed to the theory of the humors, he taught that the body was

composed of disconnected particles or atoms separated by pores;--prescribed a regimen of occupational therapy

2. Three Roman Encyclopedists

a. Marcus Terentius Varro (c. 116-27 BCE)--was aware of the existence of microorganisms.

b. Aulus Cornelius Celsus (c. 1st Century of the Christian Era)--prepared the 8 extant books entitled De Re Medicina;--diseases such as Celsus’ chancre, Celsus’ vitiligo and Celsus’

papules were accredited to him;--introduced terms like heart diseases and insanity;--described inflammation, meningitis and appendicitis;--even if many of his works were derived from Hippocratic

sources, many of his observations are original (like surgical procedures, inflammation);--De Re Medicina -Six of the eight books describe various diseases and various

therapies using diet, drugs and manipulation; -the last two topics deal with surgery including operations for

goiter, hernia and bladder stones, as well as describing tonsillectomy and the removal of eye

cataracts; -also recommended treating fractures with splints and bandages

stiffened with starch.c. Pliny the Elder (c. 23-79 CE)

--possessed insatiable curiosity and great diligence but not of critical sense;--preserved many of the contemporaneous superstitions, medical practices, remedies and names of physicians.

3. Galen of Pergamum,, a Greek native of Asia Minor--practiced in Rome; became the imperial physician and achieved great

fame and authority but was responsible for the stunted development of medicine;--a competent physician, and his treatments consist of diet, massage and

use of numerous drugs;--more than 500 books of which 83 are extant in numerous editions and

translations;--approach to medicine was based on the Aristotelian philosophy;--was accepted as an authority by the early Christian Church and any

contradiction to him was regarded as heresy;--monotheistic interpretation of the World also accepted by Arab and

Jewish medieval physicians;--regarded as the founder of experimental physiology;--dissected apes and pigs but transferred the result to human anatomy

since human dissection was prohibited;

--knew the anatomy of the brain and described seven pairs of cranial nerves;

--the first exponent of the myogenic (muscle-produced) theory of the heartbeat;

--discovered the sympathetic nervous system;--established the important principle of interdependence between function

of the organ and its lesions;--recognized the motion of the blood but saw it as ebb and flow and not as circulation;--his therapy was contraria contraries—heat was applied to diseases

produced by cold and vice versa.

4. Othersa. Greek physician Aretaeus, the Cappadocian (2nd Century of

the Christian era);b. Greek anatomist Rufus of Ephesus;c. Soranus of Ephesus (another Greek)—regarded as the

founder of obstetrics and gynecology.

*Roman medicine emphasized public health, sanitation, sewage disposal, water system (unrivaled):

-physicians for the poor, armed forces and hospitals;-gymnasiums, public baths and domestic sanitation;-numerous hospitals built (while the Greek started the sanatoria)

G. Arabs

Islamic medicine was highly eclectic, combined Greek medicine, medical writings of Talmud and by astrological teachings from Egypt and the Orient to which the addenda and commentaries were attached, especially concerning the use of drugs. The whole was codified in writing so that clinical trials could be evaluated to a limited extent. Basic chemical processes including distillation, crystallization and sublimation were discovered. Such Arabic words as alkali, alcohol, syrup, and drug are now widely used. Chemistry is derived from Al kimyaa, which was from the Chinese chin/kim (a process where base metal is turned into gold (chin).

1. Nestorian sect of Christians, founded by Nestorius, Patriarch of Constinople, was proclaimed heretical, fled to Edessa in Asia Minor in 431 where a school of medicine was founded; then transferred to Gundeshapur (Jundisahapur) in Persia during Emperor Zenno’s time (479-491). For the

next 2 centuries, they make this city a medical center. They also translated Greek and Latin medical

texts into Arabic.

1-a. The Prophet Muhammed made Mecca the center of Islam on CE 630 using his native language,

Arabic, the official medium of communication while his successors adapted the Nabatean-Aramaic

writing system when the Qur’an was officially compiled. He was succeeded by the four Caliphs (Al

Rashidun) and this was followed by the rise of the Umayyads centering on present-day Syria and

when Caliph al Mansur of the Abbassids (the next dynasty) made Baghdad his capital in the early

8th Century, Arab science and medical development also started for he followed the Prophet’s

injunction to “seek knowledge from as far away as China.” Thus, Indian Ayurvedic and Chinese

Huangdi Nei Ching were incorporated into the compilation of medical traditions combining those

of the East and the West and even the ancient Egyptian hieroglyphics were deciphered by them,

much earlier than those based on the Rosetta stone.

b. Husain ibn-Ishaq (809-877)-most prominent among the Nestorian physicians;-wrote “Alteration of the Eye”—earliest known Arabic text on ophthalmology.

c. Isaac Judaeus (845-940) -known also as Isaac Ben Solomon Israeli, an Egyptian Jew whose writings on diet, fevers and drugs were in great demand up to the 17th Century; -wrote the first book devoted entirely to dietetics.

2. Rhazes (860-930)--a Persian Arabic physician, clinician and writer;--the first to identify smallpox from measles in 910 and to suggest blood

as the cause of infectious diseases;--wrote approximately 200 works on medicine including a tremendous

medical encyclopedia known as the Continent of Medicine;--he followed the Hippocratic methods and was a good clinician;--remembered for his merciless exposure of quakery;--authored Al-Hawi (Comprehensive Book) but whose famous work De

variolis et morbilis (A Treatise on Smallpox and Measles) gives a clear description of both.

3. Haly Abbas (Ali ibn al Abbas)

--another Persian of the 10th Century, author of Royal Book, a compendium of contemporary medical knowledge, much better arranged presentable than Rhazes’ Continent.

4. Albucasis (936-1013)--also known as Abul Kasim, the only Arabian specialist in surgery;

practiced profession in the Caliphate of Cordoba;--his treatise was one of the earliest known illustrated books on surgery

and the surgical tools include not only forceps but a variety of dental tools; --was also the first to describe hemophilia.

5. Avicenna or Abu Ali al-Husayn ibn Sina (980-1037)--also a Persian, known as “Prince of Physicians” who strove to reconcile

the dogmas of Galen and Aristotle;--his principal work, Al qanum fi’l-Tibb (The Canon of Medicine) became

a classic and was used in many medical schools like Montpellier in France as late as 1650.

6. Avenzoar of Seville (1072-1162)--one of the few physicians prior to the Renaissance with the courage to

challenge the writings of Galen;--responsible for popularizing the medieval fetish known as the benzoar

stone;--in spite of the superstitious streak, he was a good clinician;--diagnosed cancer of the stomach and was first to use nutrient enemas;--the first to describe the parasite causing scabies;--teacher to Averroes.

7. Averroes (1126-1198)--wrote extensively on the study of medicine but is famous in the

philosophic contributions;--combine philosophy and medicine;--greatest commentator on Aristotle.

8. Maimonides (1136-1204)--his works on diet, hygiene and toxicology were widely read;--his period marks the end of the atmosphere of tolerance and greatness of

Arabian civilization when he refused to exchange Judaism for Islam was banished from Spain

and became a physician to Saladin and had a flourishing practice in Cairo;--more recognized as philosopher than a physician;

--few of his works, written in Arabic, were eventually translated to Latin and printed.

9. Al Quarashi (1210-1288)--also known as Ibn as-Nafis, wrote commentaries on the writings of Hippocrates and treatises on diet and eye diseases and most important, was the first to indicate the pulmonary transit of blood from the right to the left ventricle via the lungs.

The Arabs did much to elevate professional standards by insisting in examinations for physicians before

licensure.They introduced numerous therapeutic substances.They excelled in the field of ophthalmology and public hygiene and were superior to the physicians of medieval Europe.Arabian civilization was Arabian in language only. Many nations of the East and

the West contributed to its development. Persians, Syrians, Spaniards, Christians and Jews were among its

great luminaries.

In the 7th Century, a vast portion of the Eastern world was overrun by Arab conquerors. In Persia, the Arabs

learned the Greek medicine in the schools of the Nestorian Christians, a sect in exile from Byzantine

Empire. These schools preserved many texts that were lost in the destruction of the Alexandrian library.

The Islamic civilization established several hospitals. The greatest were the ones at Damascus (1160) which

remained active for three centuries and the Al Mansur hospital in Cairo (1276). The latter was the first

hospital to emphasize science, teaching and social service. It had separate wards for women, children and

convalescents. There were wards dedicated to specific diseases, an extensive library and out-patient clinics.

H. Christianity

In Constantinople, a series of epidemics served only to initiate a revival of magical practices.

-Some outstanding Greek physicians: Oribasius (c. 325-400); Alexander of Tralles (c. 525-605); Paul of

Aegina—who maintained the older tradition amidst moral decadence, superstition and intellectual

disorders.

1. In Monte Cassino, Italy, the Benedictines studied and collected ancient medical text in their library.

a. St. Bernard of Nursia (founder of the order)—obligated members to study the sciences, especially medicine.

b. Bertharius III (Abbot of Monte Cassino)—a famous physician.2. First European medical school founded at Salerno, near Naples, then, still a part of the Byzantine empire (8th Century).

-Trotula, a best-known woman professor, was a gynecologist who published a handbook on

midwifery.3. Under the Frankish theologian Rabanus Maurus (780-856), Fulda became a

famous center of medical learning in Germany (a territory of France formerly known as Gaul).

4. By the 9th Century, medicine was included in the curriculum of the cathedral schools. This was due to the efforts of Charlemagne, the Holy Roman Emperor, who was illiterate.

5. During the 9th and 10th Centuries, the ancient health resort of Salerno, situated near Monte Cassino, gradually became the recognized center of medical activity.

6. At the beginning of the 11th Century, Salerno became the site of the first Western school of medicine. Teaching was primarily practical and secular in tone and emphasized diet and personal hygiene.

a. Constantine the African (1015-1087), Italian physician and translator, became a Benedictine monk and retired to the Abbey of Monte Cassino; prepared Latin translations from the Arabic of many Greek medical classics for students at both Salerno and Monte Cassino.

b. The school of Salerno, having many famous graduates, produced Regimen Sanitatis, a compendium of domestic medicine in the form of proverbs.

(1) Women were admitted to the school but it was not certain whether as nurses, midwives or physicians.

(2) For all its comparatively advanced character, Salermo still regarded suppuration as part of natural wound healing. Its first textbook on anatomy was based on that of the pig.

(3) With Constantine Africanus’ translations of Arabic medical text into Latin, its lost Graeco-Roman heritage was revived. Subsequently, Avicenna (Abu Ali al-Husayn ibn Sina), Haly Abbas, and Maimonides, as well as Galen and Hippocrates were entrenched in all the schools of medieval Europe.

7. Salerno school, by the 11th Century, had become a center of medical knowledge.

a. Physiology and pathology followed that of Galen but was counter- balanced by a spirit of investigation.

b. Course of study took five years to complete after which students were required to pass an examination before being allowed to practice.

c. Although the school declined after the 12th Century, its spirit was transmitted to the greatest medical schools of the Renaissance period, which were in Bologna and Padua.

8. By the end of the 12th Century, the revival of lay medicine and restrictions in activities outside the cloister brought about the decline of monastic medicine but it had performed the valuable function by preserving the traditions of medical learning.

a. At about 1140, Archbishop Raimundo founded at Toledo, Spain, in institute for the translation of Arabic medical manuscripts, including the works of Rhazes and Avicenna, into Latin.

b. Lanfranchi (1150-1315), a student of William of Saliceto, was credited as the first to differentiate between hypertrophy and breast cancer.

c. William of Saliceto (1210-1280) and Lanfranchi pioneered in surgical anatomy.

d. At Padua, Pietro d’Abano (1250-1316) attempted to reconcile the difference between adherents of the Greek and Arabic systems.

e. One dominant figure of French surgery was Henri de Mondeville (1260-1320), surgeon to the King of France, who advocated antiseptic treatment of wound and the use of sutures.

f. In 1240, according to laws by Emperor Frederick II, a year of postgraduate practice under an established physician was required before the graduate was licensed.

g. Ownership of an apothecary shop or any business related with an apothecary was forbidden. The preparation of drugs was supervised by inspectors.

h. At Bologna, the physician Taddeo Alderotti (1223-1303) was a prime mover in establishing postmortem dissections and an early developer of the Consilia, a medical case book, in which advice was given by the professor to younger or less sophisticated physicians—the start of clinical case history.

9. The famous school of Salerno, which flourished from the 10th to the end of the 13th Century, was the first organized medical school in Europe. It was also, probably, the most enlightened Greek, Latin, Arabic and Hebrew influences that merged in Salerno which became known as the Hippocratic City. The curriculum required three years for preliminary studies and five for medical studies. The graduate received the

degree of magister or doctor. The practice calling a physician as “doctor” was derived from Salerno.10. By the end of the 14th Century, Guy de Chauliac (1300-1368), Father of

French surgery, stressed in his writings the importance of anatomical dissection in surgeons’ training. He is credited with being the first to

recognize the plague which first appeared in Europe in 1348. He is also thought to be the first to

describe femoral hernia (1361). He also invented several surgical instruments and was also among the first to employ extension for fractures. On the other hand, he believed in the doctrine of pus and popularized scorpion oil as a diuretic in venereal disease (resistant to penicillin).11. After the decline of Salerno at the end of the 13th Century, the medical schools

at Montpelier, Bologna, Padua and Paris came into prominence but their contribution to medical evolution was slight.

a. Mundinus of Bologna dissected two cadavers but he saw them through the eyes of Galen an Avicenna, and thus added nothing to the development of anatomy. The University of Paris outlawed surgical operations and clinical examinations.

b. Arnold of Villanova, a teacher at Montpelier, invented alcoholic tincture of herbs, but he placed the disease of women in his book of poisons since, according to him, “women are poisonous creatures.”

12. The superstition and dogmatism that marked the rise of Christianity in Europe continued to flourish throughout the Middle Ages. As in Babylon, astrology ruled prognosis. Diagnosis was largely limited to an inspection of urine. Free inquiry, observations and experiments were out of the question.

a. Learning, including those of medicine, was devoted to the study of the ancient, authoritative texts. Therapy relapsed to magic, prayer, fantastic and often revolting concoctions, charms, amulets and faith healing.

b. Venesection and various herbs were widely used. Anatomy, if studied outside of textbooks, was based on the dissection of pigs. The root of mandrake was surrounded with legends and regarded as sovereign remedy. Hygiene and sanitation were at a very low level since the human body was held in contempt.

c. Saint Jerome saw no reason for any baths after baptism.d. Tertulian thought that investigation was made unnecessary by the

Gospel.e. Gregory of Tours regarded seeking secular medical aid as blasphemy.

The demonic theory of disease again gained ascendancy.f. In the case of the devastating plague epidemics, the blame was placed

on the Jews.13. However, there was improvement in the 13th Century:

a. Dissection of the human body was permitted; medical licensure endorsed; and strict measures were instituted for the control of public hygiene.

b. Representative scientists of this period include the German scholastic St. Albertus Magnus who engaged in biological research, and the English philosopher Roger Bacon, who undertook research in optics and refraction, was the first scholar to suggest that medicine should rely on remedies provided by chemistry.

14. In the Middle Ages, the influence of Christian theology affected medicine in several ways:

a. The Christian emphasis on charity and concern for the sick and the injured led to the establishment of hospitals often related to and maintained by monastic orders.

b. In the Middle Ages, spacious, fine hospitals were built by the knights of St. John, which includes St. Bartholomew’s in London.

II. Pre-Hispanic Philippines

A. Dr. Jose P. Bantug (UST Med) noted that the so-called “physicians” in the pre-Hispanic society was a priestess known by the Tagalogs as “katalonan”; “babaylan”—Visayas; “balian”—Bicolanos; “baglan”—Ilocanos; “baylan”—Mandayas.-Supreme Being—“Bathala” (Tagalog); “diwata” (Visayas)-Lesser gods—“anitos”—protectors of the home-Bathala—disperser of good and evil but power is shared by Captan—who planted the bamboo from which sprung the first man and woman.

B. Beliefs:1. Evil spirits caused sickness, evil kinds: witches, water nymphs, goblins,

and monsters.2. Sickness caused by gods as chastisements to offenders3. God’s forgiveness have to be sought by the sick and in cases of ailments,

by the priestesses for the cure4. Later, priestess-healers replaced by men known as “tawak”

a. those known with the power to neutralize snake poison;b. “Suhi” (born breeched)—has the power to remove fish bones

from the throat;c. “Gayuma”—those adept in concocting love potions/charms.d. “Aswang”—responsible for disease of children and for

miscarriages;e. “Mangkukulam”—those possessing diabolical power to cause

suffering or disease (also “mambabarang”);f. “Mangagaway”—witches that cause lesions or insanity.

C. In Antique, Dr. Elizabeth V. Ellaga (in 1996-97), President of Antique Medical Society reported the following beliefs and practices as dating back to pre- Hispanic: 1. Botbot (or Pasuk)—a quack doctor who concocts ginger and buyo leaves and rub over the affected area of the patient while uttering orasyon (incantation) to extract objects like stones, broken glass, hair, bark of trees, etc.;

2. Tanduk —treatment for dog/cat bites by making incision over the bitten area to bleed then dress with a piece of carabao horn scrapings believing that if it sticks to the wound, the poison or the rabies would be sucked out;

3. Buga —treatment for stomach ache—an elder chooses a mixture of buyo leaves, betel nut, tobacco leaves and lime and spits them on the umbilical area and then spread with hand;

4. Usog —abdominal colic of children caused by someone with stronger power over the afflicted and saliva from the one causing the sickness be rubbed on the knees of the affected child;

5. Buyag —when an old individual pays a special attention and appreciation on the physical and attribute of the child (i.e., chubby, cute)—the parent or one holding the child should utter “pwera buyag;”

6. Uses of tawas/alum or egg—used for diagnosis of sickness cause by evil spirits and the interpretation through the burnt material coming out of these objects;

7. Use of amulets or anting-anting as preventive.

D. Early Spanish missionaries reported the presence of herbolarios or coranderos and their efficacy in indigenous remedy:

1. –had a fairly wide knowledge of therapeutic properties of many plants, aside from specific used for different diseases; know many poisons and their respective antidotes;

2. –Materia medica included febrifuges, anti-helmintics, styptics, sedatives, antiseptics, remedies for swelling, furuncles, abscesses, ulcers, wounds.

(Source: pages 234, 236, History of Philippine Medicine by Conrado Dayrit, Perla Santos-Ocampo and Eduardo de la Cruz, MDs)

E. Tagalog Folk View and its Implications on Filipino Concept of Health and Sickness

1. The physical universe—the earth, sky, sea, wind, and the surrounding vegetation is known as sansinakop.

2. The Likas ng sansinakop (inherent properties of the universe) are: disequilibrium, contradiction, and balance.

3. Their manifestations are controlled by the direction/source of the wind which brings about fluctuations in atmospheric pressure and whether conditions, as well as harmony or disharmony, between man and nature affect each other.

4. –And their fluctuations result from their passage of cold and warm meteorological fronts, locally known as “simoy ng hangin.”

5. Wind flows collectively known as masamang hangin is one of the sources of diseases.

6. Two kinds of masamang hangin:a. –one controlled by lamang lupa or dwellers of the earth;b. –one controlled by the engkanto or spirits of the atmosphere.

7. Some common diseases and discomforts caused by these two are: pantada (muscle pain), pasma (joint pains), sikmura (stomach ache), lagnat (fever), and nawalan ng bait (madness).

8. Belief that what causes a disease to happen provides the best medicine for its cure permeates the conceptualization in the fold of healing:

a. If the ailment was acquired from the lake—pasma sa tubig—water from the lake is used as medicine;

b. If the stomach ache was due to over-eating, the most potent hot or cold food known as matapang na pagkain; from among the food the sick has eaten, the left-over is secured and burned and the decoction is taken orally since it was the bisa of the food that has caused the upset; the bisa can restore health.

9. Belief in the two perceptual organizations of events in nature:a. Bring the system of opposition—bad and good, sacred and evil,

favorable and unfavorable, the controller and the manipulated, hot and cold;

b. The self-rectifying quality of objects themselves give the idea that:(1) technology may control nature but nature may control technology(2) Thus—in folk medicine, before a patient is brought to the

clinic or a hospital for treatment, the lamang lupa are first appeased for the scientific approach to medicine can be effective;

(3) that the conflict between the power of the spirits and modern medicine have been reconciled.

10. Binary system of opposition is one of the most important conceptual frame of reference in understanding the man—nature relationship. a. The terms hot and cold do not imply the presence or absence of temperature but the effects of such qualities in the human body. b. Certain illnesses are believed to be caused by the imbalance of too many hot elements either in the human body through the pores on the skin, food consumed, and air inhaled.

c. Some of the most common illnesses caused by the imbalance of too many hot elements either in the human body or in the environment or skin diseases: galis, bulutong, tagulabay (psoriasis) etc.; d. Some of the most common illnesses caused by the imbalance

of too many cold elements either in the human body or in the environment are the following:pantada chest or muscular painubo coughsipon common coldtrangkaso influenzapagtatae diarrheahika asthmaT B, cholera, manas tissue edema/beri-berirayuma rheumatism, arthritispulmonya pneumoniakabag gas pain

11. Certain illnesses closely related to the kinds of food eaten:a. Over-consumption of hot food brings about malaise and most

skin ailments—examples of which are: guava, coffee, chico,

santol, duhat, ripe jackfruit, saba, ripe coconut, pineapple, mango, lanzones, mongo, horse meat, carabao meat, pork, eel, lapu-lapu, shark, downstream spring water, noontime sunlight, habagat, half-moon.

b. Unregulated intake of cold food brings about malaise characterized by swelling of joints, muscle pains and stomach discomfort—examples of which are: avocado, atis, macopa, lemon, dalanghita, pomelo, beef, chicken meat, lake water, upstream spring water, early morning sunlight, amihan, stars.

12. The human body and its responses to hot and cold elements:a. Physically, the head, neck, arms and legs are, by nature, cold;b. The joints, chest, stomach and genitals are hot.c. When these parts are exposed to either the opposite set of hot and

cold elements, illness and discomfort arise.d. Treatment may use the opposite of the nature of the body.

13. Concepts of health and illness:a. Kalusugan implies freedom from illness with three different

states of physical fitness:(1) malusog ang katawan (able bodied)(2) mabuti ang katawan (in good condition, desirable state of

well-being, even mentally)(3) matipuno ang katawan (rounded, firm, muscular)

b. These are also the attributes of kalusugan: (1) malaki ang braso (2) mataba (3) masigla ang ayos (full of vitality) (4) mahusay ang karamdaman (state of feeling well) (5) matiwasay ang pag-iisip (mentally balanced, intellectually sound) (6) magaan ang katawan (7) mabuti ang niloloob (good attitude)

14. Health is perceived more as good relationship between man and his surroundings—between himself, the people around him, the natural and supernatural environment. 15. Concept of illness:

a. Sakit encompasses all phenomena—physical sufferings, unpleasant mental and emotional disturbances, even empathy to others.

b. Sakit, as a disease category, may be due to imbalance inside or outside the body, improper diet, and disturbance on the elements of nature, accidents or questionable conduct of life. c. Illness is not only premised on pathological grounds but also when human will power is threatened.

d. Only when man reinforced his energy can he be cured.

e. Only when the conflict between the person’s will power and the power of whichever factor is responsible for the illness can be resolved can one be cured.

f. When environmental spirits caused the sickness, they must be appeased by rituals and prayers. g. Man’s stronger will power to survive is also affected by fate.16. Classification of diseases—3 Broad Categories: a. Natural discomforts—visible physical afflictions, chronic

disorders, mechanically induced pain, changes in the environment—mostly caused by panahon—(weather—time, seasonal changes);

b. Innate disorders—all known diseases having to do with heredity, psychic experiences and blood compositions. c. Supernaturally caused maladies.

*a. Natural discomforts—most common skin ailments, of 2 kinds:(1) Mechanically caused by either sharp or dull

instruments.(2) Sugat—thru punctures—saksak, tinik, tusok—due to kalmot/scratch, kagat or bite, gasgas.(3) Bukol—swelling of tissue, umbok, pigsa (eruption), putok.

a-1. Non-mechanically caused skin ailments—likas sa katawan or inherent—due to:

(1) maruming dugo (2) hawa (contagion) (3) lakad ng panahon (4) init ng katawan (5) masamang hangin (6) pabaya sa katawan

a-2. Non-mechanically caused skin ailments: - agihap, alipunga, an-an, balakubak,

bakukang, bungang-araw , kulani, buni, ketong, kuliti, kulni, kulugo, galis, pantal, pekas. b. Innate ailments—those inherited—mental ailments, emotional troubles, TB—masamang sakit, gawa ng lihi— skin color as indicator of illness—maputla, namamantal.

Accompanying pain: (1) Hapdi-stabbing pain(2) Kirot—throbbing, squeezing, intermittent pain(3) Manhid—numbness(4) Headaches:

(a) Liyo—affecting superciliary ridges, the frontal eminences of the forehead and glabella

(b) Sentido—focused on the temporal region(c) Mabibiyak ang ulo—splitting headache, strong

pain(d) Lula—deep, entire head, accompanied by

vertigo and nausea. (In the Southern Tagalog region, this is known as “mauugong.”)

(5) Associated behavior:(a) matamlay (weak)(b) masigla(c) vomity(d) na laman lupa—shortness of breath and nose

bleeding(e) palpitation at the back of neck

-if woman—pregnant-if male (balisa—stress) or pagod (fatigue)

17. Pulse-taking—frequency, regulatory, amplitude a. Frequency—rate of heart beat Rapid—indicate anxiety, fear, headache, hunger, fright Slow—weakening, internal imbalance of elements in the body, low blood pressure, grave condition

b. Regulatory—rhythm of the pulse beat, if irregular—illness c. Amplitude—the level at which pulse beats are registered: -Malakas na tibok—high pulse beat, quick, bouncing movement -3 amplitude’s sub-levels: (1) matigas na pulso (2) mabagsik na pulso (3) malakas na tibok—1st sub-level (4) malaking pulso (5) 2nd sub-level—banayad na tibok (moderate throb)— characterized by uniformity of pulsation—midway between the high and low

(6) 3rd sub-level—mahinang tibok(7) 4th sub-level—marahan (soft), malambot (fluid),

malalim (deep), maliit (barely perceptible)18. Different fingers used to indicate different types of pulse beats: a. Hinlalaki (thumb)—for the heart—hand and all parts of the body, even color b. Hintuturo (index)—head and neck c. Dato (middle)—chest to the upper portion of the stomach d. Dumalaga (ring)—stomach and lower extremities e. Kalingkingan (little)—provides the balance with the hinlalaki19. Specialists: a. Arbularyo/Herbularyo—deals with the natural and supernatural -Supernatural—gaway (witchcraft), barang (sorcery), sumpa (curse), namatanda, na laman lupa (dwellers of the earth),na nuno

sa punso (goblin) b. Herbularyos are also known as practitioner in “hilot” or chiropractor c. Requirements to qualify as an Arbularyo: (1) Individual must come from a family of one/or at the least, one member of a family a practitioner;

(2) Have been visited by a supernatural being in dreams or while awake;

(3) Has to undergo or willing to undergo long training in the art of healing by another arbularyo;(4) Has to memorize prayers, ritual procedure and know medicinal plants in the area with reference to their application and power as to curing specific type of illness;

(5) Has to master the art of pulse taking. c. Manghihilot—for fracture or broken bones, sprains and sala— generic terms for discomfort with muscle/bones. Two types of sala: -one using salamin or mirror; the other using banana leaves d. Magpapaanak or hilot (midwife or comadrona) e. Manggagaway or sorcerer.

20. Nineteen pulse permutations among Filipino Arbularyo (1) Floating pulse – higher than normal; less susceptible when palpated

at the middle and deep levels

(2) Sinking pulse – distinct only at the 3rd level; when heavy pressure is applied. (3) Slow pulse – slow than 4 beats per respiration

(4) Rapid pulse – more than 5 beats (of the heart) per respiration (5) Thin pulse – like a fine thread but distinct and clear—blood

deficiency/(excess of Yin) (6) Big pulse – broad in diameter & also distinct—blood excess/(Yang

excess) (7) Empty pulse – big but without strength/weak & soft like balloon—

Yin (8) Full pulse –big and strong—Yang (9) Slippery pulse – extremely fluid; feels smooth like a ball-bearing

covered with viscous fluid (10) Choppy pulse – the opposite of slippery pulse; uneven & rough (11) Wiry pulse – taut feeling; like a guitar string; irregular in strength

& fullness (12) Tight pulse – strong, bouncing from side to side like a taut rope (13) Short pulse – does not fill the spaces under the three fingers and

felt only in one position (14) Long pulse – opposite of the short pulse—perceptible beyond the 1st & 3rd positions, closer to the elbow (15) Knotted pulse – slow, irregular pulse that skips beats

(16) Hurried pulse – rapid pulse that skips beat irregularly (17) Intermittent pulse – skips at around more than two previous two

pulses but does so in regular patterns; often associated with heart trouble; disharmony

(18) Normal pulse beat – moderate; perfectly healthy, balanced pulse—normal in depth, speed,

strength & width (19) Flooding pulse – combinations & refinements of the previous 18

(very rare)

Visayan Concept of Health and Illness (as perceived by early missionaries)

The Visayans called their natural environment banwa, a word which meant mountain, countryside, terrain, climate and homeland. (In colonial times, it was extended to mean town—for example, Hiligaynon “Naga binanwa kami pag pakaon sa Hokom (We supply the alcalde with food, town by town in turn.)” Banwaan meant overgrown and napabanwa gone to the hills; binmanwa was a man who could take care of himself in the wilds, and banwaanun or tagubanwa were mountain-dwelling spirits.

Health and Hygiene

A feature of Filipino life which always attracted Spanish attention was their personal cleanliness, especially the frequency with which they took a bath. Antonio Morga (1609,174) considered it noteworthy that they immersed the whole body, “without considering that it could do them harm at any time”; Father Colin thought that the reason Filipinos settled along streams and riverbanks was their fondness for bathing.

Upper class Visayans wanted to have a pleasing body odor. They therefore scrubbed their bodies with pumice when bathing, perfuming and oiling them afterwards: Pigafetta detected the scent of benzoin and storax on the persons of the two Butuan rajahs. Clothes were laundered with citrus not only because of its effectiveness in removing stains, but because of he fresh odor it left in them. The civet which Father Chirino said was mixed with sesame oil was used in making perfume, not because of its own pungent odor but because of its property of fixing the fragrance of the flowers that were added.

They were careful of personal hygiene. Kulkug or kilikug was to clean out the ears with a feather or swab, and silat was a kind of toothbrush made of vegetable husk for cleaning and polishing the teeth, sipan being fancy ones of betel nut bark which ladies often gave their lovers.Bobho was a tree whose scrapings were used as a shampoo to get rid of dandruff, and puno was a fine comb for removing head lice or ringworm scales. But any reference to dirt in the ears (atole), under the nails (atinglig), or the private parts (buras) was an extreme offense, burasan being an insult so serious it required revenge or satisfaction. As late as the American Period, the Tagalogs, by comparison, used gugo, a kind of fiber for shampoo while katmon, a kind of fruit, whose peeling was used as hair conditioner.

Ailments

Despite their attention to personal cleanliness, Visayans suffered skin diseases as one of their most common complaints. Some of these were simple discomforts connected with ordinary activities:

Nugas—blisters from poisonous plantsAripunga—sores between the toesChafing from loads or clothing—buyook on the throat, buyok or bulok on the

groin;Alatay or kalamayo—maybe caused by erysipela, intense inflammation

accompanied by streptococcus Infection;Buti—general term for pocks, with pinarurkan being distinguished as “the

virulent kind,”—smallpoxBangtas, tabahak or tabukaw—widespread known ulcersBulog—glandular swelling (which the Spaniards called as bubas indiscriminately)Buboso—covered with sores so that one afflicted should be iri or completely

separated outside of the Village (The classic meaning of bubas was the lymphatic swelling symptomatic

of bubonic plague.)

Karanga, kagirkit, or tuyug—Saint Lazarus’s disease or leprosy—amomotol when fingers or toes are lost;

goor or godon as the stage when the ravages of the disease were still not visible externally; butog—the

thickening of the skin; bangag—the loss of the nose; binokbok—wounds so deep they seemed to be eaten

by bokbok wood borers.

Ailments localized in internal organs:Bagu—the spleenSulok-sulok—stomachPantog—bladder or scrotal ruptureAny complaints pertaining to the liver (atay) was attributed to the appetite

of witches, so that “Ginitay ka!” was in itself a curse invoking such a result.Wati or bituk were intestinal wormsOtol, bloody stoolBotbot—protruding hemorrhoidsTibak—goutTiyan—dropsy or edema (cause by a spell cast by a datu against one who

had deceived him)Piyol—joint painBonga—scrofulous swellings or goiter but termed as due to its resemble to

a betel nut

Uyangas—ingrown nail or an infection that a nail to drop off

Atolay—any infected scratch or abrasionTahum—tootache or gum infectionMalhit and mila-mila—eye ailmentsPuling—any defect in visionHukab, hubaw—cough, asthma, or hoarseness (may include symptoms of

tuberculosis)Bugtas—an infirmity attributed to hunger or overwork

Treatment

There were five general categories or Visayan treatment of disease—massage, fumigating or sweating, prescription of medicine, counter sorcery, and propitiation of supernatural being. The first three were indicated for recognizable physical symptoms, the latter two for ailments requiring diagnosis and treatment by religious specialists.

Hilot—physical experts who massage injured or dislocated muscles, or pressure put on nerve centers and they have good reputation to be effective—Balokar or hilotar—to massage a woman’s abdomen to cause a miscarriage or abortion. Mamarokpok—massage technique where the back and spine are pummeled. Abortion was induced by massage, strong herbal medicines, or probing with a stick and there was the custom of abandoning babies born with debilitating defects.

Surgery was limited to suturing or cauterizing wounds and to cosmetic surgery to repair torn earlobes.

Sisip or kulot—to trim the edges of ragged lobes so that the raw surfaces could be sutured together. Red

ants/animitas were used to stitch flat areas like stomach or scalp since its jaws remain clamped when the

head is severed from the body.Tiyun—“button cautery” where a pellet of moxa, the wooly lint of certain plants

are made to smolder on a small wound.Atolob—sweating induced by smoke, steam, or rubbing with hot stones or ashes,

and was the most popular against skin diseases.Toob—to fumigate by covering the patient with mats and blankets to concentrate

the smoke of medicinal fuelsOslob—steam bath in which the patient lay enclosed on a rack over containers of

water into which hot stones were dropped. Woods for this purpose were called bulung, meaning

medicine—China wood (sarsaparilla) in which obat was the most effective—from which was derived the

term burulngan or bulnganan for the little enclosed sheds, so hospitals were to be called

pamulngagan when they were introduced by the Spanish missionaries.

Tambal were all plants, roots, leaves, or bark with medicinal properties, for which reason the Spaniards called the tambalan an herbolario—“one who has knowledge of plants (hierbas), their powers and properties.

Samples of Visayan material medica

Agoho—a tree whose leaves were specific against muscle cramps (The leaves were applied to the affected

part or used for a bath.)Agusip—a tree whose bark was specific for intestinal pains (The bark was

chewed, or decocted for drinking.)Argaw—a very medicinal plant (Its shoots were boiled and the decoction drunk

for stomach ache, its leaves used as a plaster for headache; it was also used in baths to bring down

fevers.)Bangati—a vine used as a preventive for epilepsyHagonoy—a plant prescribed for bladder stones, or other urinary complaintsHalilitan—a plant whose leaves were chewed mixed with lime, or mixed with oil

and hot sulfur as an antidote for poisonHangapitan—a tree whose toasted leaves were boiled as an antiseptic of bathing

woundsKalampisaw—a plant whose root and leaves were applied to open soresKalaring—an antiseptic composed of citrus juice and iron filings, for drying up

small soresLagtang—a potent vine whose root was an antidote for poison and when sliced,

cleared vision (Its fruit was poisonous; its juice filtered, a laxative.)Lampuyang—a plant with an offensive odor applied to swellingsLumaka or hanono—a tree whose leaves were masticated, sprinkled with salt,

heated, then wrapped in another leaf for application to woundsPili—a large tree whose resin was used as a healing balm or ointmentSalimbangat—a plant whose cooked broth was a specific for bloody stoolTangan-tangan—very peppery seeds from which a medicinal oil was made, and

whose leaves were good for swellings, chills, and soresTigaw—a small tree whose leaves, smoked like tobacco or decoction drunk, were

good for cough

There were also medicines of animal or mineral origin. The soil of abandoned termite mounds was good for fumigating; calculous stones found in shark’s head were a cure for similar stones in the human bladder or kidney; and powdered duyong bones were almost a panacea, good for bloody stool, diarrhea, colds and fevers. A kind of jet black

coral was not only taken internally, pulverized, but worn on the wrist as jewelry as a preventive for rheumatic pains. Antidotes for poison often had properties more magical than medical—for example, the marginals (bontok) of turtle shells were said to crack in contact with any poison. As for a tincture of python bile, of it Alcina (1668a, 3:347) remarked, “I tried it once, but frankly, only by an innate desire to preserve life could such a medicine be taken.”

Illnesses attributed to sorcery had to be relieved either by the sorcerers themselves, by discovering their secret, or by employing the services of another sorcerer. Hokhok is a term used to refer to a power for a sorcerer to kill with a breath or the touch of a hand. Panlus was either a spear, G-string, or some other personal possession which caused leg pains or swelling in the victim when he stepped over it. Indeed, bosong, swelling of the stomach, was immediately suspected of having been caused by an evil spell worked by a datu.

Diseases with no visible symptoms or those which stubbornly resisted treatment, as well as chronic or lingering illnesses, were attributed to spirits, ancestral or otherwise, who had been wittingly or unwittingly offended by the behavior of the person afflicted. These required diagnosis and prescriptions by babaylan or daetan, shamans or mediums able to contact the spirit world in a state of trance to learn the nature of the offense and what was required for satisfaction. In the case of witches, or naturally malignant spirits, monsters, or ghouls who could not be reached by this technique, the babaylan sought to enlist the intervention of a personal patron spirit. Prescriptions were the performance of a specific paganito involving the sacrifice of a live animal or other food offerings. Omens were taken during both diagnosis and treatment to facilitate prognosis, and were the last resort in preparing the moribund and their families for the inevitable.(Source: Scott, William Henry, Barangay, Quezon City: Ateneo de Manila University Press, 2004, pp. 113, 116-123)

II Spanish Period

A. The 17th and 18th Centuries

Spain brought to her overseas colonies, the Christian concept of charity and care for the sick. The responsibility of taking care of the sick was jointly shared the Church and the State. The Spanish kings took upon themselves the burden of founding hospitals. Viceroys, judges and governors were entrusted the actual task of constructing hospitals which were supposed to be found in all towns for Spaniards, as well as for the natives. The role of the Church was in taking care of the sick. Hospitals were especially ordered to be established near churches where the religious could easily come to the care of the sick. Also, by constructing hospitals near churches, the sick were assured to be taken cared of in a manner that conformed to the ideals of Christian charity (Jose Bantug. A Short History of Medicine in the Philippines During the Spanish Regime, 1565-1989. Manila: Colegio Medico-Farmaceutico de Filipinas, Inc.)

The Development of “Hospitals”

Hospital de Santa Ana de Naturales—It was made of nipa and cane, of two large rooms (with each room measuring 50 brazas/arms length); built through the effort of Father Juan Clemente (Franciscan), the donations of Manila residents and work of the convalescents (those cured by Fr. Clemente) and was finished in 1577. (This might be the precursor of the present Hospital de San Juan de Dios.) Fire destroyed the hospital in 1583. The hospital that rose anew was built of stone, through the help of Bishop Domingo de Salazar.

Fr. Juan Fernandez de Leon, another Franciscan, built an additional third for the hospital in 1593. Another Franciscan, Fr. Marcos de Lisboa suggested the establishment of Hermandad de Santa Misericordia (Brotherhood of Holy Mercy) as source of funds for the hospital from a core of patrons notably the wealthy residents of Manila. This was approved by Gov.-Gen. Luis Perez Dasmarinas and established on April 16, 1594 at the San Ignacio Church. Fire destroyed the hospital in 1603. Since the large portion of the cost of building the hospital is from the Hermandad, it came to be called Hospital de Santa Misericordia and a strong earthquake destroyed it on 1655.

Due to the difficulty of funding the building of another hospital through the Hermandad, the officials ceded it to the religious of San Juan de Dios, who at time owned a small hospital in a village called Bagumbayan, southeast of Manila. The deed of donation was signed on May 31, 1656 where Archbishop Miguel de Poblete signed on behalf of the Santa Misericordia, Gov.-Gen. Sabiniano Manrique de Lara and Hernando Ponce de Virues (general manager of the Santa Misericordia.)

Hospital built mainly for the natives was founded in 1603 and assistance for it came in form of 500 pesos in silver, 1,500 gallinas (hens), 1,500 fanegas of rice and 200 Ilokano blankets every year and this was built by the Franciscans in the village of Dilao.

In 1636, the Japanese emperor deported to the Philippines 130 lepers whom the Spanish missionaries had converted to Christianity. As the more prominent patients of the hospitals were lazarinos or lepers, the hospital for the natives in Dilao came to be called Hospital de San Lazaro. Royal assistance came in the form of an additional 200 pesos for every year of stay of the Japanese lepers. On this same year, Gov.-Gen. Hernando de Corcuera withdrew the Franciscans from further administration of the hospital and placed it under the inspection and protection of the Real Patronato. For this reason, it came to be called Royal Hospital. The Franciscans appealed to the king in Spain to revoke Corcuera’s unilateral action so that by the order of the royal cedula of 1641, the king restored the Franciscans the authority that they formerly exercised to administer the hospital.

In 1662, thinking of the possible Chinese attack on Manila and of the hospital’s site as posing danger in the defense of the city, Gov.-Gen. Sabiniano Manrique de Lara ordered it demolished. Knowing that the hospital performed an indispensable service to the people, the Gov.-Gen. allowed the Franciscans to build a new hospital at the site of the old settlement of Dilao and Balete and this was finished on 1678 but was again demolished on 1783 when Gov.-Gen. Basco y Vargas thought that it posed a threat to the defense of the city

The Gov.-Gen. provided another place for the Franciscans to build the hospital and compensated them for the demolition so that a grant of land was given royal approval on 1784. In 1786, the hospital came to occupy Hacienda de Mayhaligue.

Treatment Methods

Treatment methods employed by the Spaniards conformed to those already in use in Europe including:Calillas (suppositories), cataplasmas (poultices), emplastos (plasters), masticatorios (masticatories), unguentos (ointments or salves), aceites (oils), colirios (eye drops), polvos (powders), agues destiladas (distilled water), cocimientos (decoctions), jarabes (cough mixture), juleps (juleps), lamedores (lemonades), licores (liquors), opiates (narcotics), pildoras (pills).

Medicinal Plants There were those who studied the healing properties of medicinal plants in the Philippines and they were:

1) Fr., Francisco Ignacio Alcina, S.J.—studied the fertility of chacteristics of the Visayan Islands and wrote

Historia natural del sitio, fertilidad y calidad de las isles e indios de Bisayas (1669);

2) Fr. Jose de Valencia, O.S.F.—described in great detail the medicinal qualities of various roots and herbs found in the Philippines and indicated the places where

they grew in his Flora Filipina: en la que con minuciosidad de describen las raices y hierbas, sus figures, sitios en donde se crian y sus virtudes medicinales;3) Fr. Pablo Clain, S.J.—wrote Remedios faciles para diferentes enfermedades, which offered easy remedies for different illnesses and gave tips on how to differentiate those illnesses due to hot elements or to cold elements following the practice of the natives at that time (1712);4) Fr. Juan Delgado, S.J.—wrote Historia general,sacroprofana, politica y natural de las Islas Poniente llamadas Filipinas discussing the medicinal properties of a number of Philippine trees, palms, herbs and vines (1754);5) Fr. Fernando de Sta. Maria, O.P.—wrote Medicinas caseras para Consuelo de los pobres indios, a manual on household remedies used by the natives.

These are the list of medicinal plants used by the early Filipinos:1) gulaman—the gelatine made from the algae is used as a pectoral;2) pandan—the decoction of the adventitious roots, taken in the form of an

ordinary drink, is an anti-blennorhagic, the action of which is accelerated by urethral injections of the juice of the rootstock of the banana plant;3) palay/Oryza sativa—a decoction of the roots and rootstock is prescribe against anury and the lye made of the strawis an abortive; it is also an emollient;4) mais—the stalk, both fresh and dry, and the stigma (tassel) are reputed among the to be a strong diuretic;5) niyog/Cocos nucifera—an empyreumatic substance is obtained from it which is used against tootache and in skin diseases where a disinfectant or a parasiicide is required;6) agoho—a decoction of the bark, administered in big doses, is used as an infallible emmenagogue and abortive;7) balete/Ficus—the crushed root is reported to be a very efficacious vulnerary;8) langka—the charred leaves are sued for the treatment of certain inveterate ulcers and as a cicatrizant specific for the surgical wound made in operations for congenital phymosis;9) makabuhay—the juice of the fresh stalk is a very efficacious medicine for malaria which not cede to quinine and other remedies while in decoction, it a tonic, cicatrizant, parasiticide and even a cardiac;10) mongo—the decoction of the seeds is an efficacious diuretic used in beriberi and also used in cataplasms as a maturant;11) suha—the leaves, flowers and pericarp are given in infusion as anti-spasmodic;12) siniguelas—the decoction of the bark is a good remedy for dysentery and also used to cure tympanitis in children;13) saluyot—the seeds are said to be purgative;14) ratiles or manzanitas—the flowers are used in infusion;15) bulak—the young fruit is an emollient and the bark is a vomitive while the decoction is considered efficacious for catarrhal fever;16) achuete—the decoction of the bark is used for bathing catarrhal fever patients while the red resin of the seeds is effective for certain skin diseases;

17) papaya/Carica papaya—the decoction of the bark of the root is a digestive and tonic is much used for the treatment of dyspepsia;18) duhat—the bark is an astringent while the leaves or seeds, macerated in alcohol, make a good tincture for diabetes;19) bayabas/Psiudium guajava—the bark and leaves are astringent and vulnerary while a decoction of the leaves is also used for the treatment of diarrhea and the unripe fruit, dried and pulverized, cures amoebic dysentery;20) kintsay—the decoction of the whole plant is sometimes given as a diuretic, anti-rheumatic and emmenagogue;21) laurel—the grated root is used in cataplasms as a remedy against headache and the bark is a vesicatory used in certain fevers;22) kampupot or sampaguita/Jasminum sambac—the flowers are applied in cataplasms to the breast of women who have lost their infants in order to check the secretion of milk;23) chichirica/Vinca rosea/Catarannthus rosea—the decoctrion of the roots is an emmenagogue an acts an an abortive if the potion is concentrated;24) calachuchi—the decoction of the bark is a purgative, emmenagogue and febrifuge.

Government and Public Health

The government during the Spanish era established different offices to govern the public health of their colonies. These are the Junta Superior de Sanidad Inspeccion, General de Beneficiencia y Sanidad, Junta Central de Vacunacion, Cuerpo de Vacunadores, and Direccion General de Sanidad Maritima del Puerto de Manila.

The Junta Superior de Sanidad, also called The Superior Council of Health was composed of the Governor General, Director General for Civil Administration and doctors from UST. Its function is to advice the Governor General on public health matters. In 1889, this office proposed advices that focused mainly on environmental cleanliness and cholera prevention.

Another office, Inspeccion General de Beneficiana y Sanidad or General Inspection for Welfare and Sanitation functions to implement the instructions of the Director General for Civil Administration.

One of the great epidemics that struck the Philippines during the Hispanic era was smallpox. This is also called variola. This is an acute infectious disease caused by a virus called Variola mino, a disease characterized by fever, chills, vomiting, pain in the back, rapid pulse, sweating in adults and convulsions in children. On the third or fourth day, the face becomes covered with red spots which become generalized. On the 7th or 8th

day, desiccation begins; the pustules open and the content is spread and hardens, forming a scab over each eruption. In about 15 days, the patient begins to feel intense itching and scabs fall, leaving dark red spots which remain for a long time.

China, Japan, Vietnam, Hong Kong, Canton, Amoy, Shanghai, Singapore, Nagasaki, Kobe, Saigon specifically also suffered from smallpox. In Bacoor, Cavite, 391 out of 12,423 people died. Smallpox devastated the Spanish colonies periodically. The most remembered event took place in 1797 when, in the vice kingdom of New Spain, 44,286 persons fell ill, of which 8,220 died in a period of three months.

Edward Jenner “discovered” an empirical approach to smallpox vaccination. In 1798, he published Inquiry into the Causes and Effects of the Variolae Vaccine in London. Vaccination was first conducted among the royal houses of Europe.

King Charles IV of Spain, through an advice of the Viceroy of New Granada, ordered an expedition to spread the knowledge of vaccine, since his daughter, Maria Luisa, had suffered the illness. The expedition occurred on the Maria Pita ship led Francisco de Balmis.

On November 30, 1803, Balmis and his associates left the Spanish harbor of La Coruna and traveled to Puerto Rico and Venezuela, vaccinating thousands of people along the way. Reaching Venezuela, they divided into two groups. First, Dr. Salvany journeyed to various countries in South America, where the rigors of travel and work took its tool and Salvany died at 34 years of age. Dr. Balmis traveled to Mexico, Central America and the Philippines. In Mexico, Dr. Balmis took 25 orphan children, ages 4 to 6, from the provinces of Morella, Guadalajara, Queretaro, Zacatecas, Fresnillo, and Sombrerete and set sail on February 5, 1805.

The children were crucial to the trip because in those times, there were no ice plants yet to preserve the vaccine, nor were there airplanes for quick transport. Thus, the smallpox vaccine had to be kept alive by arm-to-arm vaccination from one child to another. Each child would be a repository for the vaccine for around 10 days. After which, an extract from the child’s arm lesion (lymphatic fluid) was cut into the next child, and so forth. Balmis vaccinated two kids at a time for safety, just in case something terrible happed to one. Thus, by computation, 25 kids could carry the vaccine for a 3 to 4 month trip, if all went well. As fate would have it, just two months later, Balmis and the children successfully arrived in Manila with much fanfare and rejoicing. Quickly, Balmis guided the Spanish authorities in Manila on how to perpetuate the vaccine. Balmis wrote with much foresight that the goals were to spread the benefit of vaccination and also to assure its perpetuation. Balmis said that Manila was the ideal site for a Central Board of Vaccination to coordinate a nationwide vaccination campaign.

The success of Balmis’ expedition was manifested by the establishment of offices that promotes treatment of smallpox. Junta Central Vacunacion, also called the Institute of Vaccination, functions to preserve smallpox vaccine in glass vials and to distribute smallpox vaccines in the provinces. Cuerpo de Vacunadores or Corps of Vaccinators functions to vaccinate the people against smallpox.

Direccion General de Sanidad Martima del Puerto de Manila General or Direction for Maritime Sanitation for the Port of Manila performed the following tasks:

To inspect all foreign ships entering the port of Manila; to impose quarantine period of three days to all ships and passengers; to give ships a clean bill of health and to allow them to enter the port of Manila if there are no new developments during the period of quarantine; to note the number of sick people aboard in its inspection of ships; to isolate any sick person from the rest of the crew and the passengers; and to note the number of people who died while en route to Manila.

Cholera is another epidemic that spread in the Philippines during the Spanish period which is an acute bacterial infection of the small intestine that is caused by Vibrio cholerae. This is characterized by massive diarrhea with rapid and severe depletion of body fluids and salts. The Vibrio enters the body through the mouth, usually in contaminated water or foods, causing an infection in the mucous membrane lining the lumen of the small intestine. This occurs after an incubation period of 12 to 28 hours.

Cholera usually starts with an abrupt painless watery diarrhea that may amount to a volume of 15 liters to 20 liters (3 to 4 gallons) or more every 24 hours. This is also characterized by purging diarrhea which is soon followed by vomiting, dehydration, cold and withered skin, drawn face and low blood pressure.

In 1862, Carriedo water system started to function. San Juan became the site of reservoir. The excavations were made into a solid tuft with a height of 60 meter and a depth of 50 meter with an approximate capacity of 52,000 cubic meters. The underground reservoir was made with holes made of zinc sheet, and surrounded by a three-meter wall. In Santolan, five kilometers from the reservoir, two pumps were installed to lift water from Marikina River, leading to San Juan. Iron pipes of about three feet in diameter led water to city down to Sta. Mesa with pipes, supported with bricks and cement, following the contour of the country in downward course. Through this, faucets in different strategic points in Intramuros and districts were put up as well as faucets in private houses and public fountains.

Health Education

Health education was introduced to the Philippines during the late 1800’s. In 1871, the Spanish government granted the petition of the University of Santo Tomas to establish a College of Medicine and Pharmacy but financial and technical difficulties were many. This first medical school was erected in Intramuros and was patterned after the universities of Spain. In 1875, King Charles II of Spain vested the title “Royal” on UST. The local government ordered the establishment of the medical school during the term of Rector Magnificus Domingo Terserra, O.P., and Dr. Rafael Ginard was the first dean in 1902. The school offered a 7-year course leading to a Licentiate in Medicine. In 1907, the medical school started affiliation with the San Juan de Dios Hospital for clinical training, by decree of King Alfonse of Spain. The first commencement exercises were held and there were seven graduates in 1908. Classes were moved to the present Espana Campus but the clinical years continued in Intramuros since the San Juan de Dios Hospital was there.

The first five courses offered were Doctorate in Medicine, Doctorate in Pharmacy, Licentiate in Medicine, Licentiate in Pharmacy and Licentiate in Midwifery. Doctorate in Medicine and Doctorate in Pharmacy both required Advanced Physics, Advanced Chemistry, Mineralogy, Botany and Zoology.

Doctorate in Medicine had a curriculum with six terms. The first two terms focused on Anatomy with the second term more detailed. The third and fourth terms focused on Pathology with the latter more detailed. The 5th term focused on clinical works while the 6th term focused on care of public hygiene. The entire curriculum focuses on the basic, clinical and emergency medical sciences. Dr. Jose Rizal got his Doctorate in Medicine in UST in 1882 while he got his Licentiate in Medicine in the Universidad Central de Madrid on June 21, 1884.

The curriculum in Doctorate in Pharmacy included in its four terms laboratory works and how Physics and other sciences can be related or used in Pharmacy. In its 5th term, it tackled mostly on laws applied to Pharmacy and practical works. Licentiate in Pharmacy on its first term taught on preliminary ideas of physics and general ideas on Pharmaceutical Chemistry. The second term focused on the general ideas on Pharmacology while its 3rd term focused on practical work in determining chemical properties. Finally, on its 4th term, it focused on practical work in operations and Pharmaceutical tarrif.

Jacobo Zobel came from Hamburg to Manila and opened, together with his wife, a drugstore in Intramuros, the Botica Zobel. Later, Johannes Andreas Zobel expanded his commercial and research activities by establishing a chemical lab and engaging in the exploitation of iron and copper mines in Bulacan and Baguio.

Another famous drugstore was the Botica Boie which was started also by German pharmacists in the late 19th century like Reinhold Boie, Paul “Pablo” Schuster, Otto Koch, Heinrich Rothdauscher, among others.

Antonio Luna Y Novicio (October 29, 1866-June 5, 1899) was a Filipino pharmacist and military general who fought in the Philippine-American War. He founded the Philippines’ first military academy. He went on to study literature and chemistry at the University of Santo Tomas, where he won first prize for a paper in chemistry titled “Two Fundamental Bodies of Chemistry.” On the invitation of his brother, Juan, he continued his studies in Spain, obtaining the Degree of Licentiate in Pharmacy from the University of Barcelona. He pursued further studies by obtaining the Degree of Doctor of Pharmacy from the Universidad Central de Madrid.

Lastly, UST also offered Licentiate in Midwifery which is a health profession that provides expertise in women’s reproductive health. Its graduates give prenatal care to expectant mothers; attend the birth of infant; and provide postpartum care to the mother and her infant. First term focuses on theoretical information on women’s anatomy while the 2nd term taught more about pregnancy, problems arising during pregnancy, delivery.

The 3rd term tackles in serious cases; care to be taken, laws and duties, baptism, practice or clinic. The 4th term tackles about review and clinical works.

Conclusion

Since the colonization of Spain in the 16th century, the progress of health care in the country had been slow. Advances in the European countries would gradually filter into the archipelago. Popular indigenous medicines available were from the herbolarios and Anito worshippers.

According to American sources, the Spanish health system was inadequate in terms of sanitation system, water and sewer system and public health measures. Jose Bantug, however gives a more favorable view by citing the contribution of Francisco de Carriedo who was a Spanish aristocrat who, in 1733, left in his will the sum of 10,000 pesos for the city of Manila to build waterworks. Before the American take-over, the Spanish Board of Health had undergone many changes in the last two decades of their rule. In 1863, a general reform was made by the Spanish authorities for better cooperation between the public health officials and the provincial and municipal authorities. Another reorganization of the Board of Health in 1888 altered the composition of the board to include a lot of physicians. The first laboratory was established in 1887 to do chemical and bacteriological studies for the Board of Health but, according to the Americans, there was little scientific research or literature present by 1898.

III American Period

September 10, 1898 - General Order No. 15, under the American military government, by the command of General Wesley Merritt, first military governor of the Phil. Colonial Gov’t., ordered the organization of the Board of Health for the City of Manila.

Under this order, the Board of Health, as of September 29, 1898’s General Order No. 16 would be composed of Major Frank S. Bourns, Chief Surgeon, as president; Captain C. L. Mullins, Assistant Surgeon, Dr. C. E. McQuesten, Acting Assistant Surgeon, as active members and as honorary members, Dr. T. H. Pardo de Tavera and Dr. Ariston Bautista Lim.

The Board of Health divides Manila into ten sanitary districts with each one under a municipal physician; while eight municipal midwives were also appointed and a physician to manage the San Lazaro Hospital.

October 8, 1898 – the Board of Health published its first rules and regulations.Health and sanitary management were in shambles.There was an epidemic of smallpox and to handle the situation, the Board

reestablished the old Spanish vaccine farm and a corps of city vaccinators was put to work. Simultaneously, a smallpox hospital, a leper hospital, and a hospital for the treatment of venereal diseases were established and a veterinary corps was organized.

July 5, 1898 – Dr. Guy Edie was appointed as the first Commissioner of Health to replace Major Bourns. The Commission of Health added a bacteriological department to the municipal laboratory, established a plague hospital, instituted the registration of births, deaths and marriages, organized a municipal dispensary and continued the campaign against smallpox.

March 16, 1900 – Philippine Commission was created with William H. Taft as head with Luke Wright, Henry Ide and Bernard Moses as members.

July 4, 1901 – Civil Government established with William H. Taft as Chief Executive and as Civil Governor. Under Taft were the Department of Interior, Commerce and Police, Finance and Justice, and Publish Instruction.

Under the Department of Interior were the Bureau of Health, the quarantine service of the marine hospital corps and the government laboratories.

April 6, 1901 – Under Act No. 62, the provost marshal promulgated health ordinances encompassing almost every phase of municipal sanitation like: isolation infectious and contagious diseases such as cholera, smallpox, chicken pox, diphtheria, typhoid; the compulsory vaccination for every person in Manila at intervals of one year, and provided that every person who had been exposed to the infection of smallpox should be successfully vaccinated.

July 1, 1901 – Act N. 57, passed by the Philippine Commission, created the Board of Health for the entire Philippines.

The Act was in response to the deplorable sanitary and health conditions of the Islands such as the absence of sanitary water supply, the filthy and open canals and esteros, the unsanitary disposal of human waste and absence of a sewer system, the poor drainage, rat infestation, the improper construction of buildings, the presence of rinderpest, the lack of provision for the care of the insane and the lepers who roam around, the cholera, smallpox and plague epidemics that persistently erupted, the prevalence of beriberi, malaria, tuberculosis and dysentery.

July 1, 1901 – The Bureau of Government Laboratories was established under Act No. 156 which consisted of eleven divisions: Provincial Health, Inspection, Clerical, Property, Statistical, Sanitary Engineering, San Lazaro Hospital, Civil Hospital, Prison Sanitarium, Benguet Sanitarium, and Culion Leper Colony Divisions.

July 2, 1901 – The Insular Board of Health operated with Lieutenant Colonel L.M. Maus as Deputy Surgeon General and as Commissioner of Public Health;Major Franklin A. Meacham as Chief Inspector, Dr. Paul C. Freer as Superintendent of Government Laboratories, Dr. Manuel Gomez as Secretary, and Captain C. W. Mead as City Engineer of Manila.

Insular Board of Health was divided into two types of committees: the Permanent Committees and the Special Committees.

The Permanent Committees’ duties were: the study and investigation of parasitical, contagious, infectious, and tropical diseases occurring in the Philippines, including those of domestic animals; foods and beverages; the effects of employments, conditions, habits, and medicines on the health of the people, and the chemical composition and medicinal properties of minero-medicinal waters of the archipelago.

Included in the Committees’ duties were the demographical and statistical data on marriages, births, deaths, and their causes, together with the population of provinces, pueblos, and barrios within the archipelago; also for the publication of regular and special reports pertaining to the Board of Health.

Included in the sanitary laws and special health measures are the legislation for the practice of medicine, dentistry, pharmacy, veterinary medicine, surgery, midwifery, embalming, undertaking, public vaccinations and for the segregation of lepers, consumptives, and of other contagious and infectious diseases requiring isolation.

Health ordinances included municipal sanitation and inspection, the control of dangerous and offensive trades and industries, and for the punishment of violations of sanitary laws.

The Special Committees’ duties were: the control and prevention of bubonic plague, smallpox, and other contagious and infectious diseases, including the construction and management of detention camps.

The drafting of municipal health regulations and ordinances for provinces, pueblos and barrios, the suppression and control of rinderpest and the locust plague, the plans for and management of the pail system for the disposal of night soil in the city of Manila, river and harbor quarantine for Manila and other seaport towns in the archipelago are also the duties of the said committee.

Construction, alteration, repair and management of public dispensaries, hospitals for contagious and infectious diseases, asylums, laboratories for the production of vaccine virus, serums or prophylactics, disinfecting plants, morgues, etc are also under its control. So are the monitoring of the vices affecting the health of communities, their control, and suppression; the cemeteries and the disposal of the dead.

The resolutions passed by the Insular Board of Health are the following:

August 22, 1901 – Inauguration in the city of Manila the pail conservancy system for the collection and disposal of night soil on proper places allowed.

The closing of all open foul vaults and the installation of the closet system by the city which will also pay the cost, making it a lien against the property, the owner of the property to collect the same from tenants and sub-tenants, that the cost of removing the excreta be borne by the persons renting the property.

September 6, 1901 – Resolution prohibiting the overcrowding of any dwelling house, bungalow, lodging house, boarding house, or factories.

October 26, 1901 – Resolution authorizing the sanitary engineer to draw up plans and specifications for additional hospital accommodations of a temporary character at the San Lazaro Hospital, women’s department, in view of its overcrowded condition at present.

October 29, 1901 – That the sum of $335, or so much as necessary, be expended from the money appropriated for miscellaneous expenses, suppression of plague, in the anti-toxin experimental station, in order to complete the work of isolating the plague culture laboratory.

- Adoption of the submitted plans for the construction of around 30 smalland large buildings for the plague pavilion at the San Lazaro Hospital.

October 30, 1901 – Resolution authorizing the Commissioner of Public Health to advertise for the bidding on newspapers for the construction of the said buildings.

November 1, 1901 – Drafts of ordinances to make the city of Manila as hygienic and free from diseases and its spread as much as can possibly be done. Included are the filling up of open and stagnant cesspools, privies, etc.; the proper handling and disposals of organic and decaying matters; the avoidance of polluting the water systems necessary for the daily needs of the people; even the management of the cemeteries within the city.

November 5, 1901 – The implementation of ordinances that deals with the cases of prostitution like the compulsory weekly examination, detention and treatment of those fond to be infected with contagious venereal at the women’s section of the San Lazaro Hospital or be privately treated, in agreement with the infected person therein.

November 8, 1901 – Resolution setting aside the sum of $135 to handle the rinderpest and bubonic plague and for rat poison.

November 16, 1901 – Resolution requiring the owner of nipa huts to provide or build proper flooring to safeguard the health of their dwellers; also requiring spaces of 3 meters or more between houses.

1901 – A civil hospital with one hundred beds was established along Azcarraga St. (now C.M. Recto Avenue) for government employees and their families.

- The first sanitary ordinance was enforced in the City of Manila.

1902 – The Hospital Espanol de Santiago was founded in Malate for the Spaniards suffering from contagious diseases but who refused to be treated in the same hospital as the natives. As the hospital was large enough, it also accommodated other Europeans and Americans.

July 1, 1903 – For the first time, a systematic and official medical inspection of immigrants was done.

December 1, 1903 – The sanitary school for native heads of Provincial Boards of Health was started in Manila. A system of instruction was devised covering a period of one month.

1903- The idea of introducing the nursing profession among Filipino girls led to the creation of a committee of three to draft a bill for the establishment of a school of nursing. However, the Philippine Commission failed to pass the bill which had already aroused public interest.

1904 – A pail conservancy system was established.

December 1904 – A hospital exclusively for diseases of women was established in Sampaloc.

October 26, 1905 – Under Act No. 1407, the Bureau of Health takes over the abolished Board of Health. Being a bureau, its head, the Director of Health is empowered, subject to the approval of the Secretary of Interior, “to revoke or modify any order, regulation, by-law or ordinance of a local board of health of any municipality except the City of Manila concerning any matter which in his judgment affects public health.”

1905 – The Bureau of Government Laboratories, established in 1901, was taken by the created Bureau of Science under Act No. 1407.

- St. Paul’s Hospital was established by the Archbishop of Manila, the first private hospital established during the American period. It became one of the biggest and best equipped hospital.

- Funds were appropriated for the construction of a modern sewerage system for the City of Manila and this sewerage system was started in 1906 and was completed and inaugurated in 1909.

June 1905 – Under Act No. 1323, the Philippine Commission, through which bonds up to the value of $1,000,000 were sold to secure funds for the construction of a new water supply and sewerage for Manila.

1905 – Dean Worcester built UP College of Medicine and Surgery, using the blueprint of Johns Hopkins University.

1905 – Dr. Victor Heiser assumed health post, demanded and got “dictatorial” powers to effect sweeping changes. Health Department launched compulsory vaccination campaign on smallpox and cholera for adults and school children.

1906 – Mary Johnston Hospital was established.

February 21, 1906 – Under Act No. 1458, the Philippine Commission enacted provisions regarding the regulation of the establishment and maintenance of burial grounds and cemeteries. It also covered public funerals and the disposal of the dead in the provinces.

December 10,1907 – The Philippine Medical School was opened. This was the result of a special act that was passed in December 1905 incorporating the medical school of the Philippines and defining the manner in which it shall be controlled and conducted. 1907 – Leper Law (Act No. 1711) – compulsory apprehension, detention and segregation of lepers at Cullion Leper Colony. Hospital care continued at San Lazaro Hospital.

Free Treatment Clinics

1907 – A dispensary clinic was established by Bishop Charles Brent of the Protestant Episcopal Church in Magdalena St. offering free treatment.

Filipino physicians were appointed to attend to the medically indigent in the districts of Manila. They were Dr. Florentino Herrera (San Nicolas and Binondo), Dr. V. Pantoja (Tondo), Dr. P. Gabriel (Quiapo), Dr. C. Reyes (Sta. Cruz and San Miguel), Dr. F. Castaneda (Sampaloc), Dr. J. B. Cabarrus (Paco, Ermita, Malate), Dr. V. Cavana (Intramuros) and Dr. Teehankee (Chinese population).

The Bureau of Health contracted the San Juan de Dios Hospital and St. Paul’s Hospital for the care of one hundred poor patients daily; the Hospicio de San Jose for the care of a limited number of insane, aged and orphans, and the Convent of the Sisters of San Vicente de Paul and the Sta. Isabel Convent for the care of homeless and friendless girls.

1907 – Act No. 2468 provided for a systematic organization of personnel, radiating from the director through chiefs of division, deputy chiefs, medical inspectors, senior surgeon and junior surgeons, all arranged in regular civil service grades, with a secure system of civil service entrance and promotion. According to this Act, the organization would be arranged in four divisions, one each for general inspection, sanitation in the provinces, sanitation in Manila, and hospitals and dispensaries.

A feature of the Act was the creation of an advisory Council of Hygiene composed of seven members, to be appointed by the Governor-General and upon the recommendation of the Secretary of the Interior, one each from the Colegio Medico-Pharmaceutico, the Philippine Islands Medical Association, the University of the Philippines, the University of Santo Tomas and the Bureau of Health, together with one lawyer and one property bidder.

This Act also established the system of commission service. Under the system, commissions were issued to all officers of the Philippine Health Service by the Governor-General in their respective grades.

In the Commissioned Service, officers were commissioned in four grades – surgeon, senior surgeon, medical inspector, and senior medical inspector, all under civil service rules and regulations.

June 27, 1907 – The first students to the nursing school were admitted. Sixteen students were accepted on the basis of competitive examination, personal qualification and good social standing in their communities. They were supported by scholarships provided by business firms in Manila. Preparatory classes were held at the dormitory of the Philippine Normal School while practical instruction was subsequently given at the old Civil Hospital. The success of the organization of the school was due to the initiatives of Dr. Victor Heiser, the Director of Health.

1908 – Plans for the construction of a general hospital in the city of Manila were completed and a sum of 1,000,000 pesos was appropriated for hospital purposes. The hospital was also envisioned to serve as a training school for nurses and a clinical hospital for the Philippine Medical School.

1909 – Nursing instruction at Philippine Normal School

1909 – Dr. V. Heiser boasted about the drinking water that are safe from diseases with the installation of 80 artesian wells in the provinces and 52 miles of new sewer system in Manila.

September 1, 1910 – The Philippine General Hospital was opened and assumed the functions of the old civil hospital.

1910 – Act No. 1975 reorganized the school of nursing under the Bureau of Health where it continued as one of the activities of the Philippine General Hospital. It came to be called The Philippine Training School for Nurses of the Philippine General Hospital.

September 10, 1910 – The legal status of the nursing school was further modified by Act No. 1996 which provided for the admission of students from non-Christian provinces.

1911 – In connection with the work of the Philippine Tuberculosis Society, the San Juan del Monte Sanatorium was opened to the public.

February 6, 1912 – Regulations for admission to the nursing school (of the Philippine General Hospital) were prescribed buy Act. No. 2161.

1912 – Act No. 2156 was passed which authorized the consolidation of municipalities into sanitary divisions and the reorganization of the municipal boards of health. This Act, also known as the Fajardo Act, provided for each province a special fund known as the Health Fund.