The History of Health Care

Amanda Clark

Ancient Times

• Prevention of injury from predators

• Superstitious beliefs that all illness/disease was caused by supernatural spirits.

Can you think of two types of predators?

-Carnivorous animals

-Warring Enemies

Ancient Times

• Herbs and plants were used as medicineexamples:

– Digitalis from foxglove plants

Digitalis from foxglove plants

Then, leaves were chewed to strengthen & slow heart

Now, administered by pills, IV, or injections

............Interesting isn’t it?

Ancient Times

• Herbs and plants were used as medicine examples:–Quinine from bark of cinchona tree

•Controls fever and muscle spasms

•Used to treat malaria

Cinchona tree

Cinchona Flower

Quinine from bark of cinchona tree

Ancient Times

• Herbs and plants were used as medicineexamples:– Belladonna and atropine from

poisonous nightshade plant• relieves muscle spasms especially GI

Atropine from Nightshade Plant

Morphine and Codeine from opium poppy

Both relieve severe pain

Egyptians

• Earliest to keep accurate health records

• Superstitious

• Identified certain diseases

• Pharaohs kept many specialists

Egyptians

• Priests were the doctors

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

– Only the priests could read the medical texts

Egyptians

• Magicians were also “healers”

• Believed demons caused disease

• Prescriptions were written on papyrus

Papyrus

Egyptian Priest

Egyptians

• Embalming

– Done by special priests (NOT the doctor priests)

– Advanced the knowledge of anatomy

– Strong antiseptics used to prevent decay

– Gauze similar to today’s surgical gauze

• Homework Assignment:

• Research on your own time, more about the Egyptian Embalming process.

• Be able to answer:

• 1. How is medicine the same? Different? How do progressive improvements occur over time?

• 10th period homework: what is the difference btw unintelligent and uneducated

Egyptian Embalming

Tools for Embalming

Egyptians

• Research on mummies has revealed the existence of diseases

– Arthritis

– Kidney stones

– Arteriosclerosis

Egyptians

• Some Egyptian medical practices still used today– Enemas– Circumcision (4000 BC) preceded

marriage– Closing wounds– Setting fractures

Egyptians

• Eye of Horus

– 5000 years ago

– Magic eye

– amulet to guard against disease, suffering, and evil

– Mythology: Horus lost vision in attack by Seth; mother (Isis) called on Thoth for help; eye restored

– Became modern day Rx sign

Eye of Horus

Eye of Horus >>>> Rx Sign

Jewish Medicine

• Concentrated on health standards concerning food, cleanliness, and quarantine of diseased persons

• Moses:

– banned quackery (fake docs)

– enforced Day of Rest

Jewish Medicine- Hand washing

Jewish Medicine- Day of rest

Greek Medicine

• First to study causes of diseases

• Research helped eliminate superstitions

• Unsanitary practices were associated with the spread of disease

Greek Medicine

• Hippocrates – no dissection, only observations – took careful notes of signs/symptoms of

diseases – disease was not caused by supernatural

forces• Referred to as the Father of Medicine

– wrote standards of ethics which are the basis for today’s medical ethics!

Hippocratic Oath

• I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

• To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art; and that by my teaching,

• I will impart a knowledge of this art to my own sons, and to my teacher's sons, and to disciples bound by an indenture and oath according to the medical laws, and no others.

• I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

• I will give no deadly medicine to any one if asked, nor suggest any such counsel; and similarly I will not give a woman a pessary to cause an abortion.

• But I will preserve the purity of my life and my arts.

• I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

• In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or men, be they free or slaves.

• All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

• If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my life.

Greek Medicine

– staff and serpent symbol of medicine

– Still Seen Today

Roman Medicine

• Learned from the Greeks and developed a sanitation system

–Aqueducts and sewers

–Public baths

• Beginning of public health

Roman Acqueduct System

Roman Medicine

• First to organize medical care

• Army medicine

• Room in doctors’ house became first hospital

• Public hygiene– flood control

– solid construction of homes

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

• Medicine practiced only in convents and monasteries

• custodial care

• life and death in God’s hands

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

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

• (Pick two, write half a page describing the disease you chose)

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

• Crusaders spread disease• Cities became common• Special officers to deal with sanitary

problems• Realization that diseases are

contagious• Quarantine laws passed

Renaissance Medicine (1350-1650 A.D.)

• Universities and medical schools for research

• Dissection

• Book publishing

16th & 17th Century

• Leonardo da Vinci

– anatomy of the body

• Anton van Leeuwekhoek (1676)

– invented microscope

– observed microorganisms

16th & 17th Century

• William Harvey– circulation of blood

• Gabriele Fallopian – discovered fallopian tube

• Bartholomew Eustachus – discovered the eustachian tube

• Some quackery

18th Century

• Edward Jenner 1796

– smallpox vaccination

• Joseph Priestly

– discovered oxygen

18th Century

• Benjamin Franklin

– invented bifocals

– found that colds could be passed from person to person

• Laennec

– invented the stethoscope

19th & 20th Century

• Inez Semmelweiss– identified the cause of puerperal fever

which led to the importance of hand washing

• Louis Pasteur (1860 –1895)– discovered that microorganisms cause

disease (germ theory of communicable disease)

19th & 20th Century

• Joseph Lister

– first doctor to use antiseptic during surgery

• Ernest von Bergman

– developed asepsis

• Robert Koch

– Father of Microbiology

– identified germ causing TB

19th & 20th Century

• Wilhelm Roentgen

– discovered X-rays

• Paul Ehrlick

– discovered effect of medicine on disease causing microorganisms

• Anesthesia discovered

– nitrous oxide, ether, chloroform

ether

Ether

• Highly toxic

• Highly flammable

• Unpredictable side effects

• No longer used medicinally

Chloroform

Chloroform

Wikipedia-Chloroform

• Chloroform was once a widely used anesthetic. Its vapor depresses the central nervous system of a patient, allowing a doctor to perform various otherwise painful procedures. On 4 November 1847, the Scottish obstetrician James Young Simpson discovered the anesthetic qualities of chloroform when he and his friends were experimenting

Wikipedia- Chloroform ctd

• with different substances on themselves in search of a replacement for ether as a general anesthesia. He was so astounded by the success of his own trial that the next morning he hired a chemist and within the next few days was administering it to his patients during childbirth. The use of chloroform during surgery expanded rapidly

Wikipedia-Chloroform ctd

• thereafter in Europe. In the 1850s, chloroform was used during the birth of Queen Victoria's last two children.[18] In the United States, chloroform began to replace ether as an anesthetic at the beginning of the 20th century; however, it was quickly abandoned in favor of ether upon discovery of its toxicity, especially its tendency to cause fatal cardiac arrhythmia analogous to what is now termed “sudden sniffer’s death”.

19th & 20th Century

• Alexander Fleming

– discovered penicillin

• Jonas Salk

– discovered that a killed polio virus would cause immunity to polio

1900 to 1945

• Acute infectious diseases identified and named (diphtheria, TB, rheumatic fever)

• DDT for mosquitoes (dangerous Cancer causing pesticide, Banned in 1970’s)

• water sanitation to help stop spread of typhoid fever, diphtheria vaccination

• Hospitals were places to die

• Most doctors were general practitioners

Diphtheria Wikipedia History• The bacterial disease was named by French doctor

Pierre Bretonneau in 1855 (substituted for his earlier term diphthérite).

• In 1878, Queen Victoria’s daughter and her family became infected with it, causing two deaths.

• In the 1920s, there were an estimated 100,000 to 200,000 cases of diphtheria per year in the United States, causing 13,000 to 15,000 deaths per year. Children represented a large majority of these cases and fatalities. One of the most famous outbreaks of diphtheria was in Nome, Alaska.

Diphtheria Wikipedia• The disease may remain manageable, but in more severe cases,

lymph nodes in the neck may swell, and breathing and swallowing will be more difficult. People in this stage should seek immediate medical attention, as obstruction in the throat may require intubation or a tracheotomy. Abnormal cardiac rhythms can occur early in the course of the illness or weeks later, and can lead to heart attack. Diphtheria can also cause paralysis in the eye, neck, throat, or respiratory muscles. Patients with severe cases will be put in a hospital ICU and be given a diphtheria antitoxin. Since antitoxin does not neutralize toxin that is already bound to tissues, delaying its administration is associated with an increase in mortality risk. Therefore, the decision to administer diphtheria antitoxin is based on clinical diagnosis, and should not await laboratory confirmation.[

Diphtheria – Swollen Neck

Diphtheria related skin sore

Diphtheria

• Now Vaccinated against!

• Very rare

TB bacteria / antibiotic Tx

1945 to 1975

• Immunization common

• antibiotic cures

• safer surgery

• Transplants

• increased lifespan

• chronic degenerative diseases

1945 to 1975

• new health hazards

– obesity

– neuroses

– lung cancer

– hypertension

• disintegrating families

• greatly increasing medical costs