History And Evolution Of Preventive Medicine

Dr.Vikram Gupta PG Student(PSM),Patiala

From time immemorial man has been interested in trying to control disease.The “explosion” of knowledge during the 20th century has made medicine more complex, and treatment more costly, but the benefits of modern medicine have not yet penetrated the social periphery in many countries. The glaring contrasts in the state of health between the developed and developing countries, between the rural and urban areas, and between the rich and poor have attracted worldwide criticism as “social injustice”.

Introduction …………Currently, the commitment of all countries,

under the banner of the World Health Organization, is to wipe out the inequalities in the distribution of health resources and services, and attain the Millennium Development Goals.

The goal of modern medicine is no longer merely treatment of sickness.

The other and more important goals which have emerged are prevention of disease, promotion of health and improvement of the quality of life of individuals and groups or communities.

MEDICINE IN ANTIQUITY Medicine was dominated by magical

and religious beliefs which were an integral part of ancient cultures and civilization.

Any account of medicine at a given period should be viewed against the civilization and human advancement at that time, i.e. philosophy, religion, economic conditions, form of government, education, science and aspirations of the people.

PRIMITIVE MEDICINE It has been truly said that medicine was conceived

in sympathy and born out of necessity. The prehistoric man, motivated by feelings of

sympathy and kindness, was always at the behest of his kindred, trying to provide relief, in time of sickness and suffering.

The primitive man attributed disease, and in fact all human suffering and other calamities, to the wrath of gods, the invasion of body by “evil spirits” and the malevolent influence of stars and planets.

The concept of disease is known as “supernatural theory of disease”.

The administration of certain herbs or drugs whose effect is doubtful or nil, but hopefully harmless, may also be likened to a kind of magic ritual associated with the need to “do something”.

PRIMITIVE MEDICINE There is also evidence that prehistoric man

improvised stone and flint instruments with which he performed circumcisions, amputations .and trephine of skulls.

It is thus obvious that medicine in the prehistoric times (about 5000 B.C.) was intermingled with superstition, religion, magic and witchcraft.

The supernatural theory of disease in which the primitive man believed is as new as today.

For example, in India, one may still hear the talk of curing snake bites by “mantras”.

Diseases such as leprosy are interpreted as being punishment for one’s past sins in some cultures.

Although primitive man may be extinct, his progeny the so-called “traditional healers” are found everywhere.

INDIAN MEDICINE The medical systems that are truly Indian in

origin and development are

1. The Ayurveda practised throughout India &2. The Siddha systems practised in the

Tamil-speaking areas of South India. These systems differ very little both in theory and practice.

Ayurveda It is the knowledge of life” or the knowledge by

which life may be prolonged. Its origin is traced far back to the Vedic times, about

5000 B.C. Dhanvantari, the Hindu god of medicine is said to

have been born as a result of the churning of the oceans during a ‘tug of war’ between gods and demons.

In ancient Indian, the celebrated authorities in Ayurvedic medicine were Charaka Atreya,, Susruta and Vaghbhatt.

Atreya (about 800 B.C.) is acknowledged as the first great Indian physician and teacher.

Ayurveda witnessed tremendous growth and development during the Buddhist times.

Ayurveda-…………Charaka the most popular name in

Ayurvedic medicine, was a court physician to the Budhist king, Kaniska.

The Indian snakeroot (rauwolfia) was employed for centuries by the Indian physicians, before reserpine was extracted from the root and found spectacularly effective in the treatment of hypertension.

“Susruta father of Indian surgery complied Susruta Samhita”. Though this work is

mainly devoted to surgery, it also includes medicine, pathology, anatomy midwifery, ophthalmology, hygiene and bedside manners.

Ayurveda- ……..The early Indians set fractures,

performed amputations, excised tumours, repaired hernias and excelled in cataract operations and plastic surgery.

It is stated that the British physicians learned the art of rhinoplasty from Indian surgeons in the days of East Indian Company.

However, during Buddhist times, Indian surgery suffered a setback because of the doctrine of ahimsa (non – violence).

“tridosha theory of disease”The doshas or humors are: 1. vata (wind), 2. pitta (gall) and 3. kapha (mucus). Disease was explained as a distrubance in the

equilibrium of the three humors; when these were in perfect balance and harmony, a person is said to be healthy.

Hygiene was given an important place in ancient Indian medicine.

The laws of Manu were a code of personal hygiene.

Archaeological excavations at Mohenjo-daro and Harappa in the Indus valley revealed rather advanced knowledge of sanitation, water supply and engineering.

Unani-Tibb & Homoeopathy,These systems of medicine are not of Indian

originThe Unani-Tibb system of medicine, was

introduced to Indian by Muslim rulers about the 10 Century A.D.

By the 13th Century , the Unani system of medicine was firmly entrenched in certain towns and cities notably Delhi, Aligarh, Lucknow and Hyderabad.

HomoeopathyHomoeopathy, which was propounded by

Samuel Hahnemann of Germany gained foothold in Indian during 1810 and 1839.

It is a system of pharmacodynamics based on “treatment of disease by the use of small amount of a drug that, in healthy persons, produces symptoms similar to those of the disease being treated”.

India claims to have the largest number of practitioners of this system in the world.

CHINESE MEDICINEChinese medicine claims to be the world’s first

organized body of medical knowledge dating back to 2700 B.C.

It is based on two principles – the yang and the yin.

The yang is believed to be an active masculine principle and the yin a negative feminine principle.

The balance of these two opposing forces meant good health.

The Chinese were early pioneers of immunization. They practised variolation to prevent smallpox. The Chinese system of “bare-foot doctors” and

accupuncture have attracted worldwide attention in recent years.

EGYPTIAN MEDICINE In Egyptian times about 2000 BC the art of

medicine was mingled with religion.Egyptian physicians were co-equals of priests,

trained in school within the temples. Egyptian medicine reached its peak in the

days of Imhotep. He was considered both a doctor and divinity.

Specialization prevailed in Egyptian times. There were eye doctors, head doctors and

tooth doctors. All these doctors were officials paid by the

State. They believed that disease was due to

absorption from the intestine of harmful substances which gave rise to putrefaction of blood and formation of pus.

EGYPTIAN MEDICINE ….They believed that the pulse was “the speech of the heart”.

Diseases were treated with cathartics, enema, blood-letting and a wide range of drugs.

In the realm of public health also, the Egyptians excelled.

They built panned cities, public baths and underground drains.

They also had knowledge of inoculation against smallpox, the value of mosquito nets and the association of plague with rats.

MESOPOTAMIAN MEDICINE In ancient Mesopotamia (now part of Iraq),6000 years

ago the basic concepts of medicine were religious, and taught and practised by herb doctors, knife doctors and spell doctors –a classification that roughly parallels our own internists, surgeons and psychiatrists.

Hammurabi, a great king of Babylon who lived around 2000 b.C. formulated a set of drastic laws known as the Code of Hammurabi.

Doctors whose proposed therapy proved wrong ran the risk of being killed.

Laws relating to medical practice, including fees payable to physicians for satisfactory services and penalties for harmful therapy are contained in the Babylonian Code of Hammurabi.

GREEK MEDICINE-460-136BC The Greeks taught men to think in terms

of ‘why’ and ‘how’. An early leader in Greek medicine was Aesculapius.

Aesculapius bore two daughters – Hygiea and Panacea.

Hygiea was worshipped as the goddess of health and

‘ Panacea as the goddess of medicine Panacea and Hygiea gave rise to

dynasties of healers (curative medicine) and hygienists (preventive medicine) with different philosophies.

GREEK MEDICINE ….By far the greatest physician in Greek

medicine was Hippocrates who is often called the “Father of Medicine”.

He studied and classified diseases based on observation and reasoning.

He challenged the tradition of magic in medicine, and initiated a radically new approach to medicine i.e., application of clinical methods in medicine.

“Hippocratic oath” has become the keystone of medical ethics.

GREEK MEDICINE ….Hippocrates was also an epidemiologist. Since he distinguished between diseases which

were epidemic and those which were endemic. He was constantly seeking the causes of disease. The Greeks believed that matter was made up of

four elements – earth, air, fire and water. These elements had the corresponding qualities

of being cold, dry, hot and moist and were represented in the body by the four humors – phlegm, yellow bile, blood and black bile – similar to the “tridosha theory” in Ayurveda.

ROMAN MEDICINE By the first Century B.C. the centre of civilization shifted to Rome.

The Romans borrowed their medicine largely from the Greeks whom they had conquered.

The Romans were a more practical-minded people than the Greeks.

They had a keen sense of sanitation. Public health was born in Rome with the

development of baths, sewers and aqueducts.

ROMAN MEDICINE…. An outstanding figure among Roman medical

teachers was Galen. He was physician to the Roman emperor, Marcus

Aurelius. His important contributions were in the field of

comparative anatomy and experimental physiology.

His writings influences European medicine. They were accepted as standard textbooks in

medicine for 14 centuries, till his teachings and views were challenged by the anatomist, Vesalius in 1543, and the physiologist, William Harvey in 1628, almost 1500 years after his death.

MIDDLE AGESThe period between 500 and 1500 A.D. is

generally known as “Middle Ages”. Europe was ravaged by disease and

pestilence: plague, smallpox, leprosy and tuberculosis.

The practice of medicine reverted back to primitive medicine dominated by superstition and dogma.

Rejection of the body and glorification of the spirit became the accepted pattern of behaviour.

The medieval period is therefore called the “Dark Ages of Medicine” – a time of great strife, of socio-political changes, of regression and progression.

MIDDLE AGES…..At this time Arabs stole a march over the rest of

the civilization. They translated the Graeco-Roman medical

literature into Arabic and preserved ancient knowledge.

They developed Unani system of medicine. Leaders in Arabic medicine were the Persians,

Abu Becr known as Rhazes; and Ibn Sina known as Avicenna to the western world.

Rhazes was a director of a large hospital in Baghdad and a court physician as well.

He was the first to observe pupillary reaction to light; to use mercurial purgatives; and to publish the first known book on Children’s diseases.

However, the work most highly regarded today is his book on smallpox and measles which he distinguished clinically.

The greatest contribution of Arabs, in general, was in the field of Pharmacology.

They introduced a wide range of syrups, oils, poultices, plasters, pills, powders, alcoholates and aromatic waters.

The words drug, aclohol, syrup and sugar are all Arabian.

Spread of christianity…..During the turbulent middle ages,

Christianity exerted a wholesome influence. The spread of christianity led to the

establishment of hospital. The first hospital on record in England was

built in York in 937 A.D. With the growth of medicine, a chain of

hospitals sprang up from Persia to Spain There were more than 60 in Baghbad and 33

in Cairo.

Spread of christianity…. Cairo’s Al Mansure hospital had separate

departments for various diseases, wards for both sexes, fountains to cool fever patients, libraries, musicians and story tellers for the sleepless.

During the middle ages, religious institutions known as “monasteries” headed by monks, saints and abbotts also came up.

They not only helped preserve the ancient knowledge but also rendered active medical and nursing care to the sick.

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.

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

Hippocratic Oath ....I will not give a lethal drug to anyone if I am

asked, nor will I advise such a plan; 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

Hippocratic Oath ....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 with 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 men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

Thank You