The History of Health Care

Ancient Times

• Prevention of injury from predators

• Illness/disease caused by supernatural spirits

Ancient Times

• Herbs and plants were used as medicineexamples:– Digitalis from foxglove plants

•Then, leaves were chewed to strengthen & slow heart

•Now, administered by pills, IV, or injections

Ancient Times

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

•Controls fever and muscle spasms

•Used to treat malaria

Ancient Times

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

poisonous nightshade plant• relieves muscle spasms especially GI

–Morphine from opium poppy • relieves severe pain

4000 BC – 3000 BC Primitive Times

• Illness and diseases were a punishment from the Gods

• Tribal witch doctors treated illness with ceremonies

• Herbs and plants used as medicines (morphine and digitalis)

• Trepanation or trephining (surgically removig a piece of bone from the skull)

• Average life span was 20 years

3000 BC – 300 BC Ancient Egyptians

• Physicians were priests• Bloodletting or leeches used as medical

treatment• Average life span was 20-30 years

Egyptians

• Earliest to keep accurate health records• Superstitious• Called upon gods• 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 knowledge from the god Thoth

Egyptians

• Magicians were also healers

• Believed demons caused disease

• Prescriptions were written on papyrus

Egyptians

• Embalming–Done by special priests (NOT the

doctor priests)–Advanced the knowledge of anatomy–Strong antiseptics used to prevent

decay–Gauze similar to today’s surgical gauze

Egyptians

• Research on mummies has revealed the existence of diseases

–Arthritis–Kidney stones–Arteriosclerosis

Egyptians

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

marriage–Closing wounds–Setting fractures

Egyptians

• Eye of Horus–5000 years ago–Magic eye– amulet to guard against disease,

suffering, and evil–History: Horus lost vision in attack by

Seth; mother (Isis) called on Thoth for help; eye restored

–Evolved into modern day Rx sign

Jewish Medicine

• Avoided medical practice• Concentrated on health rules concerning

food, cleanliness, and quarantine• Moses: pre-Hippocratic medical practice

–banned quackery (God was the only physician)

–enforced Day of Rest

1200 BC –200 BC Ancient Greeks

• First to observe the human body and the effects of disease – led to modern medical sciences.

• Believed illness is a result of natural causes• Used therapies such as massage, art therapy,

and herbal treatment• Stressed diet and exercise as ways to prevent

disease• Average life span was 25-35 years

Greek Medicine

• First to study causes of diseases• Research helped eliminate

superstitions• Sanitary 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• Father of Medicine

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

Hippocrates (460 – 377 BC)

• Greek physician known as the “Father of Medicine

• Authored code of conduct for doctors known as the “Hippocratic Oath” that is the basis of medical practice today

• Believed illness was not caused by evil spirits and stressed importance of good diet, fresh air, cleanliness, and exercise

Greek Medicine

• Aesculapius–staff and serpent

symbol of medicine–temples built in his

honor because the first true clinics and hospitals

753 BC – AD 410 Ancient Romans

• First to organize medical care by providing care for injured soldiers

• Later hospitals were religious and charitable institutions in monasteries and convents

• First public health and sanitation systems by building sewers and aqueducts

• Galen established belief that the body was regulated by four body humors; blood, phlegm, black bile, and yellow bile

• Life span was 25-35 years

Roman Medicine

• Learned from the Greeks and developed a sanitation system–Aqueducts and sewers–Public baths

• Beginning of public health

Roman Medicine

• First to organize medical care• Army medicine• Room in doctors’ house became

first hospital• Public hygiene

–flood control–solid construction of homes

AD 400 – AD 800 Dark Ages

• Emphasis on saving the soul and study of medicine was prohibited

• Prayer and divine intervention were used to treat illness & disease

• Monks and priests provided custodial care for sill people

• Medications were mainly herbal mixtures

• Average life span was 20-30 years

AD 800 – AD 1400 Middle Ages

• Renewed interest in medical practices of Greek and Romans

• Bubonic Plague killed 75% of population in Europe and Asia

• Major diseases included smallpox, diptheria, tuberculosis, typhoid, the plaque, and malaria

• Arabs began requiring physicians pass examinations and obtain licenses

• Average life span was 20-35 years

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–Typhonid fever–Tuberculosis

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

AD 1350 – AD 1650 Renaissance

• Dissection of body led to increased understanding of anatomy and physiology

• Invention of printing press allowed medical knowledge to be shared

• First anatomy book was published by Andreas Vesalius (1514-1564)

• Average life span was 30-40 years

16th and 17th Centuries• Cause of disease still not known – many people

died from infections• Invention of the microscope allowed

physicians to see disease-causing organisms.• Apothecaries (early pharmicists) made,

prescribed, and sold medications• Ambroise Pare (1510-1590), a French surgeon,

known as the Father of Modern Surgery established use of ligatures to stop bleeding

• Average life span 35-45 years

16th & 17th Century

• Leonardo da Vinci– anatomy of the

body• Anton van

Leeuwekhoek (1676)– invented

microscope–observed

microorganisms

Anton van Leeuwenhoek (1632-1723)

• Invented the microscope lens that allowed visualization of organisms

• Scraped his teeth

and observed the

bacteria that

causes tooth

decay

16th & 17th Century

• William Harvey– circulation of blood

• Gabriele Fallopian –discovered fallopian tube

• Bartholomew Eustachus –discovered the eustachian tube

• Some quackery

18th Century

• Gabriel Fahrenheit (1686-1736) created the first mercury thermometer

• John Hunter (1728-1793), established scientific surgical procedures and introduced tube feeding

• Benjamin Franklin invented bifocals• Average life span 40-50 years

18th Century

• Edward Jenner 1796–smallpox vaccination

• Joseph Priestly –discovered oxygen

Edward Jenner (1749-1823)

• Developed a vaccination for smallpox in 1796

18th Century

• Benjamin Franklin–invented bifocals–found that colds could be passed from

person to person• Laennec

–invented the stethoscope

Benjamin Franklin (1706-1790)

• Invented bifocals

• Found that colds could

be passed from person

to person

Rene Laennec (1781-1826)

• Invented the stethoscope in 1819• First stethoscope was made of wood

Elizabeth Blackwell (1821-1910)

• First female physician in the United States in 1849

Florence Nightingale (1820-1910)

• Known as the “Founder of Modern Nursing”

• Established efficient and sanitary nursing units during the Crimean War in 1854

• Invented the call bell system and use of dumbwaiters to deliver meals

• Begin the professional education of nurses

19th Century• Rapid advancements due to discoveries of

microorganisms, anesthesia, and vaccinations• Infection control developed once

microorganisms were associated with disease• Formal training for nurses began• Women became active participants in health

care• Average life span 40-60 years

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)

Louis Pasteur (1822-1895)• Known as the “Father of Microbiology”• His germ theory proved that microorganisms

cause disease• Proved that heat can be used to destroy germs through a process called pasteurization• Created a vaccine for rabies in 1885• Founded the basic rules for sterilization

Robert Koch (1843-1910)

• Developed the culture plate method to identify pathogens

• Isolated the bacterium

that causes tuberculosis

Clara Barton (1821-1912)• Volunteer nurse for wounded soldiers during the Civil

War• After Civil War, established a bureau of records to

search for missing men• Campaigned for the USA to sign the Treaty of Geneva, which provided relief for sick and wounded soldiers• Formed American Red Cross in 1881 and served as its first president

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

Joseph Lister (1827-1912)

• Used carbolic acid on wounds to kill germs

• First doctor to use an antiseptic during surgery

19th & 20th Century

• Wilhelm Roentgen–discovered X-rays

• Paul Ehrlick–discovered effect of medicine on

disease causing microorganisms • Anesthesia discovered

–nitrous oxide, ether, chloroform

Wilhelm Roentgen (1845-1923)

• Discovered roentgenograms (X-rays) in 1895

• Let doctors see inside the body

• X-rayed wife’s hand

Sigmund Freud (1836-1939)

• Discovered the conscious and unconscious part of the mind

• His studies were the basis for psychology and psychiatry

19th & 20th Century

• Alexander Fleming–discovered penicillin

• Jonas Salk–discovered that a killed polio virus

would cause immunity to polio• Alfred Sabin

–discovered that a live virus provided more effective immunity

Sir Alexander Fleming (1881-1955)

• Discovered penicillin in 1928 which is considered one of the most

important

discoveries of

the twentieth

century

Jonas Salk (1914-1995) Albert Sabin (1906 – 1993)

• Discovered polio vaccine• Saved many people from

this virus that paralyzed

thousands of adults and

children each year.

1900 to 1945

• Acute infectious diseases (diphtheria, TB, rheumatic fever)

• No antibiotics, DDT for mosquitoes, rest for TB, water sanitation to help stop spread of typhoid fever, diphtheria vaccination

• Hospitals were places to die• Most doctors were general practitioners

1945 to 1975

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

Christian Barnard (1922 – 2001)

• Performed first successful heart transplant in 1968

Robert Jarvik

• Creator of the first artificial heart

• On December 2, 1982, it was implanted into Barney Clark, who lived for the next 112 days

• The second patient, William Schroeder, lived for 620 days

1945 to 1975

• new health hazards –obesity–neuroses–lung cancer–hypertension

• disintegrating families• greatly increasing medical costs

Current Trends in Health Care

Cost Containment• Cost of health care began rising due to:

– Technological advances– Aging population– Health-related lawsuits

• Cost Containment measures include:– Diagnostic related groups (DRG)– Combination of services– Outpatient services– Mass or bulk purchasing– Early intervention and preventive services

• Health care facilities specialized to include:– Home health care– Hospice care– Geriatric care

• Types of facilities• Omnibus Budget Reconciliation Act (OBRA)

– Telemedicine

• Emphasis on promoting wellness of the whole individual:– Physical wellness– Emotional wellness– Social wellness– Mental and intellectual wellness– Spiritual Wellness– Holistic Health

• Alternative and Complementary Methods of Health Care– Chinese medicine practitioners– Chiropractors– Homeopaths– Hypnotists– Naturopaths

• National Health Care Plan– Has become a leading topic of debate due to

the increasing number of uninsured Americans

• Education and preparation for a potential pandemic– Due to the high rate international travel, the

possibility for a devastating pandemic has increased