Health systems include the cute care services that only hospitals are equipped to provide and a cadre of

other services that may include primary care, specialty outpatient care, home care, nursing home
facilities, hospice care, ambulatory surgery programs and a network of physicians and other health care
providers.

1. Ancient Times : Health care problems and diseases have been with us from the beginning of time.
a. study of fossilized bones indicate diseases already existing then were arthritis, tumors of the bone
and dental caries to name a few.
b. Egyptian mummies revealed diseases such as arteriosclerosis, kidney stones, pneumonia,
appendicitis, skin sores, uterine and intestinal problems.
c. Ancient people believed that diseases were caused by supernatural forces and attributed these to
spirits.
d. Hippocrates, the Father of Medicine, believed that health is a balance of four humors. His approach
was to treat the individual not the disease and to treat the entire body not just a part of it. He also
believed in the healing power of nature and that the physician’s role was to assist nature in the
healing process rather that direct it arbitrarily. He also used dietitics as a means of balancing the
humors and resorted only to drugs and surgery if diet failed.
2. Medieval Times (400-1350 A.D)
a. Two plagues killed a majority of people that led to the breakdown in civilization. At this time,
Christianity became the increasing center of power and believed that diseases were punishment for
sins, possession of the devil or result from witchcraft. Christianity emphasized saving the soul, not
the body, hence treatment methods included prayers, patience and assistance of saints. Any cure
then was considered as a miracle.
b. In 1163, at the Council of Tours, the church prohibited physicians “not to shed blood” thus they
were no longer allowed to perform surgery. Surgery and bloodletting were turned over to the
barbers and surgery books disappeared from the libraries of universities.
c. The title of Doctor became known and Medicine became an official profession although there were
not enough physicians for the population. As a result, lower-class citizens still relied on barbers and
lay healers.
d. When the Black Plague in 1348 killed a large percentage of the European population, the concept of
quarantine as a preventive measure was recognized. Public health measures were instituted for the
first time when the food in market came under control. Control of prostitution also was initiated to
prevent spread of disease.
e. A network of hospitals were built which marked a new and more humane approach toward the ill.
These were primarily for the sick, old, disabled and homeless.

3. Renaissance (1350-1650)
a. A time for revival of learning and science was instituted, particularly anatomy. Accurate
anatomical drawings were made and numerous dissections were performed to make clinical
observations of the body.
b. The science of pharmacognosy flourished as travel between countries increased and plants
became the main source of drugs. Some 500 new plant species were categorized and the first
modern pharmacopeia was written.
c. Efforts were also made to interpret “miracles” in a rational way and gave rise to the role of
psychological factors in influencing diseases.
d. The printing press was invented at this time, which allowed the widespread distribution of new
information and books.
e. Gunpowder was also invented and this resulted in numerous gunshots wounds during the wars that
necessities surgical treatment of the wounds. This elevated the status of the barber-surgeons to a
higher level.
4. 17th Century
a. An Englishman William Harvey, discovered the circulatory system that led to the realization that
medications could be injected into the circulatory system and that blood could be transfused. After
many failed attempts, however, it fell out of favor for several centuries.
b. In 1666, Anton van Leeuwenhoek invented the microscope making the study of microorganisms
and microscopic anatomy possible. However, the connection between microscopic organisms and
disease came later after several centuries.
c. Quinine was imported from Peru as a cure for malaria. This made malaria a separate type of fever.
This also confirmed that specific diseases have specific cures.
d. The study of the brain and psychology was of interest making physicians aware of psychosomatic
illnesses, then known as hysteria.
e. The first medical journal was also published by the academe in an attempt to communicate
discoveries.

5. 18th Century
a. Researchers and theorists still struggled with an explanation of how the body functioned. Three
theories were proposed : First, that the body functioned like a hydraulic pump that was run by an
undefined fluid flowing through the nervous system; Second, that every disease was the result of
overstimulation or inability to respond to stimulation. Treatment was then either a depressant or
a stimulant (ex. opium and alcohol); Third, that direct clinical observation should be used to
define and categorize diseases.
b. Surgery became a respected form of treatment in France. It was upgraded from a craft to an
experimental science. Procedures were developed that could cure problems that were only
treatable through surgery such as repair of an anal fistula.
c. Techniques for measuring BP and temperature were developed. Also first recommendations to
measure respiration and pulse were described. This initiated the measurements of vital signs in
monitoring patient status.
d. The science of chemistry also came of age. Digestion was now seen as chemical process rather
than a purely mechanical process or one of putrefaction.
e. Focus went from belief in the devil and “possession” to recognition of metal illness as a disease.
Previously, patient were locked up in filthy conditions as they thought it was due to possession,
sin, crime or vice. Mentally ill patients were released from their chains and treated in a more
humane way. Hypochondria (now called neurosis) was recognized as a common psychological
problem and was written about by various terms (ex. melancholy, spinal irritation, neurasthenia,
hysteria).
f. Preventive health care came to the forefront in the form of public health. Sanitary reform was
initiated in hospitals, prisons and military. Personal hygiene also improved dramatically.
g. Edward Jenner demonstrated that vaccination with cowpox provides immunity for smallpox.
Countless lives were saved and opened doors into investigation for other vaccines.

6. 19th Century
a. The Industrial Revolution created a growth of city population as peasants flooded into the city.
Hospitals were built that could hold many patients. Large hospital populations allowed for the
clinical observation of many cases, followed by autopsy when patients died. Previous focus had
been on research in libraries, laboratory experiments or with the care of the individual sick person.
b. Tremendous increase in medical knowledge was acquired and documented. Physicians and
surgeons were united into one profession. Many first-time surgical operations were performed such
as tracheostomy, removal of thyroid and uterus. Medical professions also started to develop
specialty areas such as pediatrics, psychiatry, dermatology, public health and preventive medicine.
 Study shifted from practicing physicians to full-time scientific researchers. Pharmacology was also
established as a new science.
c. Dentists introduced anesthesia and this practice expanded to major surgical procedures. Death rate
fell as the anesthesia decreased shock and the need for speed in surgery.
d. Vivisection (operation on living animals) was routinely performed in the desire to study more
accurate and detailed functions of the body. However, some of the general public and researchers
questioned the ethics of such procedures.
e. In 1836, the first school of nursing was created by the German clergyman. Theodor Fleidner. The
school served as an inspiration to Florence Nightingale, an English woman whose work in the field
hospitals during the Crimean War made her a powerful influence. She opened a nursing school in
1860.
f. Medical education opened for the first time to women. Elizabeth Blackwell was the first woman
M.D. in the U.S. She opened the first nursing school in the U.S. in 1860 and nursing is established
as a profession in the U.S.
Louis Pasteur, a chemist, proved that specific microorganisms called bacteria are the cause of
specific disease in both humans and animals. The result of his work created the development of the
germ theory.
In 1864, Joseph Lister M.D. applied the germ theory to his surgical practice by reasoning that
microorganisms could also fall into open surgical wounds. Specific identification of
microorganisms led to the development of vaccines for prevention. This revolutionized the ability
to prevent, diagnose and treat infectious diseases.
g. In 1867, Adolf Kussmaul used a stomach pump to treat stomach diseases. This advanced the
understanding of digestion in the stomach and led to the increased knowledge in dietetics and use
of tube feedings.
h. Anesthesia, asepsis and invention of a variety of surgical instruments changed the face of medicine
forever. Previously, the public viewed hospitals as a place one went to die. Now there was hope of
recovery for the first time. Many more advanced surgeries could be performed (ex. joints,
abdomen, head, spinal column).
i. Preventive medicine makes great strides as pasteurization, vaccination, asepsis and sanitation are
implemented. This increased the life span from 40 years in 1850 to 70 years in 1950 due primarily
to preventive not curative measures.

7. 20th Century
a. In 1921, Karl Landsteiner of Vienna discovered blood groups. This made transfusion of blood
products safe for the first time in history.
b. F.G. Bunting of Toronto identified insulin in 1921 for the treatment of diabetes making diabetes a
disease that is no longer fatal but can be managed by injections of insulin.
c. New diagnostic and therapeutic techniques were developed. The field of biomedical engineering
was made possible with the invention of the computer, X-rays, ECG, EEG, ultrasound,
pacemakers, dialysis and tomography provided physicians with more diagnostic
and therapeutic tools.
d. Vitamins were discovered and the US took the leadership role in this research. The belief that all
diseases were caused by microbes is disproved when some maybe due to lack of certain vitamins
were linked to various diseases (ex. scurvy, beri-beri).
e. Chemotherapy was used to fight cancer. New synthetic drugs, like antibiotics were developed to
fight various infections caused by bacteria. Antihistamines were also developed.
f. Surgical techniques and anesthesia methods make great advancements together with organ
transplantation. Heart, brain and prosthetic joint replacements were performed.
The definition of death also changed from cessation of heart and lung function to demonstration
of brain death by EEG. As such, people can now be kept alive by mechanical means beyond the
 point of having any quality of life. This established the start of people writing Living Wills to
specify what they want and do not want to prolong their lives.
g. The scientific approach was now used exclusively. This included the diagnosis of the disease and
then treatment with synthetic medications and surgical procedures. Herbal and alternative therapies
were rejected by many traditional medical practitioners. However, many
people started to flock to herbalist and alternative therapists in a search for a more natural therapies
but lack of regulation in these areas resulted in many abuses and adverse effects.
h. Genetic research was now used to determine the causes of some diseases and conditions, The
specific genes were identified but how to alter to prevent the condition has yet to be discovered.
i. In 1978, the first “test tube” baby was born in England. This procedure opened the opportunity for
couples previously unable to have children to have family.
j. In 1981, AIDS was identified as a disease. This presented a huge challenge to the medical research
community until now since medications discovered only prolonged the life of the individual but
not cure the disease.
k. In 1997, the first cloning of a sheep was successfully done. This opened the door for human
cloning and growth of organs for transplantation, however, medical ethics remain its primary
adversary.
 HOSPITAL PHARMACY

A. Give five (5) contributions to the following fields in medicine that revolutionized the
health care system :

1. Surgery
2. Public health
3. Pharmacology
4. Microbiology
5. Internal medicine

B. What do you think will be the trend of the health care system in the future ? Give
seven (7) innovations that might be discovered, created or employed in the coming
future.