MAN & MEDICINE

Dr. Krishna Bhusal

MD Community Medicine
Lecturer, MCOMS
 Primitive Medicine
 Superstitions, Religion, Magic/Sorcery, Cosmology, Witchcraft,
Shamans
 SUPERNATURAL THEORY OF DISEASES
 Prayers to gods and sacrifices
 Improvised stones and flint instruments for circumcision, amputation
of limbs, drilling of skull
 Indian Medicine

 Ayurveda and Siddha Medicine

 Ayurveda in most areas; Siddhas in Tamil (South India)
 4 vedas: Rigveda, Samaveda, Yajurveda, Atharvaveda
 Atharvaveda → Medical knowledge → Ayurveda
 Ayur = Life; veda = science/knowledge (i.e. science of prolonging life)
 Branches of Ayurveda
 Medicine, Surgery, Anatomy, Pathology, Midwifery, Dental,
Ophthalmology
 Dhanvantari → Hindu god of medicine
 Origin → Samudra manthan (churning, tug of war)

Mount Mandara
Vasuki Naga
 Personalities:
 Atreya – 800 BC; Takshashila university (Now in Rawalpindi, Pakistan)
 Charaka, Sushruta, Vaghbhatt
 King Ashoka (230 BC) → Ayurveda as state medicine, Public
hospitals
 Charaka (200 AD) → Court physician → Charaka Samhita “Works of
Sarpagandha Atreya”
 Rauvolfia Serpentina (Indian snakeroot/sarpagandha) → Reserpine
source for “Treatment of Hypertension”
 Sushruta → Father of Indian Surgery
Milestones of Indian surgery

 Hernia repair
 Cataract surgery
 Plastic surgery
 Setting fractured bone
 Amputations
 Tumor excision
 Rhinoplasty
 Tri-dosha theory of disease
 Vata (Wind); Pitta (Bile); Kapha (Mucus)
 Hygiene had important place (laws of Manu = code of personal
hygiene)
 Mohenjodaro & Harappa Civilization (>2000 years old) →
Excavation → advanced knowledge of sanitation, water supply,
engineering
 Golden age of Indian Medicine = 800 BC – 600 AD
 Spread in Tibet, Central Asia, Indonesia, Japan
Unani-Tibb Medicine

 10th century AD – Muslim rulers introduced

 Flourished till 18th century
 4 humours: phlegm (balgham), blood (dam), yellow bile (ṣafrā) and black
bile (saudā')
Phlegmatic Sanguine Choleric Melancholic
calm, optimistic or bad- feeling or
easygoing positive tempered expressing
people or irritable sadness

 Largely borrowed from Greek medicine, also from Indian and

Chinese medicine.
Treatment:
 Izalae Sabab (elimination of cause)
 Tadeele Akhlat (normalization of humors)
 Tadeele Aza (normalization of tissues/organs)

 Ilaj bil Ghiza (Diet therapy), Ilaj bit Tadbeer (Regiminal therapy), Ilaj bil
Dawa (Pharmacotherapy) and Ilaj bil Yad (Surgery)
 1. RIYAZAT (Exercise)
 2. DALAK (Massage or Friction)
 3. TAKMEED (Fomentation)
 4. NUTOOL (Pouring of medicated
lukewarm water on affected
part)
 5. ZIMAAD Wa TILA (Ointment
and Liniment)
 6. TAREEQ (Sweating)
 7. IDRAR-E-BAUL (Diuresis)
 8. HAMMAM (Bath)
 9. ISHAAL (Purgation)
 10. QAI (Emesis)
 11. HUQNA (Enema)
 12. IMALA (Diversion of morbid
material)
 13. HIJAMAT (Cupping)
 14. FASD (Venesection)
 15. TALEEQ (Leeching)
 16. KAI (Cauterization)
Homeopathy

 From 18th century

 Samuel – Hahnemann, Germany
 Formerly medical doctor, did MD
 Even worked as a translator for scientific and medical
textbooks
 Principle = like-cures-like
 that which can produce a set of symptoms in a healthy
individual, can treat a sick individual who is manifesting
a similar set of symptoms
 He claimed that the medicine did the patient more
harm than good
 uses many animal, plant, mineral, and synthetic substances in its remedies
 Book: Materia Medica
 Cause of disease: Predisposition to fall sick (Miasm), which is always present
in a living organism, in different ways.
 3 types of miasms:
I) Functional changes = Psora
ii) Structural changes = Sycosis
iii) Destructive changes = Syphilis
Chinese medicine

 2700 BC
 Yin = -ve/passive feminine; Yang = +ve/active masculine energy → Balance
 Chi (Qi) = Life force energy
 Any imbalance to Qi can cause disease and illness.
 1st immunization = variolation for Smallpox
 Chinese medicine now integrates both traditional and modern medicine
 Hygiene, Diet, Massage, Hydrotherapy, Drugs, Herbal remedies,
Acupuncture, Moxibustion, Cupping, Tai-chi, Chi-Gong, Falun Gong/Falun
dafa.
Medicine-less hospital in China
Egyptian Medicine

 2000 BC
 People brought to the temples for Rx
 Doctors received medical education in temples
 No Anatomy study – strict preservation of human bodies
 Specialization – Eye, tooth, head doctors
 Toxin absorption from intestine – Putrefaction of blood → Pus formation
 Pulse = speech of the heart (Nadi chikitsa)
 They considered health and illness resulted from a person’s relationship with
the universe including people, animals, good and bad spirits
 Treatment = Blood letting, Enema, drugs like castor oil, turpentine, opium,
tannin, gentian, senna, minerals, roots
 Diabetes, Rheumatism, Worms, Eye disease, Polio, Schistosomiasis
 Horus = God of health
 Egyptian civilization = Planned cities, Public baths, Underground drains
 Inoculation for Smallpox, Mosquito nets, Plague from rats
 Treatments were given in different forms like; pills, cakes, ointments, eye
drops, gargles, suppositories, fumigations, and baths
 A lot of diseases of the osseous, alimentary, respiratory, circulatory,
genital, muscular, nervous, ocular, auditory, and olfactory systems
were described in details, They identified the function of the heart,
and its relation to the two types of blood vessels, in addition,
cerebrospinal fluid was known to them too.
 The surgery in ancient Egyptian was so advanced, surgeons used
various instruments similar to what we using today such as the
scalpel, forceps, scissors, splints, Dental pliers, Bone saw, Probes,
Catheter, Clamps for stopping blood flow, specula, lancets for
opening veins, weighing scales.
 They sutured wounds, stopped bleeding using cautery
 Boils, abscesses, and septic wounds were opened surgically and
drained by pieces of linen, and poultices were used as well
 A dislocated shoulder was treated in a similar way to the Kocher
method, also a dislocated mandible was reduced by the method
used today
 The plaster used for fractures consisted of linen soaked in a sticky
material which hardened
MESOPOTAMIA
Mesopotamian Medicine

 Herb doctors – Internists

 Knife doctors – Surgeon
 Spell – Psychiatrist
 Geomancy – Interpretation of dreams
 Hepatoscopic divination → Liver = seat of life
 Magic & Necromancy (communicating with
dead)
 Medical astrology → Sumerian, Babylonian,
Assyrian
 Oldest priscription → In tablets
 Babylonian code of Hammurabi – Fees for
doctors, Death penalty for wrong treatment
Clay Liver
HYGIEA PANACEAE
Greek Medicine

 400 B.C.
 Hygiea → Goddess of health (Preventive
medicine)
 Panaceae → Goddess of medicine (Curative
medicine)
 Father Aesculapius → staff with serpent

 Hippocrates → Father of Medicine

 Corpus Hippocraticum → First scientific clinical
case histories.
 Hippocratic oath
 First true epidemiologist
As a new doctor, and a member of the medical profession:
I solemnly pledge that I will do my best to serve humanity – caring for the sick, promoting good
health and alleviating pain and suffering.
I will care for all patients equally and not allow prejudice to influence my practice.
I will respect the autonomy and dignity of my patients, and will uphold their confidentiality.
I will acknowledge my patients’ physical, psychological, and social needs and assist them to make
informed decisions that reflect their own values and beliefs.
I will respect, support and give gratitude to my teachers, colleagues and all those who sustain the
NHS.
I will reflect on my practice and recognise my limits.
I will seek to increase my understanding and skills, and promote the advancement of medicine as
both a teacher and a learner.
I will work towards a fairer distribution of health resources and oppose policies in breach of human
rights.
I will look after my own physical, mental and emotional well-being in my personal and professional
life.
I shall never intentionally cause harm to my patients, and will have the utmost respect for human life.
I will practice medicine with integrity, humility, honesty and compassion.
I recognise that the practice of medicine is a privilege with which comes considerable responsibility
and I will not abuse my position.
I make this declaration sincerely, freely and upon my honour
 Read book HERE!!

 Studied climate, water, clothing, diet, eating

and drinking habit.
 Book: Airs, Waters & Places
 Inspired Alexandria School and Arabo-Persian
medicine.
  Theory of humours (Humours = Body fluids)

MATTER QUALITY HUMOURS

Earth Cold Phlegm

Air Dry Yellow Bile

Water Moist Black Bile

Fire Hot Blood

 Roman Medicine
 1st Century BC
 Largely borrowed from Greek medicine.
 Practical minded people
 Sense of sanitation
 Made fine roads
 Water supply
 Sewerage system
 Hospitals
 Drainage to combat malaria
 Disease causation factors: Predisposing, Exciting and Environmental factors
 Galen → Prominent figure of Medicine
 MIDDLE AGE

 500-1500 AD
 Fall of Roman Empire
 Medical schools closed
 Europe → Suffered plague, TB, Leprosy,
Smallpox
 Roll back to primitive medicine
 Rejection of body, glorification of spirit
 Immoral to see one’s body → Rarely bath;
No dissection
 Degradation of European civilization
 But Arabs became more civilized during this period
 Developed Unani system of medicine (Greek + Roman medicine)
 Prominent figures → Abu Bakr (Rhazes); Ibn Sina (Avicenna)
 Works of Abu Bakr (Rhazes) - Father of pediatrics,
 Pupillary reaction to light
- Pioneer of obstetrics
and ophthalmology
 Mercurial purgatives
 Book on children’s diseases (Smallpox VS Measles)
 Works of Avicenna
 Canon of medicine
 Pioneers in Pharmacology → Alchemy (Elixir of life)
 Introduced syrups, pills, powder, oils, alcoholates, plaster, poultice,
aromatic waters
 Al-Mansur Hospital, Cairo
 separate department for different diseases
 Separate wards for both sexes
 Fountain to cool down fever
 Library, Musician, Story teller
 Monasteries also took care of sick.
 SCIENTIFIC MEDICINE

 >1500 AD
Paracelsus
 Revolutions: Political, Industrial, Religious, Medical
Fracastorius  Paracelsus: Burnt the work of Galen & Avicenna
 Fracastorius: Theory of contagion; Syphilis transmission
 Vesalius: Anatomist
 Ambroise Pare: Father of Surgery
 United Company of Barber Surgeons → Royal college of
Surgeons

Theory of Contagion:
Disease/Infection is due to minute bodies (germs)
capable of self-replication, transmitted from infector to
Ambroise Pare infected Vesalius
 Thomas Sydenham

Edward Jenner

 Thomas Sydenham: Differential diagnosis of

Malaria VS Scarlet fever; Dysentery VS Cholera
 Harvey: Circulation of blood
 Leeuwenhoek’s : microscope
 Edward Jenner: Smallpox vaccine
 Sanitary awakening
 Industrial revolution consequence:
i) Creation of slums
ii) Overcrowding
iii) Filth
iv) ↑ sickness and death (Woman & Children)
v) Infectious diseases: TB
John Snow  Great cholera epidemic → John

Snow (Lawyer, England) → Sanitary

condition of laboring population in

Great Britain → Causative agent:

Filth → Great sanitary awakening

 RISE OF PUBLIC HEALTH

 State’s responsibility for the health of its people

 John Snow → Cholera
 William Budd → Typhoid spread by drinking water
Edwin Chadwick

William Budd
 Germ theory of disease

 Louis Pasteur + Robert Koch →

Golden age of bacteriology

Louis Pasteur Robert Koch

 Birth of Preventive Medicine

 James Lind → Fresh fruits and vegetables to prevent Scurvy

 Edward Jenner → Smallpox vaccine Walter Reed
 Anti-rabies; Cholera; Anti-typhoid vaccines; Diphtheria antitoxin
James Lind
 Antiseptics, Disinfectants
 African Sleeping sickness → Tsetse fly (Bruce)
 Malaria → Anopheles (Ronald Ross)
 Yellow fever → Aedes mosquito (Walter Reed)

David Bruce Tse-Tse Fly Ronald Ross

MODERN MEDICINE

1. Curative Medicine
- Allopathy → Mid 20th century → use of drugs; reaction; neutralize diseases
(Antibiotics)

2. Preventive Medicine
i) Vaccines & Antisera vi) Screening
ii) Quarantine vii) Contraception
iii) Nutrition viii) Genetic counselling
iv) Synthetic insecticides
v) Chemoprophylaxis
3. Social Medicine
- European specialty
- Man is not only biological animal, but also a social being.
- Epidemiological methods → Disease investigation; statistics
 PUBLIC HEALTH

 Art & Science of preventing disease, prolonging life & promoting health &
efficiency through organized community efforts.

Changing Concepts:
Millennium
1. Disease control phase (1880-1920)
Development Goals
 Sanitary legislation & reforms. (2000-2015)
2. Health Promotional phase (1920-1960)
3. Social engineering phase (1960-1980) Sustainable
4. Health for all phase (1980-2000) Development Goals
(2015-2030)
Health promotional phase (1920-1960)

 Public health neglected citizen as individual.

 Direct responsibility of state for health of individual.
 Personal health service: Maternal & Child Health; School health; Industrial
Health; Mental health; Rehabilitation Services
 Provision of Basic Health Services through Primary Health Centre & sub
center.
 Community Development Programme.
Social Engineering Phase (1960-1980)

 For newer health problems e.g. Cancer, Diabetes, Cardio-vascular diseases, Addiction
 Concept of ‘Risk factors’ in place of ‘Causative agents’
 Social & Behavioural aspects of Health and Diseases.

Health for All Phase (1980-2000)

 Attainment of a level of health that will allow people to lead a socially and economically
productive life.
 Narrowing of health gap.
 MEDICAL REVOLUTION

 Genetic Engineering
 Cloning
 In-vitro fertilization (i.e. Test-tube baby)
 Organ transplant
 Psychosurgery (i.e. Neurosurgery for mental disorders)
 SOCIAL MEDICINE

 Political control
 Not free, provision by state but regulated by professional groups.
 Socialized
 Germany →1st country to introduce compulsory Sickness Insurance
 Other Countries → England, France, Great Britain
 Russia → 1st country to introduce Socialized medicine
 Others → New Zealand, Cuba
Socialized medicine

 Free health services provided by state but regulated by professional groups.

Advantage:
i) ↓ Competition among physicians in search for clients.
ii) Social equity; Free

Drawback:
i) Inadequate utilization even though its free.

Management: Community participation (Health by the People)

 COMMUNITY MEDICINE/FAMILY MEDICINE
 Modern medicine has fragmented healthcare delivery system greatly
 Family→Focal point→integration of preventive, promotive & curative services.
 Neither disease or organ related

COMMUNITY MEDICINE
 Successor of Public Health, Community Health, Preventive and Social Medicine
 Measure the need of population (both sick and well) → Plan & administer services to meet
those needs
 Engage in research & teaching.
DEPROFESSIONALIZATION OF MEDICINE

 Other teams beside physicians

 Community health workers, Social workers, Indigenous medicine
practitioners
 New role of doctors: Educator, Counsellor, Preventer, Case-finder

NEW HEALTH SYSTEM

 Health Promotion & Disease Prevention
 Treatment services
FAILURE OF MEDICINE

 Death rate & life expectancy in developed countries =

unchanged/constant despite massive medical advances
 Threat of major diseases not lessened e.g. Malaria, Filaria, Leishmaniasis,
Schistosomiasis, Trypanosomiasis, Leprosy
 ↑ longevity much more before advent of modern drugs & technology
 Elite oriented (Disparity in health services/no equitable distribution)
 Wrong direction: Treatment of the few (No health promotion of many)
 People used to roam/explore different places and borrow education
 Nadi chikitsa