HISTORY OF MEDICINE AND

COMMUNITY MEDICINE
Learning Objectives

What are
To know What are
the
the the Different What is
What is functions
evolution different systems of Community
History of
of era of Medicine. Medicine
Community
medicine. Medicine.
Medicine

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History according to the Webster
Dictionary
-A chronological record of significant events (as
affecting a nation or institution) often including an
What is
History explanation of their causes
-A branch of knowledge that records and explains
past events <medieval history>
a : Events that form the subject matter of a history
b : Events of the past
 MEDICINE IN ANTIQUITY
I. MEDICINE IN ANCIENT II. THE DAWN OF SCIENTIFIC
TIMES
MEDICINE
1. Revival of medicine 1453-
1. Primitive medicine
1600 ad
2. Indian medicine
2. Sanitary awakening
3. Chinese medicine
3. The rise of public health
4. Egyptian medicine
4. Germ theory of disease
5. Mesopotamian medicine
5. Birth of preventive medicine
6. Greek medicine
7. Roman medicine
8. Middle ages(500-1500 ad)
unani system
9. (800-1300ad)Abu Becr
(Rhazes) Ibna sina 5
(Avicenna)
 III- MODERN MEDICINE
CURATIVE MEDICINE
1.During past 100 years
specialties in medical science
emerged on the basis of
2.Skill: Surgery, Radiology,
Anaesthesia
3.Parts of body:ENT,
ophthalmology, Cardiology,
Gyaenecology
4.Age: Paediatrics, Geriatrics,
5.Sex: Obstetrics
6.Within each specialty growth of
sub-specialties: Neonatalogy,
perinatalogy, Paediatric
cardiology, Paediatric surgery,
Paediatric
7.Neurology.
• PREVENTIVE
MEDICINE
• Achievements are Bacterial vaccines
and Antisera
• Tissue culture virus vaccines
• Eradication of small pox
• Discoveries in the field of nutrition
• Discovery of synthetic insecticides
• Discoveries of sulpha drugs, anti-
malarials, antibiotics, anti-tubercular,
anti-leprosy drugs
• Chemoprophylaxis and mass
treatment.
• Nearly to the Eradication of measles ,
tetanus, guinea worm and endemic
goitre
• Development of screening for early
diagnosis
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• Preventive medicine is also dealing
with the population explosion.
A. MEDICINE 5000 BC Disease and human ► Medicine practiced was appeasing
IN suffering are due gods by prayers rituals and
ANCIENT to wrath of gods sacrifices.
► Driving out evil spirits by
TIMES
witchcraft, using charms and
PRIMITIVE amulets.
MEDICINE
INDIAN 5000 BC Imbalance in Vata  Ayurveda and siddha systems.
MEDICINE (wind), Pitta  Celebrated authorities are
(gall), and Kapha ATREYA, CHARAKA mentioned
(mucous). 500 drugs
 SUSRATA Father of Indian
surgery

CHINESE 2700 BC Imbalance of two  Immunization and prevention

MEDICINE opposing forces
(Yang and Yin).
EGYPTION 2000 BC Absorption of  Diseases were treated with
MEDICINE harmful cathartics, enema and blood
substances from letting.
intestine and 7
putrefaction of
blood and
formation of pus.
MESOPTAMIA 6000 Based on religious Practiced by herb doctors (internists),
N MEDICINE years ago principles, the liver was knife doctors (surgeons), spell doctors
considered the seat of life. (psychiatrists), Geomancy (dreams), and
hepatoscopic divination.

GREEK 460-136 Imbalance of earth, airs, Matter was made up of four elements,
MEDICINE BC water and fire. earth, air, water and fire with cold, hot,
dry and moist properties.

ROMAN First Disease is due to three Predisposing, exciting and

MEDICINE century factors environmental factors.
BC

MIDDLE AGES 865-925 ►Observed papillary reaction to light, Use of mercurial

(500-1500 AD) 980- purgatives
UNANI 1037 ►Book on children disease, Distinction between measles and
SYSTEM small pox
(800-1300AD) ►21 volume encyclopedia (The Canon of Medicine).
Abu Becr
(Rhazes)
Ibna Sina 8
(Avicenna)
B. THE DAWN OF SCIENTIFIC MEDICINE
REVIVAL OF MEDICINE 1453-1600 AD
Parcelsius 1493-1541 Attacked superstition and dogma.
Fracastorius 1483-1553 ►Theory of contagion
Andreas 1514-1564 ►Infection via invisible particles
Vasalius 1510-1590 ►Syphilis through sexual relations
Ambroise 1728-1793 ►Founder of epidemiology
Pare 1624-1689 ► Raised the study of Anatomy
John Hunter 1628 ► Advanced the art of surgery
Thomas 1670 ► Scientific study of surgery
sydenham 1796 ► Clinical Medicine
Harvey 1682-1771 ► Discovery of circulation of blood
Leeunhok ► Discovery of Microscope
Jenner ►Vaccination against small pox
Morgagni ► Founded Pathologic Anatomy

1.SANITARY AWAKENING INDUSTRIAL REVOLUTION

Mid 19th century Public Health Act in England
1848 Creation of slums, overcrowding, accumulation of filth in
cities and towns, high death and sickness, infectious
diseases like tuberculosis, low mean age at death (44 for
gentry and 22 for working class 9
The state has a direct responsibility for the health of the
people.
THE RISE OF PUBLIC
HEALTH
John Snow 1848-1858 Epidemiology of cholera
Willium Budd 1856 Typhoid fever
Public Health Act 1875 Control of mans physical environment.
Sir John Simpson 1816-1904 First Medical Officer of Health London

GERM THEORY OF 1860 Demonstrated presence of bacteria in air.

DISEASE 1877 Discovery of Anthrax
Louis Pasteur (1822-1895) 1847 Discovery of Gonococcus
Robert Koch (1843-1910) 1880 Typhoid Bacillus, Pneumonia.
1882 Tuberculosis
1883 Vibrio Cholera
1884 Diphtheria

BIRTH OF PREVENTIVE
MEDICINE
Dates back to 18th century
James Lind 1
Edward Jenner 1753 Prevention of scurvy
Pasteur 1796 Vaccination against small pox 0
1883 Anti ‘’’rabies treatment
C. MODERN MEDICINE

CURATIVE MEDICINE
During past 100 years specialties in medical science emerged on
the basis of
Skill: Surgery,Radiology, anaesthesia
Parts of body: ENT, ophthalmology, Cardiology, Gyaenecology
Age: Paediatrics, Geriatrics,
Sex: Obstetrics
Within each specialty growth of sub-specialties:

Neonatalogy, perinatalogy, Paediatric cardiology, Paediatric

surgery, Paediatric , Neurology.
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DEFINITION……
• Faculty of Comm. Medicine, Royal College of Physicians:

• That specialty which deals with populations…and comprises

of those doctors who try to measure the needs of the
population, both sick and well, who plan and administer
services to meet those needs, and those who are engaged in
research and teaching in the field.

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 Individual Sociology, family Occupational
Group /family Planning, health, NCD

Housing
Over crowding,
Poor hygiene,
Air, water, nutrition
Hygiene,
sanitation COMMUNITY
MEDICINE
Communicable
Primary health Diseases, breeding
Care, Of mosquitoes, flies
NHP,
Immunization
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Disinfectants,
Disaster Waste 3
Insecticides
management management
Preventive medicine- history
• Medicine was conceived out of sympathy and born
out of necessity.

• First doctor was the first man and first woman was
the nurse.

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Old terminology
• Preventive medicine and social medicine

• From time immemorial man has been interested in

trying to control disease.

• Medicine man, priest, magician – were doing it

since long time.

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5
Medicine in antiquity
• Henry siegerist- medical
historian stated that every
culture had developed a
system of medicine and
medical history is but one
aspect of the history of
culture. 1
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Primitive medicine
• Diseases – wrath of gods and invasion of the body
by evil spirits and malevolent influence of stars
and planets.
• Super natural theory of disease

• Treatment – prayer, ritual, sacrifices, driving

out the evil spirits – by witchcraft
• There is evidence that prehistoric man used herbs
liberally.

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Primitive surgery
• Amputations, plastic surgeries…..

• Primitive medicine is still very much alive today……

• People surrender to traditional healers……..

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Indian medicine…
• Ayurveda – knowledge of life.
• Origin- 5000 BC.
• Danvanthari – hindu god of medicine
• Atreya – first great indian physician and teacher in 800 BC.
• Ancient university of TAKSHASHILA, abut 20 miles west of
present Rawalpindi.

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Indian medicine
• King Ashoka- 226 BC- patronised ayur as state medicine and schools
of med and public hospitals.

• CHARAKA- court physician to buddhist king KANISHKA.

• CHARAKA AND SUSRUTHA.

• Susrutha- father of indian surgery.

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0
.
• Anatomy, midwifery, plastic surgery.
• Surgeries hernioplasty, cataract, amputation,
excised tumors

• Rhinoplasty – British surgeons learnt it from

Indians during the days of East india company.

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Chinese medicine
• 2700 BC
• First organized body of medical knowledge.
• 2 principles – YANG AND YIN.
• YANG- ACTIVE MUSCULINE PRINCIPLE
• YIN- negative feminine principle.
• Early pioneers of immunization

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Egyptian medicine.
• God of health- horus.
• Disease – absorption from the intestine of
harmful substances which gave rise to putrefaction
of blood and formation of pus.
• Pulse – speech of the heart.
• Cathartics, enema, blood letting
• Edwin smith papyrus ( 3000-2500 BC)
• Worms, eye diseases, diabetes, rheumatism, polio.

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 Mesopotamian medicine.
Mesopotamia – now part of Iraq.
Cradle of civilization.
Herb drs, knife drs, spell drs.
Demons – cause of the diseases.
Geomancy – interpretation of dreams.
Liver was the seat of life.
Hammurabi –great king around 2000 BC, code of conduct for 2
practitioners- strict guidelines. 4
Greek medicine.
• 460-136 BC.
• Aesculapius – 2 daughters- hygiea and panacea.
• Worshipped as godess of health and medicine
respectively.
• Symbol of medicine – serpent – aesculapius
contribution.

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Hippocrates 460-370BC.
• FATER OF MEDICINE
• CORPUS HIPPOCRATICUM.- 72 VOLUME WORK- case histories
• Hippocratic oath
• Epidemiologist – authored one book- airs, water and places
• Four humors(earth,air,fire and water)
• - phlegm, yellow bile, black bile and blood.

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Roman medicine
 Borrowed it from Greek.
 Sanitation oriented- good drinking water, measures to
prevent malaria, drainage system,
 Galen – 130-205 AD – comparative anatomy and
experimental physiology
 3 factors in disease- predisposing, exciting, and
environmental factors.
 Medical dictator of his time.
 Planned cities, public bath rooms, underground drains.

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Middle ages- 500-1500 AD

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• Schools of medicine in different cities – BAGHDAD,
DAMASCUS, CAIRO.
• RHAZES- First to observe pupillary rxn to light. Also children's
diseases.
• Avicenna – 21 vols of encyclopedia- canon of medicine.
• The word drug, syrup, alcohol and sugar all Arabian.

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Dawn of scientific medicine
 Revival of medicine 1453-
1600
Paracelsus :
1493-1541, publicly burnt
the works of Galen and
avicenna and attacked
superstition and dogma
and helped turn medicine
towards rational system.
Fracastorius

• Theory of contagion
• Syphilis- STD
• EPIDEMICS
• FOUNDER OF
EPIDEMIOLOGY

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ANDREAS VASALIUS – 1514- 1564
• Dissections on the
human body and
found some errors in
galens work.
• First man of modern
science.
• FABRICA- text book

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Ambroise pare- 1510-1590
• Father of surgery
• Art of surgery( john hunter taught science of surgery)
• 1540- united company of barber surgeons- later royal college
of surgeon.

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Thomas sydenham1624-1689
• First distinguished
epidemiologist
• Scarlet fever, malaria,
dysentry, cholera

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17th and 18th century
• Harvey – circulation
of blood

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• Leewenhoeks
microscope

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• Jenners vaccination
against small pox

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1682-1771
• Morgagni –
pathological anatomy

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Birth of SPM
• James Lind (1716-1794)- naval surgeon advocated the intake
of fresh vegetables and fruits for prevention of scurvy- 1753
• Conqueror of scurvey
• Edward jenner - small pox vaccination-1796

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History of preventive and social
medicine
• Sanitary awakening - mid nineteenth century – in England
• Edwin chadwick- 1800-1890- a lawyer in 1832 sanitary
conditions of the labouring populations in Britan
• Good drinking water, Housing, working condition, slums,
accumulation of filth in cities……

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• English epidemiologist – John snow- role of polluted drinking
water and spread of cholera- 1848-54
• William budd- 1856- typhoid is spreading through unclean
drinking water
• Gradually imp of clean drinking water, clean surroundings
were realized.
• Louis pasteur – 1860- presence of bacterea in the air,
antirabies treatment in 1883

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 1877- Robert koch- anthrax was caused by bacterea
 Birth of germ theory of disease established.
 Gonococcus- 1847, typhoid bacillus and pneumcoccus- 1880,
TB bacilli- 1882, cholera vibrio- 1883, diphtheria bacillus- 1884
 Cholera vaccine in 1892, diphtheria antitoxin in 1894,
antityphoid vaccine – 1898

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• Antiseptics and disinfectants- 1827-1912
• 1896- Bruce – African sleeping sickness was transmitted by
psetse fly
• 1898- Ronald ross- malaria is transmitted by anophelis.
• 1900- walter reed- yellow fever- transmitted by aedes
mosquito.

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Modern medicine- 1900 onwards
• Acute infectious diseases came under control
• But diseases like DM, Htn, IHD, Cvs, Mental illness and
accidents, cancer – leading cause of death in devolped
countries.
• Multifactorial causation of disease.
• Risk factors in the aetiology of diseases.

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• Evolution of antibiotics- 1929- pencillin – ALEXANDER
FLEMING.
• Anti Tb, anti leprosy,
• SPECIALIZATION
• INVESTIGATINS
• SUPER SPECIALIZATION

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Achievements of community medicine
 Eradication of small pox- last case recorded from Somalia-
1977.
 Cases of DPT reduced drastically.
 Polio vaccine
 Nutritional blindness
 Iodine def disorders.
 Insecticides –
 DDT.(Dichlorodiphenyltrichloroethane) MALATHION- Malaria,
leishmaniasis, plague

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CHANGING CONCEPTS..
• Disease control phase (1880-1920)
• Health promotional phase (1920-1960)
MCH services, school health services, mental health services,
industrial health services and rehabilitational services
Provision of basic health services through
Primary Health Centres
Community Development Programme

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• Social engineering phase (1960-1980)
Disease pattern in the West changed:
Cancer, diabetes, cardiovascular diseases, alcoholism,
drug addiction
Social and behavioural aspects-new priority

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• Health for all phase (1981-2000AD)
In 1981, member countries of WHO pledged for Health for All
by the year 2000, that is attainment of level of health that
will permit all peoples to lead a socially and economically
productive life.

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PREVENTIVE MEDICINE
• Combating nutritional blindness and iodine deficiency
disorders
• Discovery of insecticides, DDT, HCH
• Discovery of sulpha drugs, anti-malarials, antibiotics, anti-
tubercular and anti-leprosy drugs
• Screening for the diseases

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SOCIAL MEDICINE
• Man is not only a biological being but a social being, and
disease has social causes, social consequences and social
therapy.
• Development of epidemiological methods and their
application to the investigation of diseases.
• Elucidates the role of social factors

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EVOLUTION OF PHYSICAL
THERAPY
Social history
• Wars , epidemics and accidents
• Pennsylvania becomes first state to license PTs. (1913)
• American Women’s physical therapeutic association (AWPTA, 1921)
• First Physical therapy text book published by Mary McMillan (1921)
• American Physiotherapy Association (APA, 1922)
• Role of APA in the Issue of the title of physiotherapist
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• First 4 year bachelor of science degree program for PTs
by New York University (1927)
• World Congress of Physical therapy is created.(1951)
• APA becomes The American Physical Therapy Association
(APTA, 1956)
• PTs serve in Vietnam on the front lines
• Position of PTA is created in response to staffing
shortage; recruitment and immigration of PTs from other
countries increases. (1966)
• First Doctoral program in Physical Therapy (new York
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University ,1973)
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• First foundation for Physical Therapy research grants (1981)
• Commission on accreditation for physical therapy education
(1983)
• Tri alliance ( physical therapy, occupational therapy and
speech language pathology) is established..
• First DPT degree program (Creighton University, 1993)
• Guide to Physical Therapist practice (1995)

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American Physical Therapy
Association (APTA) (2004)
Goals
• Goal I: PTs are universally recognized and promoted as the
practitioners of choice for persons with conditions that affect
movement, function, health, and wellness.
• Goal II: Academic and clinical education prepares doctors of physical
therapy who are autonomous practitioners.
• Goal III: PTs are autonomous practitioners to whom patients/clients
have unrestricted direct access as an entry point into the health care
delivery system and who are paid for all elements of patient/client
management in all practice environments.

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• Goal IV: Research advances the science of physical therapy
and furthers the evidence-based practice of the PT.
• Goal V: PTs and PTAs are committed to meeting the health
needs of patients/clients and society through ethical behavior,
continued competence, and advocacy for the profession.

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• Goal VI: Communication throughout the Association
enhances participation and responsiveness to members
and instills the value of belonging to the APTA.
• Goal VII: APTA standards, policies, positions, guidelines
and the Guide to Physical Therapist Practice, Normative
Model of Physical Therapist Education and Evaluative
Criteria, and the Normative Model of Physical Therapist
Assistant Education and Evaluative Criteria are
recognized and used as the foundation for physical
therapist practice, research, and education
environments. 5
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History in Pak
• 2 years diploma in JPMC (1956)
• Upgraded to 3 years in 1961
• 3 years Bsc
• 1999 4 years B.Sc
• 5 year DPT (2008) by Riphah
• Pak 3rd country offering DPT.

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