Title

EVOLUTION
• Text
OF PUBLIC
HEALTH

October 19, 2024 1

 OVERVIEW
DAWN OF SCIENTIFIC
MEDICINE
MODERN MEDICINE

• Revival of medicine • Curative Medicine

• Sanitary awakening • Preventive medicine
• Rise of public health • Social medicine
• Germ theory of disease • Changing concepts in
• Birth of preventive public health
medicine

October 19, 2024 2

DAWN OF SCIENTIFIC MEDICINE

 Period following 1500 A.D – political, industrial,

religious and medical revolutions.
 Political revolutions – France and America

 Industrial revolution - West

October 19, 2024 3

REVIVAL OF MEDICINE
1453-1600 A.D

October 19, 2024 4

 PARACELSUS (1493-1541)
• “Father of Modern Toxicology”
• Enlisting the help of chemicals in
therapeutics and vigorously
opposing polypharmacy -
prescription of multiple ingredients
in a single medicine.
• Revived medicine
• Publicly burnt the works of
Galen and Avicenna
• Helped turn medicine towards
rational research

October 19, 2024 5

FRACASTORIUS (1483-1553)

• “Founder of Epidemiology”
• Enunciated “theory of contagion”
• Transfer of infection via minute
invisible particles – cause of
epidemics
• Syphilis was transmitted from
person to person during sexual
relations

October 19, 2024 6

ANDREAS VASALIUS (1514-1564)

• “First man of Modern Science”

• “First master of human anatomy”
• Did lot of disssections on the
human body – demonstrated some
of Galen’s errors
• His careful studies provided doctors
with the accurate information that
they need to save lives.

October 19, 2024 7

• Vesalius’ great work “Fabric”
marked a turning point in the
history of medicine.
• It was published in 1543,
contained 663 pages and 300
beautiful illustrations.

October 19, 2024 8

AMBROISE PARE (1510-1590)
• “Father of surgery”
• French Army surgeon
• Discovered new techniques that
made surgery practical.
• In 1562, he was given the dignified
title, “First Surgeon of the King”
• He published his book in French
with useful information that all
doctors could use
• “I treated him. God healed him.”

October 19, 2024 9

THOMAS SYDENHAM (1624-1689)

• First distinguished Epidemiologist

• Differential diagnosis of scarlet
fever, malaria, dysentery and
cholera

October 19, 2024 10

WILLIAM HARVEY (1578-1657)

• In 1628 – discovered that blood

circulates around the human body.

October 19, 2024 11

ANTONI VAN LEEUWENHOEK (1632-1723)

• Developed the most powerful

microscopes of his day.
• Discovered one-celled
protozoans and bacteria.
• His work eventually led to the
discovery of the causes of
diseases, such as the Black Death.

October 19, 2024 12

 SANITARY
AWAKENING

October 19, 2024 13

 Industrial revolution in 18th century

Sparked off numerous problems

Creation of slums, overcrowding, accumulation of filth,

high sickness and death rates, infectious diseases

Deteriorated the health of the people

October 19, 2024 14

 The great cholera epidemic in 1832

Edwin Chadwick investigated the health of the inhabitants

Chadwick’s report on “The Sanitary Conditions of

the Labouring population in Great Britain”

Landmark in the history of public health

Enactment of the Public Health Act of 1848 in England

October 19, 2024 15

October 19, 2024 16
 RISE OF PUBLIC HEALTH

October 19, 2024 17

 CHOLERA

• Cholera is often called as “ Father of Public Health”

• Outbreak again in the western world during the 19th century

• Cholera caused great fear among ordinary people because of

its painful symptoms and the speed with which it struck

October 19, 2024 18

 JOHN SNOW (1813-1858)

• British physician
• He was considered one of
the founders of epidemiology
for his work identifying the
source of a cholera outbreak
in Soho, England in 1854.

October 19, 2024 19

 JOHN SNOW (1813-1858)
• Snow did not accept the 'miasma' theory (bad air) that stated that diseases such
as cholera or the Black Death were caused by pollution or a noxious form of
"bad air".
• He argued that in fact entered the body through the mouth.

• He published his ideas in an essay 'On the Mode of Communication of

Cholera' in 1849.

• In August 1854, a cholera outbreak occurred in Soho.

October 19, 2024 20

 JOHN SNOW (1813-1858)
• After careful investigation, including plotting cases of cholera
on a map of the area, Snow was able to identify a water pump
in Broad (now Broadwick) Street as the source of the disease.
• He had the handle of the pump removed, and cases of cholera
immediately began to diminish.
• He studied the epidemiology of cholera in London from 1848-
1854 and established the role of polluted drinking water in the
spread of cholera
October 19, 2024 21
October 19, 2024 22
October 19, 2024 23
 WILLIAM BUDD

• Epidemiology of typhoid

• 1856 – outbreak of typhoid fever

in the rural north of England

• Concluded that the spread was

by drinking water, not by

miasma and sewer gas

October 19, 2024 24

• Demand from people for clean water

• A comprehensive piece of legislation was brought

into force in England, the Public Health Act of 1875
for the control of man’s physical environment

October 19, 2024 25

 SIR JOHN SIMON (1816- 1904)

• First medical officer of health

in London
• He built up a system of public

health in England – admiration

of rest of the world

October 19, 2024 26

• This early phase of public health (1880-1920) – DISEASE
CONTROL PHASE
• By the beginning of the 20th century, the broad foundations of
public health – clean water, clean surroundings, wholesome
condition of houses, control of offensive trades, etc. were laid
in all the countries of the western world

October 19, 2024 27

 GERM THEORY OF DISEASE

October 19, 2024 28

 LOUIS PASTEUR (1822-1895)
• French chemist

• Dismissed the “miasmatic” theory

of disease.
• He argued that diseases were
caused by germs and so effectively
established bacteriology as a
science.

October 19, 2024 29

 LOUIS PASTEUR (1822-1895)
• Old Theory: Spontaneous generation

– by Félix Pouchet

– micro-organisms are the result of decaying matter.

• New Theory: Germ theory

– micro-organisms cause decaying matter.

• In 1861, Pasteur published his Germ theory based on his

experiments.

October 19, 2024 30

 LOUIS PASTEUR (1822-1895)
• Having discovered that ‘bad’ wine
had germs in it which could be
seen through a microscope,
Pasteur developed a process for
killing the germs by boiling the
wine and then cooling it down. He
called this process
‘PASTEURISATION’.
October 19, 2024 31
 LOUIS PASTEUR (1822-1895)
• 1880 - Pasteur and Chamberland immunised chickens against
cholera
• 1881 - Pasteur successfully inoculated sheep against anthrax

• 1884 - Pasteur discovered rabies was caused by a virus instead of

bacteria and then developed a vaccine for humans
• 1888 - The French government set up the Pasteur Institute in
Paris.
•
October 19, 2024 32
 ROBERT KOCH (1843-1910)
• German scientist

• Koch was responsible for

establishing the new 'Science of
Modern Bacteriology'.
• He developed staining methods for
bacteria and introduced the use of
gelatin and agar as growing media
for bacterial colonies.
October 19, 2024 33
 ROBERT KOCH (1843-1910)
• In 1875 Koch began his

pioneering research to identify

the cause of anthrax

• This approach is known as

“KOCH’S POSTULATES”

October 19, 2024 34

 KOCH’S POSTULATES
• The causative agent must be present in every case of the
disease and must not be present in healthy animals.

• The pathogen must be isolated from the diseased host animal

and must be grown in pure culture.

October 19, 2024 35

 KOCH’S POSTULATES
• The same disease must be produced when microbes from the
pure culture are inoculated into healthy, susceptible animals.

• The same pathogen must be recoverable once again from this

artificially infected animal and must be able to be grown in
pure culture.

October 19, 2024 36

October 19, 2024 37
 EXCEPTIONS TO KOCH’S
POSTULATES

• Microorganisms that are unable to be cultured on artificial

media (eg: Trepanoma pallidum)
• 2 or more organism work in synergy to cause a disease

• Symptoms and diseases can be caused by any one of several

microbes

October 19, 2024 38

 ROBERT KOCH (1843-1910)
• His pupils found the organisms responsible for diphtheria,
typhoid, pneumonia, gonorrhoea, cerebrospinal meningitis,
leprosy, bubonic plague, tetanus, and syphilis, among others,
by using his methods.
• 1876 - Discovered the microbe that caused anthrax

• 1878 - Discovered that microbes cause wounds to go septic

October 19, 2024 39

 ROBERT KOCH (1843-1910)
• 1882 - Identified the microbe that caused tuberculosis

Tuberculosis was known as the 'White Death' because

sufferers vomited up white matter as their lungs disintegrated
• 1883 - Identified the germ that caused cholera

Cholera was nicknamed 'King Cholera' because no one

seemed to be able to cure it

October 19, 2024 40

 ROBERT KOCH (1843-1910)

• 1891 - The German government set up the Institute

for Infectious Diseases in Berlin
• 1905 - Koch was awarded the Nobel Prize for his
work in microbiology

October 19, 2024 41

• The discoveries of Pasteur and Koch confirmed the germ
theory of disease

“GOLDEN AGE OF BACTERIOLOGY”

• 1880 – Pneumococcus

• 1884 - Diphtheria bacillus

• 1847 – Gonococcus

and so on…….

October 19, 2024 42

BIRTH OF PREVENTIVE
MEDICINE

October 19, 2024 43

• Dates back to the 18th century

• Developed as a branch of medicine distinct from

public health

October 19, 2024 44

 JAMES LIND (1716-1794)
• 1739 - He was a surgeon's mate in
the British navy
• 1747 - He was promoted to
surgeon
• Conducted a series of clinical
experiments that proved citrus
fruits or their juices would cure
scurvy
October 19, 2024 45
 JAMES LIND (1716-1794)

• Lind performed one of his

most important experiments on
curing scurvy in 1747
• Sailors on British warships
died from scurvy than from
battle due to lack of Vitamin C
in the food
October 19, 2024 46
 JAMES LIND (1716-1794)
• 1754 - Lind published A Treatise of the Scurvy.

• 1757 - He published a second book, On the Most Effectual

Means of Preserving the Health of Seamen, which also
recommended giving sailors citrus fruits on long voyages.
• 1758 - He was appointed the chief physician of the Royal
Naval Hospital at Gosport in the south of England.

October 19, 2024 47

 JAMES LIND (1716-1794)

• Lind died in Gosport on July 13, 1794

• 1795 - The Royal Navy adopted the practice of giving seamen
citrus fruits and juices as part of their diets.
• Scurvy promptly vanished from the Royal Navy.

October 19, 2024 48

 SMALL POX
• In the eighteenth century, smallpox was a killer disease.

• The victims who contracted the disease had frightening

symptoms.
• The symptoms were a high fever, sores over the body and
when the disease spread to the organs it was a certain death.
• People who survived were terribly scarred.

October 19, 2024 49

 INOCULATION
• Lady Mary Wortley Montague from
Turkey described the process of
inoculation
• Inoculation involved taking matter
from a smallpox scab and spreading it
onto an open cut on the person being
inoculated

October 19, 2024 50

 EDWARD JENNER(1749-1823)
• Doctor from Great Britain.

• Studied under a great doctor

(James Hunter) in scientific
observations.
• He discovered vaccination
against small pox in 1796

October 19, 2024 51

 EDWARD JENNER(1749-1823)

• Jenner noted that an old tale that milk maids did not catch
smallpox appeared to be true.
• In 1796, Jenner decided to test out his theory by
experimentation.

October 19, 2024 52

 EDWARD JENNER(1749-1823)

• Sarah Nelmes, a 13 year old milk

maid who was suffering from
cowpox.
• Jenner used pus from her sores to
inoculate James Phipps an 8 year
old boy.

October 19, 2024 53

 EDWARD JENNER(1749-1823)

• The boy caught cowpox and was ill.

Six weeks later, he was inoculated
smallpox by Jenner.
• He had no symptoms – he was
vaccinated.
• The term Vaccination comes from
Vacca meaning ‘from a cow’

October 19, 2024 54

 EDWARD JENNER(1749-1823)
• A James Gillray cartoon
from 1808, showing Edward
Jenner, working at the
Smallpox Inoculation
Hospital in St Pancras. The
cartoon was entitled the
‘Wonderful Effects of
Inoculation’
October 19, 2024 55
 EDWARD JENNER(1749-1823)
REACTION:

Not everyone welcomed it.

• Some people thought that they would turn into cows
• Others argued that as Jenner did not know why it worked
they feared it would not.
• Doctors who got rich by inoculation did not like it.

October 19, 2024 56

 EDWARD JENNER(1749-1823)
• 1798 - Jenner published his findings and submitted them to the
Royal Society - refused to publish
• 1840 - Vaccination became free for all infants

• 1853 - compulsory in Britain

• 1980 - smallpox was deemed to have been eradicated by the

WHO (World Health Organisation).

October 19, 2024 57

 JAMES LIND EDWARD JENNER

Beginning of new era

THE ERA OF DISEASE PREVENTION BY

SPECIFIC MEASURES

October 19, 2024 58

• The latter part of the 19th century – marked by discoveries in
the preventive medicine
• 1892 – cholera vaccine

• 1894 – Diphtheria antitoxin

• 1898 – anti-typhoid vaccine

• 1827-1912 – antiseptics and disinfectants

October 19, 2024 59

 1896 – BRUCE, a British Army surgeon

African sleeping sickness was transmitted by tsetse fly

1898 – RONALD ROSS

Malaria was transmitted by the Anopheles

1900 – WALTER REED

Yellow fever was transmitted by Aedes mosquito

October 19, 2024 60

 RONALD ROSS (1857-1932)

• Ronald Ross was born in Almora,

India on 13 May 1857
• Ross studied malaria between 1881
and 1899.
• He worked on malaria in Calcutta at
the Presidency General Hospital

October 19, 2024 61

 RONALD ROSS (1857-1932)
• 1883 - Ross was posted as the Acting Garrison Surgeon at
Bangalore during which time he noticed the possibility of
controlling mosquitoes by controlling their access to water.

• Later, he was transferred to Secunderabad, where he

discovered the presence of the malarial parasite within a
specific species of mosquito - the Anopheles.

October 19, 2024 62

 RONALD ROSS (1857-1932)

• 1902 - Ross was awarded the Nobel Prize in Physiology or

Medicine for his remarkable work on malaria
• He made many contributions to the epidemiology of malaria
and to methods of its survey and assessment
• Development of mathematical models for the study of
epidemiology of malaria

October 19, 2024 63

 RONALD ROSS (1857-1932)
• In Calcutta the road linking Presidency General Hospital with
Kidderpore Road has been renamed after him as Sir Ronald
Ross Sarani.
• In Hyderabad, the famous Quarantine (Koranti) hospital is
named as Sir Ronald Ross Institute of Tropical and
Communicable Diseases in recognition to his services in the
field of tropical diseases.

October 19, 2024 64

 MODERN MEDICINE

October 19, 2024 65

• 19th century – two major branches of medicine
i) Curative medicine
ii) Public health/preventive medicine
• Control of acute infectious diseases

• Modern diseases– leading cause of death

• Aetiology – social, economic, genetic, environmental and

psychosocial factors
• “Multifactorial causation of disease” – Pattenkofer of
Munich (1819-1901)
October 19, 2024 66
 CURATIVE MEDICINE

October 19, 2024 67

• Primary objective – removal of disease from the
patient

• Various modalities:
 Diagnostic techniques
 Treatment

October 19, 2024 68

• Diagnostic tools – refined, sophisticated and numerous

• 20th century – revolution in “Allopathic Medicine”

Antibacterial and Antibiotics

October 19, 2024 69

 SPECIALISATIO
N

October 19, 2024 70

• SPECIALISATION –
 raised the standards of medical care

 Increased the cost of medical care

 Declined general practice

 Isolated medical practitioners at the periphery

October 19, 2024 71

 PREVENTIVE MEDICINE

October 19, 2024 72

 •It is the science and art of
Preventing disease

Prolonging life and

Promoting health and efficiency groups of individuals and

individuals within these groups,
THROUGH INTERCEPTION OF DISEASE PROCESSES

• Applied to healthy people

• Primary objective – prevention of disease and promotion of

health
October 19, 2024 73
• Bacterial vaccines and antisera

• Morbidity and mortality of diphtheria,

tetanus, typhoid declined
• Introduction of tissue culture of

viruses – development of anti-viral

vaccines (eg: polio vaccine)
• Eradication of small pox

• Search for better and newer vaccines

October 19, 2024 74

• Discoveries in the field of nutrition –
new dimension to preventive

medicine
• Recognition of role of vitamins,
minerals, proteins and other nutrients,
recently dietary fibre

October 19, 2024 75

• Discovery of synthetic insecticides
like DDT, HCH, malathion

• Control of vector borne diseases

October 19, 2024 76

• Discovery of drugs - sulpha
drugs, anti-malarials, anti-
biotics, anti-tubercular and anti-
leprosy drugs
• Chemoprophylaxis and mass
drug treatment – important
tools of preventive medicine

October 19, 2024 77

• Concept of disease eradication

• Eradication of diseases – measles, tetanus, guinea

worm and endemic goitre are on the anvil

October 19, 2024 78

• 20th century – “screening for the diagnosis of disease” in its
presymptomatic stage

• 1930 – two most commonly used tests

 Serological tests – syphilis

 Chest x-ray - tuberculosis

October 19, 2024 79

• Population explosion in the

developing countries
• Population overgrowth – social,

economic, political and

environmental problems
• Research in human fertility and
contraceptive technology

October 19, 2024 80

• Three levels of prevention –

primary, secondary and tertiary

• Modern preventive medicine defined
as – “the art and science of health
promotion, disease prevention,
disability limitation and
rehabilitation”

October 19, 2024 81

 SOCIAL MEDICINE

October 19, 2024 82

• Primarily an European Speciality

• 19th century - Concept proposed by

Virchow (1848) and Neumann (1847)
• Revived by Alfred Grotjahn (1869-
1931) of Berlin.
•By derivation - It is the study of man as a
social being in his total environment.

October 19, 2024 83

CHANGING CONCEPTS OF
PUBLIC HEALTH

October 19, 2024 84

 4 DISTINCT PHASES:
 Disease control phase (1880-1920)

 Health promotional phase (1920-1960)

 Social engineering phase (1960-1980)

 Health for all phase (1981-2000)

October 19, 2024 85

 DISEASE CONTROL PHASE

•Sanitary Legislation and reforms aimed at the control of man’s

physical environment.
•They were not aimed at control of any specific diseases, but yet
they improved the health of the people

October 19, 2024 86

 HEALTH PROMOTIONAL PHASE

• Health promotion of individuals.

• Initiated as personal health services

October 19, 2024 87

•C.E.A WINSLOW in 1920 defined
public health as “science of art” of
preventing disease

prolonging life &

promoting health & efficiency

through organized community

effort

October 19, 2024 88

• State assumed direct
responsibility of the health of the
individuals. This lead to

(a) PROVISION OF BASIC

HEALTH SERVICES:

primary health centres and

subsentres for rural and urban
areas

October 19, 2024 89

1920 – concept of health centre by Lord Dawson in England
1931 – League of Nations Health Organisation

established health centres

1946 – The Bhore committee in India recommended

(b) COMMUNITY DEVELOPMENT PROGRAMME:

to promote village development through the active

participation of whole community

October 19, 2024 90

 SOCIAL ENGINEERING PHASE
• Social & behavioral aspects of disease and health were
given a new priority
• Public health moved into preventive & rehabilitative
aspects of disease & behavioral problems.
• In this process goals of public health & community
health overlapped.
• So, the term “community health” has been preferred

October 19, 2024 91

 HEALTH FOR ALL PHASE
•Only 10 - 20 percent of people in developing countries
enjoyed good health facilities
•To provide good health facilities to other 80 percent
‘health for all’ by 2000 was pledged by members of World
Health Organisation

October 19, 2024 92

 Thank
you!
October 19, 2024 93