public health history

1. Rabina Panta
1701938
A History of Public Health

2. • Studying history helps to understand how predicament is similar to someone
else's who came prior to us.
• We might also be able to examine what they did and assess if this is a path that
we want to take or something we wish to avoid.
• Studying history connects us to something larger than merely subjective
consciousness.
INTRODUCTION
• From time immemorial man has been interested in trying to
control disease. The medicine man, the priest, the herbalist and the
magician, all undertook in various ways to cure man's disease
and/or to bring relief to the sick. It has been truly said that
medicine was conceived in sympathy and born out of necessity.

3. Public Health according to Charles-Edward
Amory Winslow (1920)
“the science and art of preventing disease, prolonging life, and promoting physical health and
efficiency through organized community efforts for the sanitation of the environment, the control
of community infections, the education of the individual in principles of personal hygiene, the
organization of medical and nursing service for the early diagnosis and preventive treatment of
disease, and the development of the social machinery which will ensure to every individual in the
community a standard of living adequate for the maintenance of health”.
Health according to WHO “the state of complete physical, mental and social well-
being and not merely the absence of a disease or infirmity.”
Health according to Ottawa Charter for Health Promotion
(1986)“resource for everyday life, not the objective of daily living. Health is a positive concept
emphasizing social and personal resources as well as physical capacities.”

4. ANCIENT ERA OF MEDICINE OR PRIMITIVE
MEDICINE
As centuries rolled on , civilisations' emerged in various regions , each civilisation
having its own characteristic culture and life style. Every civilisation had a different
hypothesis on health.
 Health was considered as a state of balance between various humors of human
body, variously defined by various cultures.
 Disease were believed to result from a state of imbalance caused by disturbance in the
relative proportion of these humors.
CERTAIN THEORIES OF ANCIENT ERA
DEMONISTIC THEORY - Indivisuals suffering from disease were possessed by demons
(Demons were usually evil).
FATALISTIC THEORY - God rewards or punishes indivisuals on basis of their good and
evil deeds.
CHARMS THEORY - Good spirits bring health & prosperity (Evils spirits bring
upon wrath).

5. • early civilization looked at diseases from a supernatural
perspective.
• pre-historic peoples apparently adopted “health-related
practices” not for health reasons but more for religious
purposes. After all, as mentioned previously, health or
disease is seen as a “divine act”.
Shamans – medicine man
 The use of medicinal herbs, usually gathered by
most probably the women in the tribe.
 The use of amulets, charms or spells that would
supposedly ward off evil spirits that would cause
the illness.
 The conduct of ceremonies that would appease the
gods or supernatural beings and eventually revert
the curse that caused the ill-ness.
 Giving advice to individuals on how to maintain an
illness-free life.

6. INDIAN MEDICINE
 Dhanvantari : Hindu god of medicine.
Ayurveda: meaning “the science of life” is the indigenous system of Indian medicine
Ayurveda originated from Atharvaveda.
Siddha: practiced in Tamil speaking areas of south India.
Yoga: the key to a longer and healthy life is and was a basic component of health care
WORKING HYPOTHESIS
Tri – dosa: Vata (wind), Pita (gall), kapha (mucus)
LEADING PERSONALITIES
 Atreya : first Indian physician &teacher
 Charaka : Composed charaka samhita. Known
as “father of Indianmedicine”
 Sushuruta : composed sushuruta samhita (which describes various operative
procedures & techiniques of plastic surgery). Knownas “father of Indian
Surgery”

7. CHINESE MEDICINE
WORKING HYPOTHESIS
Five fold system : EARTH, METAL, WATER, WOOD & FIRE (Each related to
five firm organs : Heart, Spleen, Lungs, Liver, Kidney
Celestial emperors: Qi (Spiritual power or energy)
 Huang Ti : developed medical facilities
 Nei Ching : a classic master of internal medicine
LEADING PERSONALITIES
EGYPTIAN MEDICINE
WORKING HYPOTHESIS
They believed that the natural history of disease starts with the
food consumed by an individual.
LEADING PERSONALITIES
 Imhotep : was considered a master in all fields of learning and medicine.
He developed a deep sense of sanitation among the Egyptians.

8. GREEK MEDICINEWORKING HYPOTHESIS
4 fold system : Blood, Phlegm, Black bile & Yellow bile
Each possessing properties of Heat, cold, moisture and dryness respectively.
Greek God of medicine APPOLO
The staff of Aesculapius -> CADUCACEUS
AESCULAPIUS
HYGEIA : Goddess of Hygiene -> PREVENTIVE MEDICINE
PANACEA : Goddess of Treatment ->CLINICAL MEDICINE
LEADING PERSONALITIES
ROMAN MEDICINEWORKING HYPOTHESIS
(Describing Warmth and cold)
LEADING PERSONALITIES
 Galen : He produced some 500 treatise which were
studied for around 14 centuries.
 Celsus : A surgeon who developed method for controlof Hemorrhage and Infection.
Galen - foundation for the study of Human Anatomy

9. ARABIAN MEDICINE
 Rhazes : produced over 200 medical and philosophical treatise
 Avicenna: Compiled the “canon of medicine” for general practitioners
 Ibn. An. Nafis : Investigator and writer. He is known to conceive the idea of pulmonary circulation.
LEADING PERSONALITIES
Unani medicine, also called Unani tibb, Arabian medicine, or Islamic medicine, a traditional system of
healing and health maintenance observed in South Asia. The origins of Unani medicine are found in
the doctrines of the ancient Greek physicians Hippocrates and Galen.
They developed UNANI system of medicine
MESOPOTAMIAN MEDICINE
WORKING HYPOTHESIS
Liver was considered as the seat of life. There were interpretations of dreams relating them to
disease.
Medical practice was rigidly codified, starting with Hammurabi's Code in the 18th century BC and
persisting to the late 1st millennium BC.
LEADING PERSONALITIES
Gula, also known as Nintinugga, Ninkarrak, Meme, Bau, and Ninisina, is the Mesopotamian
goddess of healing and the divine patroness of doctors and medicine-workers.

10. THEORIES OF THE MODERN ERA OF
MEDICINE
Miasmi - Toxic vapor or miasma emanated from decaying animal & vegetable
matter are diffused into the surrounding and spread al sort of disease.
Contagion/ GERM - This theory held that epidemics resulted from transmission of
germs.
Spontaneous generation Or Abiogenesis - Twas originally propounded by
Aristotle, who believed that living organisms directly emerged from non living
organisms. Later the theory was displaced by theory of biogenesis, i.e., “Life
originates from life” by Louis Pasteur.

11. 1500 BC LEVITICUS - It is believed to be the first written health code inworld. The book dealt with
personal and community responsibilities and included guidance regarding cleanliness of body, sexual
health behaviors & protection against contagious diseases.
THE CODE OF HAMMURABI - Created by the King of Babylon, is one of the earliest sets of laws found. It
focuses on theft, farming, Human rights, murder, death and injury. There was also a documented code for
physicians and health practices. There was also evidence of bathrooms and drains in homes as well as
written medical prescriptions
HIPPOCRATES 460 – 375 B.C. - Introduced Scientific methods to the study of medicine. His famous oath,
the "Hippocratic oath "has become the keystone of medical ethics. Hippocrates will always be regarded as
one of the “masters of the medicalart”.
THE ROMANIAN PRE-MATH - Also during this period, Greeks were active in the practice of
community sanitation. Romans improved upon Greek engineering in the building of aqueducts to
protect watersupplies. They alsocreated the first hospital.
MIDDLE AGE 500AD-1500AD - The Middle Ages, also knownas "The Dark Ages”. Health problems were
considered to have spiritual causes andsolutions. Bloodletting and alchemy werecommon practices. Most
importantly, the failure was to consider the role of the environment in health that led to epidemics and thus
resulting in inability to controlthem.

12. Black Plague
 Also known as the Bubonic Plague, it
decimated one third of Europe’s population
over the span of 5 years.
 The disease was caused by a bacteria, Yersinia
pestis, transmitted through flea bites.
 The outbreak started in China and through
the trade routes the disease was brought to
Europe. According to historical records, the
Bubonic plague arrived in Europe by sea via
when Genoese trading ships that sailed
through the Black Sea docked at the port of
Sicily in Messina carrying the bodies of dead
seafarers. Those who were not yet dead were
gravely ill. And because they were covered
with black boils, the disease was called “Black
Death”.

13. “Dark Ages” or “Middle Ages”
 Landlords or serfs replaced monarchs and villages which were once
part of huge city-states conglomerated to form what was known as a
feudal system. Landlords protected the villages and built forts which
later evolved into castles in order to provide defense from potential
invaders or plunderers.
 Early Christian monks and philosophers preserved Roman and Greek
ideologies through preservation efforts most of which occurred within
monasteries.
 these monasteries established hospices that would cater to traveling
pilgrims who would either get sick along the way.
Quarantine - quaranta giorni, meaning 'Forty days'
 This was practiced as a measure of disease prevention related to
the Black Death.
 Venice took the lead in measures to check the spread of plague,
having appointed three guardians of public health in the first
years of the Black Death (1348).

14. Industrial Revolution
 Edwin Chadwick, Secretary of the England's
Poor Law Commission, wrote “Report on the
Inquiry into Sanitary Conditions of the Laboring
Population of Great Britain”. It revealed the
results of the Commission’s study on the
prevalence and causation of preventable
diseases, particularly of the working poor
in England.
 Among the many challenges faced by
England during this time was the cholera
outbreak. Historians would argue that the
Cholera outbreak that started in 1831
eventually killed more people in England
than the Black Plague. Dr. John Snow finally
was able to elucidate how Cholera was
transmitted by tracing the source.

15. Post World War 2
 1948 – WHO was established
 1976 – Ebola virus was discovered
 1977 – smallpox was totally
eradicated
 1978 – Declaration of Alma Ata on
Primary health care (PHC)
 1982 – UNICEF came up with GOBI
as an alternative to PHC
 1980’s – HIV/AIDS
 1997 – Avian Flu -A(H5N1)
 1998 – Swine Flu
 21st century – resurgence of vaccine
preventable diseases

16. COMMUNITY MEDICINE
 With the emergence of Non-communicable diseases and due to their multifactorial etiology,
the concept of “MULTIFACTORIAL DISEASE CAUSATION” came into vogue.
 So, measures like early diagnosis, identification of risk factors, limiting the development of
disability and rehabilitation of handicapped persons were included into the subject.
 Thus the scope was broadened from – HYGIENE  PUBLIC HEALTH PREVENTIVE AND SOCIAL
MEDICINE  COMMUNITY MEDICINE
PREVENTIVE MEDICINE: Definition: (By Leavell and Clark) “The science and art of preventing
disease, prolonging life, promoting physical and mental health and efficiency.”
• James Lind conclusively showed in 1748 that scurvy can be prevented by the use of fresh citrus
fruits and vegetables.
• Edward Jenner discovered small pox vaccine.
• Thus the concept of ‘Preventive Medicine’ came.
• And the scope of Preventive Medicine was broadened from the general measures of health
promotion (hygiene) to specific measures of disease prevention (immunization).

17. CONCLUSION
 The Era highlighted thevalue of a healthyand productive population, leading to advances in
occupational health.
 A milestone in the history of public health is the Great Sanitary awakening which took place in England
& gradually spread to other countries.
 Term Public Health came in to general use around 1840’s. It arose from need to protect the public from
the spread of communicable diseases In 1848 (Cholera in London).
 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.
 Preventive medicine really dates back to the 18th century. It developed as a branch of medicine distinct
from Public Health. Preventive Medicine got a firm foundation after the discovery of causative agents of
disease and establishment of the Germ Theory of disease.

18. REFERENCE
• Chave, S. P. W. 1984. "The Origins and Development of Public Health." In Oxford
Textbook of Public Health, Vol. 1: History, Determinants, Scope, and Strategies,
W. W. Holland, editor; , R. Detels, editor; , and G. Knox, editor. , eds. Oxford
Medical Publications, Oxford University Press, New York.
• Fee, Elizabeth. 1987. Disease and Discovery: A History of the Johns Hopkins
School of Hygiene and Public Health 1916–1939. Johns Hopkins University Press,
Baltimore.
• Goudsblom, Johan. 1986. "Public Health and the Civilizing Process." The Milbank
Quarterly 64(2):161–88.
• Hanlon, G., and J. Pickett. 1984. Public Health Administration and Practice. Times
Mirror/Mosby.
• Winslow, C. E. A. 1923. The Evolution and Significance of the Modern Public
Health Campaign.