HISTORICAL ASPECT OF COMMUNITY MEDICNE

PRESENTED BY:NARENDRA SINGH CHAUHANPG (NEW)DEPT OF COMMUNITY MEDICNE

HISTORY OF MEDICINE

• MEDICINE IN ANTIQUITY

• DAWN OF SCIENTICIFC MEDICNE

• MODERN MEDCINE

• MEDICAL REVOLUTION

Starting with our glorious past…

From the time of appearance of human beings we are trying our best for a healthy life …..

For which we are trying to take control over the diseases and promote healthy behavior which after a long struggle give rise to community medicine.

MEDICINE IN ANTIQUITY

Medicine was dominated by magical and religious beliefs which were an integral part of ancient cultures and civilization.

Medicine consisted of appeasing God, rituals, sacrifices.

Treatment was by priests ,witch doctors and prayer men.

PRIMITIVE MEDICINE

It has been truly said that medicine was conceived in sympathy and born out of necessity.

The primitive man attributed disease, and in fact all human suffering and other calamities, to the wrath of gods, the invasion of body by “evil spirits” and the malevolent influence of stars and planets.

The concept of disease is known as “ supernatural theory of disease”.

TRADTIONAL HEALERS• The administration of certain herbs or

drugs whose effect is doubtful or nil, but hopefully harmless, may also be likened to a kind of magic ritual associated with the need to “do something”.

• Although primitive man may be extinct, his progeny the so-called “traditional healers” are found everywhere.

INDIAN MEDICINE(5000 BC)

The Ayurveda practised throughout India CALLED AS KNOWLEDGE OF LIFE.

The Siddha systems practised in the Tamil-speaking areas of South India.

Dhanvantari is known as the God of medicine.T/t by diet and venesection and hygiene

Tridosha theory of disease-vatt, pitt, kaph

Susruta father of Indian surgery.“Though this work is mainly devoted to

surgery, it also includes medicine, pathology, anatomy midwifery, ophthalmology, hygiene and bedside manners.

LAW OF MANU

Hygiene was given an important place in ancient Indian medicine.

The laws of Manu were a code of personal hygiene.

Archaeological excavations at Mohenjo-Daro and Harappa in the Indus valley revealed rather advanced knowledge of sanitation, water supply and engineering .

CHINESE MEDICINE (2700 BC)

Concept of early preventive medicinePioneers of immunizationYang and yin theory of diseaseBare-foot doctors

The great doctor is one who treats not someone who is already ill but someone not yet ill

EYGYPTIAN MEDICINE (2000 BC)

Art of medicine mingled with religion Concept of Specialization

Pulse – “the speech of the heart”Disease come from intestinal putrefactionBuilt planned cities, public baths and underground drains. They also had knowledge of inoculation against smallpox,

the value of mosquito nets and the association of plague with rats.

GREEK MEDICINE (460-136 BC)

Thinking begun as “Why” and “How”Aesculapius two daughters:Hygeia was worshipped as the goddess of

health Panacea as the goddess of medicine• Panacea and Hygiea gave rise to dynasties: 1. healers (curative medicine) 2. hygienists (preventive medicine) with different philosophies.

Cont.…..

Hippocrates (460 – 370 BC) – “Father of Medicine”

Epidemiologist – Climate, Water, Clothing, Diet, Habits (eating & drinking)

Relationship b/w man and environment – indicators of public health.

GREEK THEORY

ROMAN MEDICINE (First century BC)

They had a keen sense of sanitation.Public health was born in Rome with the

development of baths, sewers and aqueducts.Borrowed from Greeks Disease from two humors –bile and phlegm.T/t –regulation of diet ,blood letting, folk loreLeading authorities-Galen -Celsus

GALEN

MIDDLE AGES/DARK AGES(500-1500AD)

Europe was ravaged by epidemics.

The practice of medicine reverted back to primitive medicine dominated by superstition and dogma.

Rejection of the body and glorification of the spirit became the accepted pattern of behaviour.

The medieval period is therefore called the “ Dark Ages of Medicine ” – a time of great strife, of socio-political changes, of regression and progression.

DAWN OF SCIENTIFIC MEDICINE(after 1500 AD)

marked by political, industrial, religious and medical revolution

Revival of medicine happened from 1453-1600

Paracelcius, Vesalius,Fracastorius (theory of contagion and FOUNDER of EPIDEMIOLOGY)

17th and 18th century were full of discoveries: LIKE•

William Harvey • Harvey is famous for his discovery that blood circulates around the human body and it flows in one direction.

Edward Jenner(1749-1823)

ANTONVON LEEUWENHOEK

Revival of Medicine

Revival of medicine

Sanitary Awakening

Rise of Public Health

Germ Theory of Disease

SANITARY AWAKENING Great Sanitary Awakening – Mid nineteenth in

EnglandEra of Public Health

Problems of 18 CenturyCreation of Slums, overcrowding, accumulation of

filth, high sickness and death rates, infectious diseaseAverage age – 44 yrs.Public Health Act of 1848 – EnglandAmerican Public Health Association in 1872

RISE OF PUBLIC HEALTH

Sanitary awakening lead to the birth of the concept of public health in England.

The Public Health administration in India actually started in 1869 with the appointment of a Sanitary Commission.

The first Municipal Act was passed in 1884 in Bengal.

John Simon(1816-1904) the 1st medical officer of public health in London built up a system of public health which became the admiration of the rest of the world.

By the beginning of 20th century the broad foundations of public health were laid.

John Snow(1813-1858), the Father of Public Health

• Effectively brought an end to the 1854 epidemic in Soho, London by demonstrating only those who drank from the infected Broad Street pump contracted the disease.

MODERN MEDICINE no longer merely treatment of sickness. important goals which have emerged are prevention of disease , promotion

of health and improvement of the quality of life of individuals and groups or communities .

By the end of 19th century PREVENTIVE/PUBLIC HEALTH CURATIVE

After 1900 medicine moved towards specialization , infectious diseases were cured by antibiotics

Development of MULTIFACTORIAL CAUSATION OF DISEASE .

BIRTH OF PREVENTIVE MEDICINE dates back to 18th centuryBut it got firm foundation

after the discovery of GERM THEORY OF DISEASE by Louis Pasteur

the discovery of vaccines strengthened Preventive medicine.

PREVENTIVE MEDICINE

Preventive medicine is the science and art of preventing disease, prolonging life and promoting physical and mental health and efficiency

Besides communicable diseases, it is concerned with environmental, social, economic and more general aspects of the prevention of the disease

GROWTH OF PREVENTIVE MEDICINE

Preventive medicine now grew distinctly from public health as it was applied to healthy people.

small pox eradication in 1977 was the greatest achievement

Discoveries in the field of nutrition and insecticidal agents led to the prevention of nutritional deficiency disorders led to the control of vector borne diseases.

Discovery of drugs enriched preventive medicine.

With this growth: the concept of disease eradication and screening of diseases grew.

SOCIAL MEDICINE

visualized as evolution of medicine It is defined as study of man as a social being

in his environment.It stands on two pillars – medicine and

sociologyIt is concerned with a body of knowledge

embodied in epidemiology and the study of medical needs and medical care of society.

CONCEPTS IN PUBLIC HEALTH

Disease Control Phase (1880 – 1920)

Health Promotio

nal Phases (1920 – 1960)

Social Engineering

Phase (1960 – 1980)

Health for All Phase (1981 –

2000)

DISEASE CONTROL PHASE(1880-1920)-

Sanitary legislations and reforms aimed at the control of mans physical environment.

HEALTH PROMOTIONAL PHASE(1920-1960)-

Two movements were initiated during this phase

1. Provision of Basic Health care services through PHC and subcentre.

2. Community Development Program through active participation of the community

SOCIAL ENGINEERING PHASE (1960-1980)

with the advent of chronic diseases and the concept of risk theory public health moved into preventive and rehabilitative mode.

goals of Public Health and Preventive medicine became identical i.e. prevention of disease, promotion of health and prolongation of life.

The term COMMUNITY HEALTH thus came into being .

HEALTH FOR ALL(1981-2000)-

In 1981 WHO pledged “Health For All" by 2000 to bridge the gap between developing and developed countries. To achieve this goal the concept of PRIMARY HEALTH CARE was started.

Currently WHO is working on the Millennium Development Goal.

Started by Dr. Francois this concept with the plea that with specialization, medicine has ignored personalized care and a patient now needs family physician.

It is a field of specialization that is neither disease oriented nor organ oriented.

It is health care centered on the family as a unit-from prevention to rehabilitation.

MEDICAL REVOLUTION• STATE OF ART:Medicine has moved from organism to organ and from organ

to the cell, and from cell to the molecular properties.It has acquired a promise vast body of knowledge and has

become highly technical, with concept of:• 1. genetic Counselling • 2. genetic engineering• 3. organ transplantation• 4. prenatal diagnosis of genetic diseases

Modern medicine has entered a new evolutionary stage with the promise of continued improvement in medical capabilities to preserve life , if not merely to solve the problems of sickness.

FAILURE OF MEDICINEMedicine as practiced today has begun to be

questioned and criticized.Some critics have even described modern medicine

as threat to heath.High technology medicine seems to be getting out of

hand and leading health systems in wrong direction, vis away from the health promotion for the many and toward expensive treatment for the few.

There is an increasing concern about cost and allocation of health resources but the efficacy of the modern medicine is fundamentally questioned.

This has been called as the failure of success.

SOCIAL CONTROL OF MEDICINEVIRCHOW In 1849 wrote that “medicine is a social

science and politics is medicine on a large scale”.As the cost of medical care increased two kind of

medical care came in to existence one for rich and other for the poor.

Russia was the first country to socialize medicine completely and to give its citizen a constitutional right to all health services.

Socialization eliminates the competition among physicians in search of clients. It ensures social equality that is universal coverage by health services.

HEALTH BY THE PEOPLE

The process by which individuals and families assume responsibility for their own health and welfare and for those of the community and develop the capacity to contribute to their and the community development.

It also implies community participation in the planning, organization and management of their own health services.

This is simply called as the health by the people.

COMMUNITY MEDICINE It’s a newcomer in the field of medicine.The field concerned with the study of health

and disease in the population of a defined community or group.

Its goal is to identify the health problems and needs of defined populations (community diagnosis) and to plan, implement and evaluate the extent to which health measures effectively met these needs.

• If we want to achieve Health For All, Community Medicine will definitely be the key factor during the next millennium.

SOCIAL INJUSTICE

• The “explosion” of knowledge during the 20th century has made medicine more complex, and treatment more costly, but the benefits of modern medicine have not yet penetrated the social periphery in many countries.

• The glaring contrasts in the state of health between the developed and developing countries, between the rural and urban areas, and between the rich and poor have attracted worldwide criticism as “ social injustice ”.