Historical aspects community medicine

1. Historical Aspects
Concepts in Community Medicine
Dr Amita Kashyap
Senior Professor
Com. Med, SMS Med College Jaipur

2. Objectives
By the end of these lessons you will be
able to understand:-
•How Community Medicine is
different then Clinical Medicine
•Its evolution
• What is Community Medicine/
Public Health/ Preventive and Social
Medicine and
•Its basic Concepts

3. Importance of Preventive and Social
Medicine/ Public Health
What is common in:-
• Swine flu
• HIV
• Typhoid
• Malaria
• Malnutrition
• Cancer
• Addiction

4. Public health movements
• Started in mid-nineteenth century by Edwin
Chadwick in UK (report on an inquiry into the
sanitary conditions of the labouring
population in great Britain, 1842) and
• around the same time in USA in 1850 by
Lemuel Shattuck (Report of the sanitary
commission of Massachusetts)

5. Renewal of Interest in Prev. Prom.
And Protection of Health!!
Due to:-
• Continued Emergence and Resurgence of
Communicable Diseases and increase in Life-
Style Diseases
• Realization that investment in Clinical Care;
though necessary, bring diminishing results.
• Implementing Public Health Methods; may be
difficult, time-consuming but bring maximum
gains.

6. Clinical vs Preventive
Medicine Medicine
• Cater to individual patient
• Abstract, invisible
• Focus on cure of diseases
and immediate sufferings
• Bring immediate
gratification form patient;
his family and friends and
the community at large.
• Cater to Masses (community)
• concrete, visible
• Focus on promotion and
protection of health and
prevention of diseases
• Results are not easily
recognizable, measurable
and quantifiable!!
< 1% of national health budget is spent on public health

7. Contributions of Community Medicine
• A major driving force in furthering the
cause of human health and development!
• Simple Public Health measures like –
Safe Water Supply, Sanitary Excreta
Disposal, Vaccination and Vector control
measures has saved many more lives
than would have been saved by all the
dazzling advancement of curatives and
diagnostics put together.

8. Contributions of Community Medicine
• Smallpox Eradication
• Guinae worm Eradication
• Polio Eradication
• Elimination of Leprosy
• Elimination of Neonatal Tetanus
• Control of Maternal and Child Mortality and
Morbidity
• Control of IDD, Vit A deficiency, Iron Deficiency
and so on…..
• Improved health planning (policies and system)

9. Medicine
Noted historian Henry Sigerist defined
medicine as:
“Medicine, by providing health and
preventing illness, endeavors to keep
individuals adjusted to their environment
as useful and contented members of
society; or by restoring health and
rehabilitating the former patient, it
endeavors to readjust individuals to their
environment.”

10. Contd……
From this definition, medicine has two
components –
• “The Promotive and Preventive” component &
• “Restorative and Rehabilitative” component
• However there is no sacrosanct dividing line in
practice. A Public Health expert has to adopt
both the components with focus on public
• In broader sense Preventive medicine refers
to “Limiting the progression of disease ”
at any stage of its course………..

11. Contd……..
• Initially, Preventive Medicine was identified
with “Control of Communicable Diseases”
• Subsequently, “Epidemiology”; an
important “Know-how,” included prevention
of Non-Communicable diseases as well.
• With improvement in HE techniques
“Counseling and Behavior Change
Communication” techniques developed as its
tools too.

12. Preventive Medicine & Public health
The dividing line is hazy -
Preventive medicine is an overall science
while Public Health is an approach
When preventive efforts are focused on
population groups and utilizes the
approach of ‘organized community
efforts’ it takes the shape of public health.

13. Public Health
• In public health problems are named
within the context of the community as
a whole.
• This help in establishing Priorities and
Rational use of resources for the benefit
of the health of the population as a
whole by ‘Organized Community Effort’
and ‘Systematic Social Action’

14. Public Health as defined by CEA Winslow
The science and art of preventing disease, prolonging life
and promoting physical health and efficiency; via:-
 Organized community efforts for the sanitation of the ENV.
 Control of community infections,
 Education of individuals in principles of personal hygiene,
 Organization of medical and nursing services for early
diagnosis and preventive treatment of disease and
 Development of social machinery which will ensure to
every individual in the community, a standard of living
adequate for maintenance of health.

15. Preventive and Social Medicine
• Somewhere around the mid 20th century it
was realized that the art & science of
preventing disease and promoting health
should be taught as independent subject
in medical schools (till then it was taught
as hygiene with medicine).
• Rudolph Virchow et al emphasized the
role of social factors in disease causation
and thereby in its prevention. & helped in
origin of Preventive and Social Medicine

16. Preventive and Social Medicine
• The preventive medicine essentially
combine the social aspects of health &
disease in its theory, practice and teaching.
• Socialized Medicine: refers to the policy of
providing complete medical care
(preventive as well as curative), to all
members of the society (usually a nation)
as a Govt. commitment through public
funds.

17. History of Medicine:
Ancient Times
• Primitive Man attributed disease & sufferings to
the wrath of God- “Supernatural theory of disease;”
• Indian medicine:
5000BC- Ayurveda (‘Tridosa Theory) emerged from
“Atharved”
800BC- Atrey (Takshila); great Indian physician &
Teacher
200 AD- Charak (Court physician of king Kaniska);
wrote “Charak Samhita” descibing some 500
drugs;(Rauvolfia before Reserpine).

18. Indian Medicine…..
Up to 400AD- Shushrut k/a ‘Father of Surgery,’
“Shushrut Samhita”; included Surgery, Anatomy, Pathology,
Ophthalmology, Hygiene, medicine and Mid-Wifery
800AD- Charak & Shushrut Samhita translated in Arabic & Persian
languages.
Hygiene was upfront- “Mohan zodaro”
800BC-600AD- Golden Age of Indian Medicine
Set Back in Mughal period
10th Century AD- Unani & Tibb (originated in Greec), introduced
by Muslim Rulers
1810-1839AD- Homeopathy (originated in Germany),

19. Chinese Medicine: (2700 BC) oldest body of
Medical Knowledge
• Principle - “Yang” (Active Masculine Factor)
and “Yin” (negative Feminine Factor)-
balance= Good Health
• Tools were – hygiene, dietetics, hydrotherapy,
massages, immunization and drugs
• Integrated “Traditional Methods” with “Modern
Techniques”
• Gave “Barefoot Doctors” & “Acupuncture”

20. Egyptian Medicine: (“best of all,” – Homer)
The Art of medicine was mingled with Religion
• Specialization prevailed- in ‘eye, tooth, head etc.’
• Principle - absorption of harmful substances from
intestine putrefy blood and formation of pus.
• Tools- Enema, Bloodletting and drugs
• Excelled in Public Health- Built public baths,
underground drains & planned cities.
• Knew association of plague with Rats, skull &
paralysis, worms, diabetes, rheumatism, polio &
smallpox Vaccination
• Recorded their work on ‘papyrus’

21. Greek Medicine:
460BC-136AD- civilizers of the ancient world
• Principle- “Theory of Humor” matter is build up
of four elements- Earth (cold), Air(dry), Fire(hot)
and Water (moist); represented in body by four
humors- phlegm, yellow bile, blood & black bile.
The human body was assumed to have powers
of restoration of humoral equilibrium.
• Hygiea (PH) and Panacea (Curative)were two
daughters of Aesculapius (his staff; entwined by
a serpent continues to be the symbol of
medicine )

22. Greek Medicine……
• Hippocrates (460-370BC)- Challenged magic and
initiated “application of clinical methods”
• He studied & classified diseases based on
observation & reasoning; distinguished endemic
and epidemic diseases; (Epidemiologist seeking
causes).
• Taught us to think “Why & How.” He studied
effect of climate, diet, clothing, water, habits of
eating & drinking on health.
• Established relation between “Man & his
Environment”
• Hippocratic Oath- set standards for ‘practicing
medicine’.

23. Roman Medicine:
• By 1st Century BC center of civilization shifted to
Rome. They built their Medicine on Greek medicine.
• Public health developed- they built fine roads,
sewers, aqueducts, drained marshes to combat
malaria and established Hospitals/ medical schools.
• Galen (130-205AD); - emphasized importance of
Preserving health; (since both in importance & in
time health precedes disease) & curing disease
• He said disease is due to three factors-
– Predisposing, Initiating, & Environmental Factors
• Europeans accepted his writings as Text Books

24. Middle Ages(500-1500AD)- “Dark Age”
• Fall of Roman Empire lead to Abolition of Medical
Schools/ Hospitals
• Medicine reverted back to “magic & superstition”
(T.B., Plague, Leprosy & Smallpox became
rampant)
• Arabs developed “Unani & Tibb” with borrowed
knowledge from Greek & Roman.
• Abu Becr (Bagdad)865-925AD- also k/a “Razes”
published book on child diseases, his book
differentiating smallpox & Measles !!
• Arabs were seeking “Elixir of Life,” hence
Pharmaceutical chemistry developed.
• Built Hospitals with specialized departments.

25. After 1500AD- “Age of Revolutions”
• Fracastorius: Theory of “Contagion” ( transfer of
infection via minute invisible particles):-
Explained the cause of an Epidemic.
Recognized that Syphilis is transmitted via Sex.
• Vesalius- Anatomy & Ambroise Pare- Surgery.
• 1540- united Co. of barber surgeons formed; later
became Royal College of Surgeons.
• 1628- Harvey; discovery of circulation of blood
• 1670- Leeuwenhoek’s microscope
• Morgagni; 1682-1771 founded pathologic Anatomy
• 1796- Jenner’s vaccination against smallpox

26. • 18th Century; Industrial Revolution slums
• Edwin Chedwick’s (a lawyer) report on “the
sanitary conditions of the labouring
population in Great Britain” same time
Shuttak in America.
• 19th Century; “Great Sanitary
awakening.”
• Public health Act 1848- The State has a
direct responsibility for the Health of the
people.

27. • Concept of Public Health emerged properly
with - Jhon Snow’s spot map for cholera deaths
& Willium Budd’s study on Typhoid fever leading to
source of infection even before causative organism
was identified.
• France, Spain, Australia, Germany, Italy, Belgium, &
the Scandinavian countries all developed Public
Health
• Developing Countries- slow growth of PH
• 1945 – WHO, initiated Public Health movements

28. Germ Theory of Disease (1873):
• Louis Pasteur, (1860) showed presence of
bacteria in air, weakened germ for vaccine
• Robert Koch 1877- showed bacteria of Anthrax,
after that; many other were demonstrated-
gonococcus, typhoid, pneumococcus, TB,
Cholera, diphtheria & so on
Preventive Medicine:
James Lind; 1753 for scurvy, Edward Jenner;
1796 developed vaccine for smallpox. In later
part of 19th century many more vaccines
developed.

29. • 1898; Ross demonstrated that malaria
was transmitted by Anopheles, then
Walter Reed et al identified Aedes for
Yellow fever, thus control measures
became specific e.g. – blocking
transmission channels e.g. destruction of
vectors & its breeding places, quarantine.
• With development of Laboratory Methods
“Early Diagnosis & treatment” was also
thought of as preventive measure.

30. • Tissue culture of viruses- Anti Viral Vaccines;
eradication of Smallpox in 1977 (Somalia).
• Discoveries in the field of Nutrition- control of
deficiency diseases.
• Discovery of Synthetic Insecticides.
• Discovery of Sulpha Drugs, Anti malarials, ATT,
Anti Leprosy drugs.
• Development of Chemoprophylaxis and Mass
drug treatment strategies.
• Concept of Screening – Syphilis, TB etc
• Screening for “Risk Factors”& identification of
“High Risk Groups”

31. Changing Concepts in Public Health
• 1880-1920 – Disease Control Phase
• 1920- 1960 – Health Promotional Phase
• 1960-1980 – Social Engineering Phase
• 1981 - 2000 – Health for All Phase
• Preventive Medicine- “health
promotion, Disease Prevention, Disability
limitation & Rehabilitation”