History of community medicine

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Origin of Community Medicine


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COMMUNITY MEDICNE Dr Bayapa Reddy N Associate Professor Dept of Community Medicine 10/12/2016 Dr NBR Com Med AIMSR


HISTORICAL ASPECT OF COMMUNITY MEDICNE Those who fail to read history are destined to suffer the repetition of its mistakes 10/12/2016 Dr NBR Com Med AIMSR


10/12/2016 Dr NBR Com Med AIMSR

Starting with our glorious past…:

Starting with our glorious past… From the time of appearance of human beings we are trying our best for a healthy life ….. 10/12/2016 Dr NBR Com Med AIMSR


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 . 10/12/2016 Dr NBR Com Med AIMSR


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. 10/12/2016 Dr NBR Com Med AIMSR


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 ” . 10/12/2016 Dr NBR Com Med AIMSR


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 . 10/12/2016 Dr NBR Com Med AIMSR


INDIAN MEDICINE(5000 BC) 10/12/2016 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 Dr NBR Com Med AIMSR

Indian medicine conti….:

Indian medicine conti …. Unani-Tibb and Homoeopathy, which are not of Indian origin. The Unani-Tibb system of medicine, was introduced into India by the Muslim rulers about the 10 th century A.D. Unani system of medicine was firmly entrenched in certain towns and cities Homoeopathy is practised in several countries These continue to be an important source of medical relief to the rural population 10/12/2016 Dr NBR Com Med AIMSR

Tridosha theory of disease-vata, pitta, kapha:

Tridosha theory of disease- vata , pitta, kapha 10/12/2016 Dr NBR Com Med AIMSR


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. 10/12/2016 Dr NBR Com Med AIMSR


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 . 10/12/2016 Dr NBR Com Med AIMSR


Concept of early preventive medicine Pioneers of immunization Yang and yin theory of disease Bare-foot doctors Hygiene , Dietetics, hydro- theraphy & Massage The great doctor is one who treats not someone who is already ill but someone not yet ill CHINESE MEDICINE (2700 BC ) 10/12/2016 Dr NBR Com Med AIMSR


EYGYPTIAN MEDICINE (2000 BC) Lot is known: Since they invented picture writing & recorded on papyrus (plant) Art of medicine mingled with religion   Concept of Specialization Pulse – “the speech of the heart” Disease come from intestinal putrefaction Built 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 . 10/12/2016 Dr NBR Com Med AIMSR


Mesopotamian medicine: ( betwn euphrate & tigris rivers – now part of Iraq) Oldest medical prescription – 2100 BC Hammurabi, great king of babylon (2000 BC) -  formed set of drastic laws, code of Hammurabi 1 st codification of medical practice – fees & penalties


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. Panacea : healers (curative medicine) 2. Hygiea : hygienists (preventive medicine) with different philosophies. 10/12/2016 Dr NBR Com Med AIMSR


Hippocrates ( 460-370 B.C.) He studied and classified diseases based on observation and reasoning Father of medicine Challenged the tradition of magic The first true epidemiologist Book : “Airs , Water and Places” – treatise on hygiene " Corpus Hippocraticum “ Greeks rejected the supernatural theory Believed matter to be made up of 4 elements: earth, air, fire & water represented in the body by the 4 humours – phlegm, yellow bile, blood & black bile


GREEK THEORY 10/12/2016 Dr NBR Com Med AIMSR

ROMAN MEDICINE (First century BC):

ROMAN MEDICINE (First century BC) Borrowed from Greeks They had a keen sense of sanitation. Public health was born in Rome with the development of baths, sewers and aqueducts . Built fine roads, hospitals for sick and supplied pure water Disease from two humors –bile and phlegm. T/t –regulation of diet ,blood letting, folk lore Leading authorities-Galen -Celsus 10/12/2016 Dr NBR Com Med AIMSR


GALEN GALEN observed disease is due to three factors Predisposing, Exciting and environment 10/12/2016 Dr NBR Com Med AIMSR


MIDDLE AGES/DARK AGES(500-1500AD) Europe was ravaged by epidemics . Eg ; plague , smallpox, leprosy and tuberculosis. 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 . 10/12/2016 Dr NBR Com Med AIMSR


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 ) transfer of infection via minute particles, Explained epidemic causes, recognized person – person transmission of syphillis 17 th and 18 th century were full of discoveries: LIKE 10/12/2016 Dr NBR Com Med AIMSR Occupational medicine & Industrial Hygiene Father Ambroise pare (1510-1590) – French, ‘‘ father of surgery ’

William Harvey :

William Harvey Harvey is famous for his discovery that blood circulates around the human body and it flows in one direction. 10/12/2016 Dr NBR Com Med AIMSR

Edward Jenner(1749-1823) vaccination small pox (1796):

Edward Jenner(1749-1823 ) vaccination small pox (1796 ) 10/12/2016 Dr NBR Com Med AIMSR



Revival of Medicine :

Revival of Medicine 10/12/2016 Dr NBR Com Med AIMSR


SANITARY AWAKENING Great Sanitary Awakening – Mid nineteenth in England Era of Public Health Problems of 18 Century Creation of Slums, overcrowding, accumulation of filth , high sickness and death rates, infectious disease Average age – 44 yrs. Public Health Act of 1848 – England American Public Health Association in 1872 10/12/2016 Dr NBR Com Med AIMSR


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. 10/12/2016 Dr NBR Com Med AIMSR


John Simon(1816-1904) the 1 st 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 20 th century the broad foundations of public health were laid . 10/12/2016 Dr NBR Com Med AIMSR

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

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. 10/12/2016 Dr NBR Com Med AIMSR


Germ theory of disease: For Long Darkness = supernatural theory, humors by greeks & indians , contagion theory attributing dis. to noxious air 1860: french bacteriologist ‘ Louis Pasteur ’ –(1822-1895) demonstrated presence of bacteria in air 1877: Robert Koch - anthrax was caused by bacteria Microbe after microbe was discovered Gonococcus – 1847, . Typhoid, pneumococcus - 1880 Cholera vibrio – 1883, . Diphtheria bacillus – 1884...


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 19 th century  PREVENTIVE/PUBLIC HEALTH  CURATIVE After 1900 medicine moved towards specialization , infectious diseases were cured by antibiotics Development of MULTIFACTORIAL CAUSATION of disease . 10/12/2016 Dr NBR Com Med AIMSR


BIRTH OF PREVENTIVE MEDICINE Dates back to 18 th century But it got firm foundation after the discovery of GERM THEORY OF DISEASE by Louis Pasteur the discovery of vaccines strengthened Preventive medicine. 10/12/2016 Dr NBR Com Med AIMSR


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 10/12/2016 Dr NBR Com Med AIMSR


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 10/12/2016 Dr NBR Com Med AIMSR


Discoveries in the field of nutrition, nutrients prophylaxis led to the prevention of nutritional deficiency disorders. Discovery of insecticidal agents led to the control of vector borne diseases . and Discovery of drugs enriched preventive medicine. With this growth: the concept of disease eradication and screening of diseases grew. 10/12/2016 Dr NBR Com Med AIMSR


10/12/2016 Dr NBR Com Med AIMSR


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 sociology It is concerned with a body of knowledge embodied in epidemiology and the study of medical needs and medical care of society. 10/12/2016 Dr NBR Com Med AIMSR




DISEASE CONTROL PHASE(1880-1920 )- Sanitary legislations and reforms aimed at the control of mans physical environment. 10/12/2016 Dr NBR Com Med AIMSR


HEALTH PROMOTIONAL PHASE(1920-1960 )- Two movements were initiated during this phase Provision of Basic Health care services through PHC and subcentre. Community Development Program through active participation of the community 10/12/2016 Dr NBR Com Med AIMSR


SOCIAL ENGINEERING PHASE ( 1960-1980) with the advent of chronic diseases and behavioural problems the concept of risk factors, Public health moved into the preventive and rehabilitative approach . 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 . 10/12/2016 Dr NBR Com Med AIMSR

HEALTH FOR ALL(1981-2000)-:

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. 10/12/2016 Dr NBR Com Med AIMSR


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. 10/12/2016 Dr NBR Com Med AIMSR


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. 10/12/2016 Dr NBR Com Med AIMSR


FAILURE OF MEDICINE Medicine 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. 10/12/2016 Dr NBR Com Med AIMSR


SOCIAL CONTROL OF MEDICINE VIRCHOW 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. 10/12/2016 Dr NBR Com Med AIMSR


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. 10/12/2016 Dr NBR Com Med AIMSR


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. 10/12/2016 Dr NBR Com Med AIMSR

Community Medicine:

Community Medicine It is often considered synonymous with preventive and social medicine, public health, and community health. All these share common ground, i.e. prevention of disease and promotion of health Community medicine provides comprehensive health services ranging from preventive, promotive, curative, to rehabilitative services . 10/12/2016 Dr NBR Com Med AIMSR


If we want to achieve Health For All, Community Medicine will definitely be the key factor during the next millennium. 10/12/2016 Dr NBR Com Med AIMSR


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 ”. 10/12/2016 Dr NBR Com Med AIMSR


10/12/2016 Dr NBR Com Med AIMSR

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