Evolution of Health Care Delivery Notes

Evolution of Health Care Delivery

Prehistoric and Ancient Medicine

  • Prehistoric people treated wounds by:
    • Immersion in cool water
    • Applying mud to irritated areas
    • Sucking stings
    • Licking wounds
    • Exerting pressure on wounds to stop bleeding
  • Medical treatment in prehistoric times was intertwined with religion and magic.
    • Tribal healers employed methods such as sucking, bleeding, fumigating, steam baths, and medicinal herbs.
  • Mesopotamians: Considered the liver the "seat of life".
  • Ancient Hebrews:
    • Believed disease was a divine punishment or a mark of sin.
    • In the 4th century, they considered disease an imbalance of the four humors: phlegm, blood, yellow bile, and black bile.
  • Ancient Egypt:
    • Deities were associated with health, illness, and death (e.g., Isis, Hathor, Keket).
      • Isis: Healing goddess.
      • Hathor: Mistress of heaven and protector of women during childbirth.
      • Keket: Fertility.
    • Embalming practices linked anatomy and physiology with theology.
    • Pharmaceuticals included pills, cake suppositories, enemas, ointments, drops, gargles, and fumigation.
    • Drugs were derived from vegetable, mineral, and animal substances, including imported materials like saffron, cinnamon, perfumes, spices, sandalwood, gums, and antimony.
  • Ancient India:
    • Life was viewed as an eternal cycle of creation, preservation, and destruction.
    • Detected diabetes by the sweetness of urine.
    • Treatments included tourniquets for snakebites.
    • Performed surgeries such as nose, earlobe, harelip, and hernia repairs, as well as cesarean sections.
  • Ancient China:
    • Emphasized harmony—balance of yin and yang; Tao was considered the way.
    • Confucius forbade dissections.
    • Nei Ching articulated five methods of treatment:
      • Cure the spirit.
      • Nourish the body.
      • Give medications.
      • Treat the whole body.
    • Practiced acupuncture and moxibustion.
    • Treatment modalities included exercise, physical therapy, massage, and medicinal herbs (trees, insects, stones, and grains).
    • In the 11th century, developed an inoculation against smallpox.

Ancient Greece

  • Built healing temples of Asclepios in Thessaly.
    • Tholos: Round building encircled a pool or sacred spring of water for purification.
    • Abaton: Building for incubation site where cure take place.
  • Healing rituals began after sundown and often involved fasting or abstinence from certain food or wine.

Pre-Hippocratic Medicine

  • Thales: Basic element in all animal and plant life was water, from which came the earth and air.
  • Anaximander: Living creatures originated in water.
  • Anaximenes: Air is necessary for life.
  • Heraclitus: Fire principal element of life.
  • 6th century BC: earth, air, fire and water are basic component of life

Hippocrates

  • Known as the "father of medicine".
  • Revolutionized medicine, turning it into an objective science.
  • Stressed purity and holiness for those practicing medicine.
  • Taught:
    • Observe all.
    • Study the patient rather than the disease.
    • Evaluate honestly.
    • Assist nature.
  • Addressed mental illness, anxiety, and depression.

Christianity

  • Emphasized the healing message of Christ.
  • Healing was not differentiated into physical, mental, or spiritual realms.
  • Luke the physician is a notable figure.
  • Christian faith promoted compassion, forgiveness, and concern for the unfortunate.
  • Roman Emperor Constantine founded a hospital in the fourth century; other hospitals were established by the Christian community in Caesarea, Edessa, and Bethlehem.
  • The Crusades led to the distribution of diseases like leprosy, typhus, and smallpox.
  • 1347 - Bubonic plague.

The Renaissance

  • Paracelsus: Father of pharmacology.
  • Jean Fernel:
    • Physiology, pathology, and therapeutics became standard disciplines of medicine.
    • First suggested that gonorrhea and syphilis are separate diseases.
  • Ambroise Pare: Forerunner of clinical surgery.
  • Andreas Versalius: Father of anatomy.
  • Iatrochemistry: Combination of alchemy, medicine, and chemistry.
  • Jan Baptista van Helmont: First measurement of the relative weight of urine.
  • Galileo: Presented laws of motion in a mathematical manner.
  • Isaac Newton: Discovered gravity.
  • William Harvey: Determined continuous circulation of blood in body system.
  • Christian Huygens: Introduced centigrade system for measuring temperature.
  • Gabriel Daniel Fahrenheit: Developed the Fahrenheit system of measuring temperature.
  • Marcello Malpighi and Anton van Leeuwenhoek: Forerunners in the invention of the microscope.
  • Quinine: Discovered as a treatment for malaria.
  • Leonardo da Vinci: Explored human anatomy through dissections.

18th Century

  • Albrecht von Haller: In-depth studies of the nervous system; discovered the relationship of the brain cortex to peripheral nerves, and became founder of modern physiologic theory.
  • Lazzaro Spallanzani: Pioneer of experimental fertilization.
  • Stephen Hales: Demonstrated blood circulation, stressed importance of the capillary system, and became the first person to record blood pressure with manometer.
  • Giovanni Battista Morgagni: Father of pathology; correlated anatomy with pathology.
  • Edward Jenner: Developed smallpox vaccination.
  • William Hunter: Specialist in obstetrics, founded the Great Windmill Street School of Anatomy, the first medical school in London.
  • John Hunter: Experimental surgeon; developed a method of closing off aneurysms; pioneer in comparative anatomy.
  • Philippe Pinel: Advocated humane treatment at Asylum de Bicetre near Paris (care and treatment for mentally ill patients).

19th Century

  • Autopsies were the major focus of medicine.
  • Carl Rokitansky: Most outstanding morphologic pathologist of his time.
  • Rudolf Virchow: Proposed that all cells come from other cells.
  • Claude Bernard:
    • Founder of experimental physiology; discovered the principle of homeostasis.
    • Clarified liver functions, studied pancreatic digestive activities, and linked the pancreas with diabetes.
    • Pioneered and established the specialty of internal medicine.
  • Rene-Theophile Hyacinthe Laennec:
    • Advanced pathologic and clinical understanding of chest diseases (emphysema, bronchiectasis, tuberculosis).
    • Pioneer in the invention and use of the stethoscope.
  • Ephraim McDowell: Performed the first successful abdominal surgery, removing a huge cyst from an ovary.
  • J. Marion Sims:
    • Laid the foundation for gynecology, founded the Women's Hospital of the State of New York.
    • Invented the Sims position, speculum, and catheter.
  • 1831: Nitrous oxide gas and chloroform were discovered but not yet put into practice.
  • Joseph Priestly: Discovered nitrous oxide gas; Humphry Davy suggested its use in surgery but was ignored.
  • Crawford W. Long: Used sulfuric ether during surgery in 1842.
  • Joseph Lister:
    • Discovered that bacteria were often the origin of disease.
    • Promoted safe surgical procedures.
  • Louis Pasteur: Germ theory of disease; explained the effectiveness of asepsis and antisepsis.
  • Robert Koch: Extensive research into microorganisms; founded bacteriology.
  • Benjamin Rush: First American Psychiatrist.
  • William Beaumonth: First prominent American Physiologist.
  • Gregor Mendel: Foundation of modern genetics through experiments on heredity of plants.
  • Wilhelm Conrad Roentgen: Discovered x-rays on November 8, 1895.
  • Pierre and Marie Curie: Discovered radium; provided the foundation for using radioactivity in treating disease.

20th Century

  • Major Walter Reed: Eradicated yellow fever.
  • Paul Ehrlich: Father of chemotherapy.
  • Pavlov: Extensive research on the process of digestion.
  • Abel, Rowntree, and Turner: Invented the first artificial kidney that led to dialysis.
  • Willem Einthoven: Made the first electrocardiogram.
  • Hans Burger: Invented the electroencephalogram.
  • Lind, Eijkman, Hopkins, Szent-Gyorgi, and Funk: Defined and isolated vitamins, describing their role in life processes.
  • Surgical techniques were refined.
  • The electron microscope was invented in 1930.
  • Salk vaccine virtually eliminated poliomyelitis.
  • Watson and Crick: Accurately described the deoxyribonucleic acid (DNA) molecule in 1962.
  • Christiaan Barnard: Performed the first successful human heart transplant.
  • Advancements in computers and imaging equipment.
  • Major transplants became possible.
  • Coronary bypass surgery became common.
  • Arthroscopic and Laparoscopic surgery were developed.
  • Lithotripsy was introduced.
  • Use of Lasers in medicine.
  • Artificial hips and knees were developed.
  • Improvements in Plastic surgery.

21st Century

  • Rapid expansion of technology and information.
  • Research into genetics has greatly expanded our knowledge about heredity.
  • Biotechnology.
  • Robotic surgery (less blood, faster recovery, fewer complications).
  • The electrical conduction system of the heart has been mapped.

Health and Disease

  • WHO definition of health: "State of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity."
  • Disease: a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms
  • Mortality: Death rate.
  • Morbidity: Occurrence of disease or condition.
  • Health care is affected by social forces, ethical issues, and economic forces.

Risk Factors and Primary Causes of Death

  • Heart Disease:
    • Sedentary lifestyle
    • Cigarette smoking
    • Hypertension
    • Obesity
    • Diabetes
    • High Cholesterol
  • Cancer:
    • Cigarette smoking
    • Positive stool occult blood
    • Failure to perform breast self-examination
    • Failure to have Papanicolaou tests (Pap smears)
  • Cerebrovascular Disease:
    • Cigarette smoking
    • Hypertension
    • High cholesterol
  • Accidents:
    • Failure to use seat belts
    • High alcohol use
  • Chronic Lower Respiratory Disease:
    • Cigarette Smoking

Professionalism

  • Professionalism should not be your goal; rather, professionalism is the path to follow toward your other goals.
  • True professionals rise to meet the challenges. They treat patients as guests and send them on their way feeling as if each one was the most important person cared for that day.
  • Training tells you how to do something, but education tells you why you are doing it.
  • "For I will restore health to you and heal you of your wounds,' says the Lord," -Jeremiah 30:17