HISTORY OF MEDICINE/ PUBLIC HEALTH

Dr. A.O Aremu

Dept. of Community Medicine

Bowen University Teaching Hospital

Ogbomoso

OUTLINE

• Medicine in the early days

• Changing concepts about diseases causation

• Regional evolution of medicine

• Giants of medicine

• Phases in development of public health

• Public Health in Nigeria

Medicine in the early days5000 B.C

• Primitive medicine is timeless

• Since his knowledge was limited, the early man attributed disease occurrence to the wrath of gods, the invasion of the body by “evil spirits”

• Treatment of diseases involved appeasing gods through prayers, rituals, sacrifices and casting out of “evil spirits”

• The pre-historic man also improvised stone and flint instruments with which he performed circumcisions, amputations.

• Medicine was intermingled with superstitions, religion, magic and witchcraft.

• Traces of this still persist in different parts of the world particularly in Africa, Asia, South America, Australia and the Pacific

• The traditional healer is an example in Nigeria

Changing concepts about disease causation

• Supernatural causation of disease

• Theory of humors-Hipocrates

• Theory of contagion-Fracastoro

• Miasmic theory-Galen

• Germ theory of disease-Luise Pasteur, Kockand Joseph Lister

• Epidemiologic triad

• Concept of multi-factoral causation of disease

Theory of humor

• Human body consist of blood, phlegm, yellow and black biles

• A person will be healthy once the body contains these substances in the right proportion

• All human diseases are caused by phlegm and bile

• Diseases arise when any of them become too much, too hot or too cold

HIPOCRATES

• The substances could become abnormal through contamination by food &water or by exhaustion, wound, sound, light, heat or cold.

• Various diseases were characterized by their symptoms

• E.g Fever was described as quartan, tertian etc based on the number of days of the fever occurrence

• Diseases were also classified

• To rid the body of excess bile or phlegm, methods were devised to induce vomiting or evacuate the bowel

• Veins were opened for blood letting.

• This marked the beginning of the use of purgatives, laxative and phlebotomy which are still being practiced today.

Theory of contagion-Fracastoro

• This theory did not nullify the theory of humor, rather it believed that there was another category of diseases that could be acquired by contagion rather than through humoral imbalance.

• Contagion was described as “corruption gotten by contact with an imperceptible particle”

• He envisaged disease transmission through invisible particles

• The theory could not characterize the nature of the said particle.

• The theory described how contagion could occur by direct contact, by indirect contact via clothes and other substances, and by long-distance transmission

• The differences between diseases were explained by their having different "active principles", i.e. different seeds

• Fracastoro distinguished between different kinds of fevers and explained how syphilis can be transmitted through sexual intercourse

• Cure comes from destroying or expelling the seeds of contagion.

• The seed of contagion can be destroyed through extreme heat and cold& it can be evacuated through bowel movements, urination, sweating, blood-letting, and other methods.

Miasmic theory- Galen

• This theory believed that diseases were caused by a noxious form of “bad air” emanating from rotten organic matter

Germ theory of disease-Luise Pasteur, Kock and Joseph Lister

• Pasteur (and independently the British surgeon Joseph Lister) made the most important mental leap in the history of medicine, pursuing an analogy between fermentation and disease.

• They realized that just as fermentation is caused by yeast and bacteria, so diseases may also be caused by micro-organisms

JOSEPH LISTER• As a surgeon, Lister had

seen many of his patients die from infection.

• Taking a clue from Pasteur idea, Lister (analogically) began to use carbolic acid to sterilize wounds, dramatically dropping the infection rate.

ROBERT KOCH• Koch realized that there

are many different kinds of bacteria, and specific kinds are responsible for specific diseases

• Antibiotic cures for bacterial infections were not developed until the 1930s.

• In the latter half of the nineteenth century (the golden age of bacteriology), researchers identified the microbial causes of many diseases

• The germ theory viewed diseases in terms of a causal network similar to that of Fracastoro, but with much more details about the nature of germs and possible treatments.

Epidemiological Triad

• The germ theory of disease had many limitations. e.g the presence of infectious agent alone may not result into a disease state. e.g TB

• Different factors come into play for an infectious agent to cause a disease.

• Epidemiological triad recognized three of such factors which are: Agent, Host and Environment.

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The Epidemiological Triad

Environment

vectors

Agent Susceptible Host

Multi-factorial causation of Diseases

• Pettenkofer was the lead proponent of this

theory.

• It means multiple factors rather than just three factors recognized by the epidemiologic triad may be responsible for disease causation

• This model is particularly useful in studying the etiologies of NCDs.

• E.g CAD, CANCERS, DM

Web of disease causation

• This was suggested by Mc Mahon and Pugh

• This theory considers all the predisposing factors of any type and their complex interrelationships with each other

• It provides a model of possible interventions

Regional Development of Medicine• Indian Medicine (5000 BC) : Ayuverdic medicine –

based on Tridosha (wind gall and mucus maintenance)-

Indian Medicine believed in Homeopathy

Hygiene was given an important place

• Indian medicine has played important role to the development of Medicine in Asia just as Greek medicine is to the West.

• Chinese Medicine {2700 BC} :

Believed to be world’s organized body of medical knowledge balancing masculine & feminine forces –acupuncture

• It involved balancing the Yang and Ying forces.

• Ying was believed to be the masculine principle while Yang was the feminine principle

• For a man to stay healthy, there must be a balance between the two forces

• The Chinese medicine witnessed the evolution of Immunization. They practiced variolationfor prevention of small pox

• Egyptian Medicine {1150 Bc} :

• They invented picture writing and recorded most of their activities on papyrus

• It was a mixture of preservation medicine and religion- Preservation of dead bodies

• Provided piped water to prevent water borne diseases

• They began specialized medicine

-had eye doctors,

-head doctors and tooth doctors

• They had medical schools called houses of life

• They believed diseases were caused by intestinal absorption of harmful substances

• Diseases were treated using cathartics, enema, blood letting and a range of drugs

• Mesopotamian Medicine: often called the cradle of civilization also the cradle of magic and necromancy

-Medical students were busy classifying demons as the causes of diseases

-Geomancy and hepatoscopic divination

-Formulated a set of drastic laws known as code of Hammurabi which governed medical practice

• Greek Medicine {1200 BC -370 BC} (Aesculapius to Hippocrates) :

• They taught men how to think in terms of “why” and “how”

• They separated religion from medical practice

• They study of aetiologies and epidemics ,sports medicine, personal hygiene , dietetics etc

• They rejected supernatural theory of disease causation and saw disease as a natural process.

• Following after this era was the establishment of the first university in Alexandria Egypt.

• Roman Medicine{130 – 205 AD} (Galen) :

• There was a keen sense of sanitation

-Public health was born in Rome with provision of toilets, sewers, provision of potable water

-Diseases are caused by interplay of existing, predisposing and environmental factors

• Middle Ages{0 AD – 1500AD }

• Also called the Dark ages of medicine

• Followed the fall of Roman empire

• The era witnessed the disappearance of previously established Roman Medical School

• The practice of Medicine reverted back to the primitive era

• The spread of Christianity however led to establishment of hospitals

• Arabic contribution { 7th – 8th centuries} :

• They translated the Greco-Romans Medical literatures to Arabic language and preserve this body of knowledge

• They founded Medical schools and hospitals in Bagdad, Damascus and Cairo.

• The distinction between measles and smallpox was made by Avicenna & Rhaze.

Revival of Medicine 1453-1600 AD

• It was an age of individual scientific achievements

• One of the distinguished scientists of that age

was Paracelsus who revived medicine and turned it to a rational researchable discipline.

Fracastoros was another scientist during this time

GIANTS OF MEDICINE• Edwin Chadwick (1832) -first sanitary inspector in

England• John Snow’s –studied epidemiology of cholera

(1845 -1854)• William Budd (1856)- recognized that infectious

diseases could be contagious- studied typhoid outbreak.

• Sir John Simmons (1816 – 1904)- 1ST medical officer of health for London.

• Hippocrates (460 -370BC) – 1st true epidemiologist, distinguished between epidemic and endemic diseases

Galen (130 -205 AD) – theory of 3 factors, predisposing, enabling and environmental factors

James Lind (1716 -1794) – intake of fresh fruits for the prevention of scurvy-discovery of Vit. C

John Graunt (1620 – 1674) founder of vital statistics

Thomas Sydenham (1624 -1689) –worked on diseases like plague malaria measles etc

-discovered sydenham chorea

Berrnadino Ramazzini (1633 -1714) founder of occupational medicine

• Anthony Van Leeuwenhoek – discovered the microscope

• Percival Pott(1714- 1788) scrotal cancer in chimney sweeps

• Edward Jenner(1749 – 1823)- vaccination against smallpox –father of immunology

• Peter Ludwig Panum (1820 -1880)- studied epidemic of measles in Faroe island

• Louis Pasteur (1822 -1895) –Germ theory of disease also developed vaccines for rabies, anthrax

• Robert koch (1843 -1910) microbiology & infectious disease epidemiology

• Thomas Legg (1898) -1st medical inspector of factories in Britain

• Ronald Ross (1857- 1932) studied transmission of malaria parasite by anopheles mosquito

• Patrick Manson(1844 -1922) transmission of filariasis,

- life cycle of schistosomiasis

• William Harvey-described the circulatory system of man

• Cecillie William: A peadiatrician who worked in Ghana. Major contribution was on prevention and control of PEM

Modern Medicine

• The dichotomy of medical practice into Curative and Preventive medicine started towards the end of the 19th Century

• After the 19th century, medicine moved faster towards specialization

• The pattern of diseases occurrence began to change due to the occurrence of NCDs

• Curative Medicine aimed at removing diseases from an individual

• Preventive medicine focuses on diseases prevention/control among a group of people

• Curative medicine has witnessed upsurge of sophisticated equipments for diagnosis and care

• Specialization has improved medical care significantly but it has also increased cost of care

EVOLUTION

OF

PUBLIC HEALTH

Definition of Public Health

• "the science and art of preventing diseases, prolonging life and promoting health through the organised efforts and informed choices of society, organisations, public and private, communities and individuals.“Winslow

• The early triumph of preventive medicine was in the area of vaccination

• Preventive medicine has grown to have numerous sub- specialties

• Other achievements of preventive medicine

• Discovery of insecticide,

• Discovery of antibiotics,

• Discovery of screening programmes for diseases

• Public Health is currently faced with such challenges as

• Population explosion,

• Emerging and re-emerging disease

• HIV/AIDS

• NCDs

Phases of Public Health Evolution

Disease control phase (1880 – 1920)- era of sanitary reawakening

-The era was characterized by sanitary legislation & sanitary reforms

- Emphasis was placed on control of mans physical environment

Health promotion phase (1920-1960)

-provision of personal health services ; maternal & child health, school health, industrial health, mental health, etc

-provision of primary health centers and sub centers

-inauguration of community development programmes

Phases cont’d• Social engineering phase (1960 -1980)

-priority shifted to social and behavioural aspects of diseases

-emergence of concept of risk factors preventive & rehabilitative aspect of chronic diseases

• Health for all phase (1981 -2000 AD)

-Attempt to correct imbalance between rich and poor countries

WHO declaration for health for all by 2000

where we are

Primary health care

1978 Alma – Ata declaration of WHO

The Millennium Development Goal

Sept 2000 millennium summit in New York

Sustainable Development Goals

• EVOLUTION OF MEDICINE IN NIGERIA

The Nigerian History

• Before 1861, the predominant health system was centered on the traditional and spiritual healers

• All communities had some form of organized social structure one of which is health care system

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Era before the 17th century

• There were no organized medical services for many African societies

• The traditional health systems present at that time include:

• The Adahunse, Babalawo and Eleweomo of the Yorubas

• The Wombai of the Hausas

• The Gozan of the Nupes

• The Dibia of Igbos

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17th to 18th Century

• The period of exploration and colonization, when early traders and explorers for gold, pepper, slavery introduce various crude and western medical practices

• William Balfour Baikie introduced the use of quinine for malaria prophylaxis and treatment

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Late 19th century

• Various missionary and colonial health services development

• 1846-1919 Sir William McGregor colonial Governor and medical doctor did much work to improve sanitary services in Lagos.

• Set up a General Board of Health (GBH) and did a lot in the area of prevention and treatment of malaria.4/14/2020 51

• The first two Nigerian Doctors were:

• Dr. James Africanus Beale-Hourton

• Dr. William Bourghton Davies

• The two doctors later joined the British Army Medical Service and worked in Ghana

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Role of Missions• Sponsor of Williams Davies & Africanus

Horton by Church Missionary Society (CMS) to study medicine in Britain-

• Sacred Heart Hospital was established in Lantoro (1895), Abeokuta by the Roman Catholic Church-1st hospital in Nigeria

• The Presbyterian mission sent a doctor to Calabar in 1855

• The CMS also built a small dispensary in the house of their missionaries in Zaria (Dr. Walter Miller) in 1905

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Role of Missions (cont.)• Sudan United Mission- active in the middle-belt

areas

• Sudan Interior Mission- active in the North

• Others are Methodist, Baptist etc.

• Dr. George Green: A missionary doctor from London started the Baptist Hospital in his house in Ogbomoso, the hospital metamorphosed to BMC and now BUTH

• Dr. Lucket founded the leprosarium in Ogbomoso

• Ruth Kersy: A missionary Nurse who started the first orphanage home in Nigeria

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PUBLIC HEALTH GIANTS IN NIGERIA.

• Prof. Oladele Ajose,

• Sir (Dr.) Samuel Manuwa,

• Dr. (Chief) Majekodunmi,

• Dr. MP Otolorin,

• Prof. Adeoye Lambo,

• Dr. MI Okpara,

• Dr. Akanu Ibiam,

• Prof. AO Lucas,

• Prof. Olikoye Ransome-kuti,

• Dr. GO Sofoluwe.

DR ISAAC OLUWOLE

• Called the father of public health in Nigeria

• Appointed the 1st African assistant MOH in 1925

• Started school health services in Lagos and Ibadan in 1929

• Reclaimed swampy areas to help in malaria control

• Supported measures to control smallpox, rabies and plague

• Built an abattoir to improve food hygiene in 1930

• Established healthy baby week• Opened the 1st old people’s

home in Lagos in 1929

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Prof. OladeleAjose

• 1907-1978

• First Nigerian Professor & one of the foremost Profs. in Africa

• First VC of Obafemi AwolowoUniversity

• Earliest proponent of Primary Health Care in Nigeria

• He started community medicine practice in Ilora, Oyo State

• One of his major contributions was in eradication of schistosomiasis in Ilora town

Oloye Sir Samuel Manuwa

• 1903-1976

• Pioneering Nigerian Surgeon General

• Graduated from University of Edinburg in 1934

• First Nigerian to pass FRCS

• In 1966, he was appointed the president of World Federation of Mental Health

• Contributed immensely to establishment of UCH

• He worked for the improvement of Basic medical services in the rural areas

Sir Samuel Manuwa

AdekoyejoMajekodunmi

• 1916-2012

• A minister of Health in the first republic: 1960-1966

• Sole administrator of the western region June-December 1962 after Samuel Akintola

• He played a key role in the establishment of LUTH

• Founded St. Nicholas Hospital

Thomas AdeoyeLambo

• 1923-2004

• First Psychiatrist in Nigeria and Africa

• Worked in WHO between 1971-1988 rising to the position of Deputy DG

• Studied in University of Birmingham and became a consultant in King’s College London

• Contributed to the development of mental health in Nigeria

• Founder of Aro Psychiatry Hospital in Abeokuta

Oguntola Sapara

• 1861-1935

• A trained midwife

• Organized the first dispensary in Nigeria in 1901

• He helped the government to fight small-pox and bubonic plaque

• He advocated for environmental hygiene

• His was involved in trado-medical practice

Oguntola Sapara

• Adeniyi Jones- First Director of Yaba Asylum

OLIKOYE RANSOME KUTI

Olikoye Ransome Kuti

• 1927-2003

• He was a pediatrician

• Appointed a minister of health in the 80s

• Founded an NGO called Society for Family Health

• Worked for WHO and rose to the position Deputy DG

• Regarded as father of PHC in Nigeria

Prof. Adetokunbo Lucas

Prof. Adetokunbo Lucas

• Born in 1931

• Fellow Royal College of Obstetricians and Gynecologist

• A professor of public health

• Notable work: published a Short Textbook of Public Health for the tropics

• Global health leader for Africa

• First DG of TDR/WHO, served for 10 years

• Supported the research and control of many tropical diseases such as malaria, Trypanosomiasis,Schistosomiasis, Filariasis etc

• Currently an adjunct professor at the Department of Global Health and Population of the Harvard School of Public Health

Conclusion Public health has been the proverbial mustard

seed which started as the smallest of the seeds but is now becoming the greatest

Indeed the future of health is ours, what are you doing to improve the health of the populace?