Historical Perspectives on Health and Commuication

							Historical Perspectives on Health and Communication

Ancient Times
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Neolithic age
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4000-5000 years ago Early humans thought that illness was caused by evil spirits Primitive medicines usually used in conjunction with techniques designed to expel the evil spirit. Trepanation or trephining: boring a hole in a person’s skull in order to liberate the evil spirit supposedly contained in a person’s head. Not always fatal – anthropologists have found skulls with multiple trepanation holes.

Ancient Times
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Imhotep
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2600 B.C. Ancient Egyptians understood the circulatory system and other body system functions years before the Western world did Religio-empirical approach to medicine: combined spiritualism and physical study Egypt developed: sutures, immobilizing casts, task-specific surgical instruments

Ancient Times
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Hippocrates
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460-370 B.C. Often considered the founder of scientific medicine and Western medical ethics Hippocratic Oath: code of conduct. Prohibits physician-assisted suicide, abortion, and sexual misconduct. Physicians and surgeons were separate professions and did separate health tasks

Ancient Times -- Greeks
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Hippocrates (cont.)
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Many people believed illness was a punishment from God. Being ill was something to be ashamed of. Rational/Empirical Approach: disease is best understood by careful observation and logical analysis. Medical knowledge should be derived from an understanding of the natural sciences and the logic of cause and effect relationships.

Ancient Times -- Greek
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Humors: Body fluids. Blood, phlegm, yellow bile, & black bile To be healthy, need to be in balance. Note: Prevention was unheard of in Greek medical culture. Didn’t understand the concept of contagion.

Ancient Times -- India
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The classical system of Indian medicine is known as Ayurveda. The Caraka Samhita, the key text, was said to have been divinely inspired, having been passed to humans from the Hindu god Brahma. Believed to date from between 300 A.D. and 200 B.C. Like most ancient texts of its kind, the Caraka Samhita codified, or put down on paper, practices that had probably been going on for centuries.

Ancient Times -- India
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The sister text to the Caraka Samhita was the Susutra Samhita. It reveals ancient Indians' remarkable competencies in surgery. The Indians developed unique suturing techniques, performed experimental surgery unparalleled in the rest of the ancient world, and developed the world's first surgical treatment for cataracts.

Ancient Times -- India
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Traditional Indian medicine is alive and well today, unlike other ancient systems of medicine, with the exception of China. Much of ancient Indian medical knowledge has stood the test of time. Ancient practices, still widely used in India, are complemented by modern medical practices. Some surgical instruments from ancient India, such as bone forceps, are remarkably similar to those used in modern medicine to this day.

Ancient Times -- Jews
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The Jews placed their faith in a divine intelligence, and turned to Him in prayer and aspiration; but they had to turn to the doctor, learned and skilled in the natural sciences, for earthly remedies. In ancient times, the magical practices of the Babylonians and Egyptians were biblically proscribed to the Jews.

Ancient Times -- Jews
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The Jews esteemed physicians and the science to which they were committed. "Honor the physician according to thy need of him with the honor due unto him because verily the Lord hath created him.“ The Bible introduces three rudiments of healthful existence: rest, cleanliness, and prophylaxis.

Medieval Times
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“The Dark Ages,” A.D. 500-1450 Christianity dominated the entire culture. The Roman Catholic Church controlled vast resources and dictated social policy. Medical Spiritualism:
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Belief that illness is governed by supernatural forces. Closely tied to Christianity because Jesus performed healing miracles. Most “physicians” were monks, and most medical care was provided via the church.

Medieval Times
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Catholic Church ideology at the time: disease was treated through prayer and faith and through the application of natural (God-given) substances such as plants. Because illness manifested differently in each individual, a patients’ thoughts, feelings, faith and behaviors were directly relevant to the subject of healing.

Medieval Times
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Barber Surgeons
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Most monks and secular practitioners were not trained in surgery nor did they perform it. Catholic Church doctrine prohibited cadaver dissection so no one was very knowledgeable about human anatomy, let alone physiology. Barber began offering surgical procedures in addition to hairstyling because they already had the sharp instruments and public facilities necessary.
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Tooth extraction, bloodletting, simple surgeries No anesthesia, and no understanding of germ theory

Medieval Times
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Catholic church founded the first schools of “medical theory” and the first clinics/hospitals. Christian Magic: times when the Church condoned the use of bizarre ceremonies and exorcisms. Fetishes: holy relics said to protect those who purchase them from calamities.

Medieval Times: The End
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As the monk physicians began to expand their knowledge base, their work became overwhelming, limiting their ability to continue in more religious areas of study. Medicine and pharmacology were at odds with the church’s stance on healing by faith. In 1130, the church forbade monks to practice medicine any longer.

The Renaissance
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1300s – 1600s Intellectual skepticism Artists and philosophers of the time looked to mathematics and science for answers to the question, “What is real?” Very skeptical about things that could not be “proven.”

René Descartes (1596-1650)
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Philosopher and mathematician Principle of Verification: do not believe it if you cannot prove it. People no longer considered ill just based on self-reports and feelings. Physicians began to look for verifiable signs of illness. Surgery and autopsies became acceptable, and human dissection became common (Michelangelo, di Vinci)

Cartesian Dualism
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What is the relationship between the body and soul? During the Middle Ages, the soul was considered to inhabit the entire body. Descartes’ Mind-Body Dualism: people have both souls and bodies, but the two are not the same. Matters of the soul and matters of the body are entirely separate.

Implications of Cartesian Dualism
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Separated medicine into two branches; One for the mind, and one for the body. Disease and illness are not the same. Dualism is still accepted as a general principle. Examples?

Health Care in the New World
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The New World (the Americas) was not a very health place, physically or emotionally. Health of the American Indians 1607-1625, 80% of settlers and 90% of Indians died of disease. Why? Folk remedies, steeped in tradition. Physicians used Hippocrates’ humor theory (purgatives).

Orthodox Medicine
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Industrial Revolution (late 1800’s) Population clustering in urban areas. Folk remedies stayed in the rural areas. Major changes in orthodox medicine:
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Improvements in anesthesia Sterilization of instruments Medical school reform Prevention orientation

Germ Theory
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Late 1800’s Louis Pasteur Disease is caused by microscopic organisms called germs. Prevention becomes possible Joseph Lister: sterilization of medical instruments and surgical environments to kill germs.

Orthodox Medicine’s Search for Legitimacy
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Early 1900s, orthodox practitioners sought to separate themselves from the “quacks,” and legitimize their profession. Active campaigns to discredit or discourage people from using “alternative” healers such as midwives, herbalists, etc. Physicians were characterized as all knowing authorities in order to inspire public trust. Patient in a submissive role

Flexner Report
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Prior to 1900 most medical schools were run as a private business. Profit oriented. Abraham Flexner (Carnegie Foundation) commissioned by the AMA to evaluate US medical schools and make recommendations. Published in 1910, Flexner Report charged that all but a very few medical schools (Harvard, Johns Hopkins, Western Reserve) didn’t cover enough of the sciences, and basically didn’t prepare competent doctors. Reviewed 151 schools; recommended all but 31 shut down. Nearly 2/3 of all medical schools in US shut down as a result.

NOW?
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Medical specialization. Insurance Business vs. service? Health and wealth. DRG’s Managed Care