The History of Healthcare

1. The History of Healthcare MOD B Jim Sorrick LPN Chapter 1

2. Early Beginnings Primitive human beings had no electricity, few tools and poor shelter. Their time was spend protecting themselves and finding food. Being very superstitious, they believe disease and illness were caused by supernatural spirits. Tribal doctors, or healers, attempted to exorcise evil spirits in an attempt to heal their “patient”. One such ceremony was an early form of “Trephining” - derived from the Greek word for “borer” or “auger”. The healer would remove part of the cranium with primitive tools to exorcise the demons. They also used plants and herbs as medicines. Some of these medicines are still used today. Such as: Digitalis - from the foxglove plant - used to strengthen and slow the heartbeat. Now given in pill or injection, early people chewed the leaves. Quinine - bark of the cinchona tree. Helps control fever, relives muscle spasms, and prevents malaria. Belladonna and Atropine are made from the poisonous nightshade plant, relieving muscle spasms, especially in the GI tract.

3. Early Beginnings cont. Morphine - made from the opium poppy - effective medicine for treating severe pain. Some of the lesser known, but no less important plant remedies: Willow bark - used to treat fever and as a analgesic. Later Chemists were able to convert the salicin from the bark into salicylic acid - similar to what is now known as aspirin. Yarrow (Achilleamillefolium) - was used to coagulate blood. Many disinfectants were made from many different plants such as crushed root of the Oregon grape, inner bark from white pine, wild cherry and wild plum. Some Native American tribes even used some of these herbal concoctions to treat venereal diseases and rattlesnake bites.

4. Trephining

5. Medicine in Ancient Times Egyptians were the earliest people to keep accurate health records. They were superstitious and called upon their Gods to heal them. They also learned to identify certain diseases. In their culture, Priests acted as physicians. They used medicines to heal disease, learned the art of splinting fractures and treated disorders by bloodletting with the use of leeches. Leeches are still used modern day to assist with healing skin grafts, as well as restoring blood circulation, such as in amputated limbs that have been reattached. Their primary function is to drain blood since pooled blood around a healing wound can threaten the healing of tissue. Modern scholars learned a lot from works bought by two different men. In 1872 a German man(Greg Ebers) purchased a 110-page scroll in a market in Luxor, Egypt. That scroll, which became known as the theEbers Papyrus contained a thorough explanation of medical practices in 1552 BC Egypt. In 1862 an American living in Egypt also bought a scroll in Luxor, Egypt at a marketplace which later became known as the “Edwin Smith Surgical Papyrus” , detailing surgical practices that would later become important in understanding ancient surgery performed in Egypt.

6. Egyptian Medicine Case #1 Instructions concerning a gaping wound in his head, to the bone. Examination: If thou examinest a man having a gaping wound in his head, penetrating to the bone, thou shouldst lay thy hand upon it (and) thou shouldst palpate his wound. If thou findest his skull uninjured, not having a perforation in it... Diagnosis: Thou shouldst say regarding him: “One having a gaping wound in his head. An ailment which I will treat.” Treatment: Thou shouldst bind fresh meat upon it the first day; thou shouldst apply for him two strips of linen, and treat afterward with grease, honey, (and) lint every day until he recovers.

7. Egyptian Medicine Case #2 Instructions concerning a break in the chamber of his nose. Examination: If thou examinest a man having a break in the chamber of his nose, (and) thou findest his nose bent, while his face is disfigured, (and) the swelling which is over it is protruding. Diagnosis: Thou shouldst say concerning him: “One having a break in the chamber of his nose. An ailment which I will treat.” Treatment: Thou shouldst force it to fall in, so that it lies in its place, (and) clean out the interior of both his nostrils with two swabs of linen until every worm of blood which coagulates inside his two nostrils comes forth. Now afterwards thou shouldst take two plugs of linen saturated with grease and put them into his two nostrils. Thou shouldst place two stiff rolls of linen, bound on. Thou shouldst treat him afterwards with grease, honey, (and) lint every day until he recovers.

8. Leech Therapy Leech therapy application in a case of digital replantation: (a and b) Application of the leech using non-traumatic forceps - the leech is held until it attaches; (c) Following successful attachment, the leech starts feeding; (d and e) The leech grows in size as it continues to feed

9. Medicine in Ancient Times The ancient Chinese, from as early as the stone age, were the first to use primitive acupuncture therapies. These early medical pioneers learned to treat a variety of illness and disease with some tools. Their methods eventually developed into the advanced practice of Chinese acupuncture, still in common use today.

10. Medicine in Ancient Times To the Greeks, medicine was considered an art and not just a profession. Physicians had a noble and sacred mission, often housed in sacred temples of healing. They were the first to study the causes of disease and to determine that illness may have natural, rather than a spiritual causes. They kept records on what they observed and what they thought caused illness. The Greeks understood the importance of searching for new information about disease. This research helped eliminate superstition. In addition, Greeks further developed the use of massage and herbal therapies. Ancient Greek medical practitioners even had their own form of “laboratory” tests, such as, pouring a persons urine next to an ant hill. If the ants were attracted to the urine, they knew there was glucose in the urine, which even back then they understood was not a good thing. We now call this affliction diabetes. The treatment for diabetes back then was to drink wine!

11. Medicine in Ancient Times During ancient times, religious customs did not allow bodies to be dissected. The father of medicine “Hippocrates” (469-377 B.C.) based his knowledge of anatomy and physiology on observation of the external body. He kept careful notes of the signs and symptoms of many diseases. With these records he found that disease was not caused by supernatural forces. Hippocrates wrote the standard of ethics called the Oath of Hippocrates. This standard is the basis for today’s medical ethics. Physicians still take this oath.

12. Medicine in Ancient Times The Greeks observed and measured the effects of disease. They found that some disease was caused by lack of sanitation. The Romans learned from the Greeks and developed a sanitation system. They brought clean water into their cities by way of aqueducts(waterways). They built sewers to carry off waste. They also built public baths with filtering systems. This was the beginning of public health and sanitation. The Romans were the first to organize medical care. They sent medical equipment and Physicians with their armies to care for wounded soldiers. Roman physicians kept a room in their houses for the ill. This was the beginning of hospitals. Public buildings for the care of the sick were established. Physicians were paid by the Roman government. It is interesting to note that the Roman physician wore a death mask. This mask had a spice filled beak, which the Romans believed protected them from infection and bad odors.

13. Roman Medical Tools Bone/Tissue Hooks Scalpels

14. The Dark Ages(A.D. 400-800)Middle Ages(A.D. 800-1400) When the Roman empire was conquered by the Huns (nomads from the North), the study of medical science stopped. For a period of 1,000 years, medicine was practiced only in convents and monasteries. Because the Church believed that life and death were in God’s hands, the monks and priests had no interest in how the body functioned. The primary treatment was prayer. Medication consisted of herbal mixtures and care was custodial. Monks collected and translated the writings of the Greek and Roman physicians. Terrible epidemics caused millions of deaths during this period. Bubonic plague alone killed 60 million people. Other uncontrolled diseases included smallpox, diphtheria, syphilis, and tuberculosis. Today, these illnesses are not always life threatening. Scientists have discovered vaccines and medications to help control these diseases. It is important to remember that some diseases can become epidemic if people are not vaccinated.

15. Disease Epidemics in History • Diphtheria - upper respiratory tract illness that can result in death due to swelling or blockage of the airway by adherent membrane • Smallpox - caused by a virus, identified by pustular rash covering the body. Considered eradicated nowdays. • Syphilis - bacterial disease usually sexually transmitted - four stages Primary, Secondary, Latent, Tertiary. • Bubonic Plague - zoonotic disease(circulating among rodents and fleas) Untreated kills 2 out of 3 humans within 4 days. • Tuberculosis - common disease caused by various strains of bacteria. Usually attacks lungs but can affect other parts of the body. • Cholera - infection of the small intestine causing watery diarrhea and vomiting. Contaminated drinking water most common vector. Leads to rapid dehydration and death. • Typhoid - transmitted by food/water contaminated by feces of infected person. Impact of this disease fell dramatically with application of sanitation techniques.

16. Diseases Bubonic Plague Diphtheria Smallpox Cholera

17. The Renaissance (A.D. 1350-1650) The Renaissance period saw the rebirth of learning. During this period, new scientific progress began. There were many developments during this period. • The building of universities and medical schools for research • The search for new ideas about disease rather than the unquestioning acceptance of disease as the will of God. • The acceptance of dissection of the body for study. • The development of the printing press and publishing of books, allowing greater access to knowledge from research. • These changes influenced the future of medicine.

18. The Sixteenth and SeventeenthCenturies The desire for learning that began during the Renaissance continued through the next two centuries. During this time, several outstanding scientists added new knowledge. Here are some examples: • Leonardo da Vinci studied and recorded the anatomy of the body. • William Harvey used this knowledge to understand physiology, and he was able to describe the circulation of blood and the pumping of the heart. • Gabriele Fallopiusdiscovered the Fallopian tubes of the female anatomy. • Bartolommeo Eustachio discovered the tube leading from the ear to the throat (Eustachian Tube) • Antonie van Leeuwenhock(1632-1723) invented the microscope, establishing there is life smaller than the eye can see. He scrapped his teeth and found bacteria that causes tooth decay. Although not realized at the time, the germs that cause disease were now visible. • Apothecaries, early pharmacies, started at this time and flourished in the trade of drugs and spices. Quackery, mass death from childhood fevers, and disease continued. The causes of infection were still not understood.

19. The Eighteenth Century Many discoveries were made in the eighteenth century that required a new way of teaching medicine. Students not only attended lectures in the classroom and laboratory, but also observed patients at the bedside. When a patient died, the dissected the body and were able to observe the disease process. This led to better understanding of the causes of illness and death. Also, in the eighteenth century, a wider range of students were were studying medicine. In 1849, Elizabeth Blackwell (1821-1910) became the first female physician in the United States. The study of physiology continued and more new discoveries were made. • Rene Laennec invented the stethoscope-first one made of wood. • Joseph Priestly discovered the element Oxygen • Benjamin Franklin’s discoveries include bifocals, and that the common cold could be passed from person to person • Edward Jenner discovered a method of vaccination for smallpox. His discovery saved millions of lives. His discovery led to immunization and to preventive medicine in public health.

20. The Nineteenth & TwentiethCenturies Medicine continued to progress rapidly, and the nineteenth century was the beginning of the organized advancement of medical science. Important events during the nineteenth and twentieth centuries included: • IgnazSemmelweisidentified the cause of childbed fever (puerperal fever-septicaemia contracted by female during or shortly after childbirth) Physicians at the time were not washing hands in between handling dead bodies during dissection and delivering babies. • Louis Pasteur known as the “Father of Microbiology” discovered tiny microorganisms were everywhere. Though his experiments and studies, he proved microorganisms caused disease. He also discovered heating milk prevented the growth of bacteria.(Pasteurization)He also created a vaccine for rabies in 1885. • Joseph Lister used carbolic acid on wounds to kill germs that caused infection - the first doctor to use antiseptic during surgery. • Ernst von Bergmann developed asepsis - developed method to keep area before and during surgery germ free. • Robert Koch developed the culture plate method to identify pathogens and also isolated the bacterium that causes tuberculosis. Also introduced importance of cleanliness and sanitation to prevent spread of disease.

21. The Nineteenth & TwentiethCenturies cont. Wilhelm Roentgen discovered X-rays Paul Ehrlich experimented with chemicals to kill disease-causing microorganisms. He completed 606 experiments, and on the 606th he found a treatment that worked to treat syphilis. Before the nineteenth century, pain was a serious problem. Surgery was performed on patients without anesthesia. Early physicians used herbs, hashish and alcohol to help relieve the pain of surgery. They even choked patients to unconsciousness to stop pain during surgery. Many patients died from pain and shock. During the nineteenth and twentieth centuries, nitrous oxide, ether and chloroform were discovered. These drugs have the ability to put people into a deep sleep so that they do not experience pain during surgery. The knowledge of asepsis and the ability to prevent pain during surgery are the basis of safe, painless surgery today.

22. The Nineteenth & TwentiethCenturies cont. Scientists and physicians kept learning from the discoveries of the past. They continued to study and research new ways to treat diseases, illness, and injury. Some of the most important discoveries in the late 19th and 20th centuries included: Gerhard Domagk - discovered sulfonamides - first compounds effective in killing some bacteria. In 1882 Russia, Dmitri Ivanovski discovered virii, and could not be seen with a microscope. Some of these virus are: Poliomyelitis Rabies Measles Influenza Chicken Pox German Measles Herpes Zoster Mumps

23. The Nineteenth & TwentiethCenturies cont. Sigmund Freud’s work on the human mind led to the understanding of psychosomatic illness(physical illness caused by emotional conflict) Sir Alexander Fleming found that penicillin killed life-threatening bacteria Jonas Salk found that a dead polio virus would cause immunity to poliomyelitis In contrast to Salks studies, Albert Sabin used a live polio virus vaccine, which was more effective. Frances Crick and James Watson discovered the molecular structure of DNA and how information is coded into it. Christian Barnard performed the first heart transplant in 1968 Ben Carson continues to pioneer the work that is done to separate Siamese twins and hemispherectomies, surgeries on the brain to stop seizures.

24. The Nineteenth & TwentiethCenturies cont. The discovery of methods to control whooping cough, diphtheria, measles, tetanus and smallpox saved many lives. These diseases kill unprotected children and adults. Our society is discovering new approaches to medical care every year. Patients/clients are being taught more about wellness, and they are learning more about self-care. The word “healthy” no longer just refers to a person’s physical health. It also refers to a person’s emotional, social, mental, and spiritual wellness. To help patients achieve this kind of holistic health, the medical community has become more open to alternative and complementary methods of care. People now go to ayurvedic practitioners(from India), Chinese medicine practitioners, Chiropractors, homeopaths, hypnotists, and naturopaths to help meet their medical needs. Family and friends are learning patient care skills, including how to perform detailed procedures. Nurses and technicians are visiting patients/clients at home or caring for them in an ambulatory care setting. Just a few years ago, patients were admitted to the hospital for surgery and recovered in the hospital over a period of several days. Today, many patients enter the hospital, have surgery, and are sent home the same day.

25. The Nineteenth & TwentiethCenturies cont. Doctors are now often practicing Telemedicine. Health care providers may now email, fax, or telephone important medical information to a patient or another health care provider. This has improved patient care by supplying health care providers and patients with quicker access to information and greater opportunities for communication. Telemedicine includes consultive, diagnostic and treatment services. People are living longer and are usually healthier. New inventions and procedures have changed medicine as we once knew it. Here are some examples: • Possibility of eliminating disabling diseases through genetic research • Ability to transplant organs • Ability to reattach severed body parts • Computers to aid in diagnostics, record keeping and research • Ability to use noninvasive techniques for diagnosis • Advancements for caring for unborn fetus • The medical professions acceptance of alternative therapies

26. The Nineteenth & TwentiethCenturies cont. Every day, science makes new progress. We are living in a time of great advancement and new understanding in medicine. People are living longer, creating a need to better understand geriatric medicine. This and OBRA - The Omnibus Budget Reconciliation Act passed in 1987 to provide a checklist for nursing home care facilities. In addition, new types of facilities such as assisted living centers are being developed to better meet the physical, emotional and mental needs of senior citizens. Frontiers in medical science include hope for treatment and cures for diabetes, cancer, AIDS, multiple sclerosis, arthritis and muscular dystrophy.

27. Quackery In the early days there were no “yardsticks” to measure doctors by and no laws to regulate their practice. In the nineteenth century the amount and quality of education were highly variable and inadequate. Such as: • Students were accepted into medical school with no formal education • In 1870 Harvard Medical School offered no entrance exams due to most students could not write well enough. • A degree in medicine could be purchased for 5 dollars • Sometimes disputes among medical faculty were settled with guns and knives. • “Heroic” medicine(Allopathy) was still being practiced - if bleed, blister and purge did not work, there were no alternatives • Alcohol was widely accepted “medication” • The few doctors of this time that had good ideas (washing hands prior to patient contact), were ridiculed.

28. Advancement of Nursing Men in Nursing: A Historical Time LineThe world's first nursing school founded in India about 250 B.C. Only men were considered "pure" enough to become nurses.Ancient RomeThe term "nosocomial" meaning "hospital acquired" stems from the nosocomi, the men whom provided nursing care in ancient Rome. ParabolaniIn 300 A.D., a group of men, the Parabolani, started a hospital providing nursing care during the Black Plague epidemic. Early Religious Orders St. Benedict founded the Benedictine nursing order, while St. Alexis was in the fifth century. Military, religious and lay orders of men including the Knights Hospitalers, the Teutonic Knights, the Knights of St. Lazarus and the Hospital Brothers of St. Anthony provided nursing care during the Middle Ages. The AlexiansThe Alexian Brothers began as informal groups of laymen about 1300 A.D., providing nursing care for the poor.

29. Advancement of Nursing cont. St. John Of God And St. CamilliusSt. John of God (1495-1550) devoted his life to serving the ill and mistreated and was canonized in 1690. St. Camillius (1510-1614) is credited with developing the first field ambulance. He was canonized in 1746. The symbol of his order, the red cross, remains the primary symbol of health care. In 1930, St. Camillius and St. John of God were named co-patron saints of nursing. First American NurseSeventy years before the Pilgrims landed on Plymouth Rock, Friar Juan de Mena was shipwrecked off the south Texas coast. He is the first identified nurse in what was to become the U.S. Crimean WarThe Crimean War started in 1853. A biographer of Florence Nightingale, regarded as the first modern female nurse, noted that male "orderlies" provided nursing care prior to and after Nightingale's arrival at the Crimean front. Jean Henry DunantIn 1859, Dunant provided nursing care after the Battle of Solferino. He was helped found the International Red Cross and the Geneva Convention. He won the first Nobel Peace Prize in 1901.

30. Advancement of Nursing cont. U.S. Civil WarDuring the U.S. Civil War, both sides had military men serving as nurses. Men were the majority of the front line nurses while female nurses were typically restricted to general hospitals in the major cities. Post Civil WarBoth the Crimean War and the U. S. Civil War decimated the male population. Without men to help with the labor, many women were unable to continue farming and moved to cities and became "matrons" in military hospitals. The military continued to primarily use men as nurses. The Alexian Brothers In The U.S.In 1866, the Alexians built their first hospital in Chicago, Illinois and in 1869, opened a second hospital in St. Louis, Missouri. Today their work continues around the world. St. John of God and St. CamilliusIn 1898 the U.S. fought a brief war with Spain. The Daughters of the American Revolution recruited contract female physicians and nurses during the war.

31. Advancement of Nursing cont. Nursing Schools For MenThe Mills School for Nursing and St. Vincent's Hospital School for Men were founded in New York in 1888. The Pennsylvania Hospital opened a school for female nurses in 1914 and simultaneously opened a separate men's nursing school. Army Nurse CorpsIn 1901, the Army Nurse Corps was formed. Only women could serve as nurses and military nursing changed from being predominately male to exclusively female. World War I And World War IIDuring World War I and World War II there were nursing shortages and women were given tuition, room, board, uniforms and a stipend to attend nursing school, but were not required to enter the service. Two MenIn a time when few men were practicing nursing in the U.S., two men worked to promote men in nursing. Leroy N. Craig, superintendent of the Pennsylvania Hospital men's nursing school, fought for the rights of men to participate in the American Nurses Association. Nurse Luther Christman volunteered to serve on the front, if he could serve as a nurse. Christman was turned down for combat duty as a nurse by the U.S. Surgeon General.

32. Advancement of Nursingcont. Men Again Serve As Military NursesNot until 1955, after the Korean War, were men again permitted to serve as military nurses. During the intervening decades men who were registered nurses enlisted or drafted, but were not assigned as nurses. Nursing Schools Admit MenMen were forbidden to attend some state-supported nursing schools until 1982. American Assembly For Men In NursingThe American Assembly For Men in Nursing, organized in 1971, supports and promotes men in American nursing. Originally named the National Male Nurse Association, the organization became the American Assembly For Men in Nursing in 1980. Source: Bruce Wilson, Ph.D., RN, associate professor at the University of Texas-Pan American in Edinburg, Texas, and a former board member of the American Assembly For Men in Nursing.

33. Advancement of Nursingcont. In the nineteenth century, nursing became an important part of medical care. In 1860, Florence Nightingale attracted well-educated, dedicated women to the nightingale School of Nursing. The graduates from this school raised the standards of nursing and nursing became a respectable profession. Prior to this time, nursing was considered unsuitable for a respectable lady. The people were giving care to the lowest in society - “too old, too weak, too drunken, too dirty or too bad to do anything else.” Florence came from a cultured, middle class family who opposed her interest for caring for the ill. During the Crimean War, she took a group of 38 women to care for soldiers dying from cholera. More soldiers were dying from cholera than war injuries. She became a legend because of her dedication.

34. Advancement of Nursing cont. Another legend in nursing was a lady named Clara Barton, who served as a volunteer nurse in the American Civil War. After the war she established a bureau of records to help search for missing men. She also assisted in the the organization of military hospitals in Europe during the Franco-Prussian War. Barton also campaigned for the United States to sign the Treaty of Geneva, which produced relief for sick and wounded soldiers. These experiences led her to establish the American Red Cross in 1881 and to serve as its first president. Another step forward in the field of nursing was contributed by Lillian Wald. She was an American public health nurse and social reformer. She established the Henry Steele Settlement in New York to bring nursing care to the homes of the poor. This led to the Visiting Nurse Service of New York. Today, visiting nurse services are found in many communities.

35. Patient Care Today A team approach for modern day patient care is the most effective means for meeting the goals in holistic care. Team members can consist of some, maybe all of the following: Registered Nurse Licensed Practical Nurse/Licensed Vocational Nurse Patient Care Technician Certified Nursing Assistant Medication Techs Unlicensed caregivers with many titles: Clinical Partner Home Health Aide Service Partner Nurse Extender And many other occupations, such as Dietary, Physical/Occupational Therapy, and Environmental services, to name a few.

36. A Look Back and Forward In the twentieth and twenty-first centuries, medicine has made great strides in improving health care. During three centuries, we have experienced many changes, such as: • Antibiotics for bacterial diseases • Improved life expentancy • Organ transplants • Healthier hearts (less smokers, better diets) • Dentistry without pain • Noninvasive diagnostics with computers(CAT,MRI) • End of smallpox • Childhood immunizations • New understanding of DNA and genetics • Control of diabetes and discovery of insulin • Decline in polio • Medical machines such as kidney dialysis and heart-lung machines • Test tube babies • HMOs provided alternative to insurance and hospice was organized

37. A Look Back and Forward The future of medicine holds many promises for better health. Current and future research will provide us with many new advances, including: Cure for AIDS • Decrease in cases of malaria, Influenza, Leprosy, and African Sleeping sickness • Cure for genetically transferred diseases • Improved treatment for arthritis and the common cold • Isolation of the gene that causes depression • Use of electronics that allows the disabled to walk • Nutritional therapy to decrease the number of cases of Schizophrenia

38. Key Terms • Anesthesia Loss of feeling or sensation • Antiseptic Substance that slows or stops growth of microorganisms • Asepsis Sterile condition, free from all germs • Convents Establishments of nuns • Custodial Watching and protecting rather than seeking a cure • Dissection Process of diving, or taking apart

39. Key Terms • Epidemics Diseases affecting many people at the same time • Ethics A system of moral principals • Exorcise To force out evil spirits • Geriatric Pertaining to old age • Intravenously Directly into a vein • Microbiology Dealing with microscopic organisms

40. Key Terms • Microorganisms Organisms so small can only be seen through microscope • Monasteries Homes for men following religious standards • Noninvasive No involving penetration of the skin • Observation Act of watching • Pasteurization To heat food for a period of time to destroy microorganisms • Phlebotomy Practice of opening a vein to remove blood

41. Key Terms • Physiology Functions and activities of living organisims • Predators Organisms or beings that destroy • Primitive Ancient or prehistoric • Psychiatry Science of diagnosing and treating mental disorders • Psychology Science of the mind • Quackery Practice of pretending to cure diseases

42. Key Terms • Recipient One who receives • Replicate To reproduce or make exact copy • Respiration Breathing • Stethoscope Instrument used to hear sounds in the body • Superstitious Trusting in magic or chance • Symptom A sign or indication of something

43. Key Terms • Telemedicine Electronic communications to exchange medical information • Trephining Surgically removing circular section(of bone for example) • Vaccines A weakened virus or bacteria given to a person to build immunity against a disease