History of Health CareHistory of Health Care

ObjectivesObjectives

Students will:Students will:• Identify medical/health care milestones Identify medical/health care milestones

that have led to advances in health care.that have led to advances in health care.• Predict where and how factors such as Predict where and how factors such as

cost, managed care, technology, and cost, managed care, technology, and aging population, access to care, aging population, access to care, alternative therapies, and lifestyle alternative therapies, and lifestyle behavior may affect various health behavior may affect various health delivery system models. delivery system models.

4000 BC – 3000 BC Primitive 4000 BC – 3000 BC Primitive TimesTimes

Illness and diseases were a Illness and diseases were a punishment from the Godspunishment from the Gods

Tribal witch doctors treated illness Tribal witch doctors treated illness with ceremonieswith ceremonies

Herbs and plants used as medicines Herbs and plants used as medicines (morphine and digitalis)(morphine and digitalis)

Trepanation or trephining (surgically Trepanation or trephining (surgically removig a piece of bone from the removig a piece of bone from the skull)skull)

Average life span was 20 yearsAverage life span was 20 years

3000 BC – 300 BC 3000 BC – 300 BC Ancient EgyptiansAncient Egyptians

Physicians were priestsPhysicians were priests Bloodletting or leeches used as Bloodletting or leeches used as

medical treatmentmedical treatment Average life span was 20-30 Average life span was 20-30

yearsyears

1700 BC – AD 220 1700 BC – AD 220 Ancient ChineseAncient Chinese

Believed in the need to treat the Believed in the need to treat the whole body by curing the spirit and whole body by curing the spirit and nourishing the bodynourishing the body

Recorded a pharmacopoeia of Recorded a pharmacopoeia of medications based mainly on the use medications based mainly on the use of herbsof herbs

Used therapies such as acupunctureUsed therapies such as acupuncture Began to search for medical reasons Began to search for medical reasons

for illness for illness Average life span was 20-30 yearsAverage life span was 20-30 years

1200 BC –200 BC 1200 BC –200 BC Ancient GreeksAncient Greeks

First to observe the human body and First to observe the human body and the effects of disease – led to modern the effects of disease – led to modern medical sciences.medical sciences.

Believed illness is a result of natural Believed illness is a result of natural causescauses

Used therapies such as massage, art Used therapies such as massage, art therapy, and herbal treatmenttherapy, and herbal treatment

Stressed diet and exercise as ways to Stressed diet and exercise as ways to prevent diseaseprevent disease

Average life span was 25-35 yearsAverage life span was 25-35 years

753 BC – AD 410 753 BC – AD 410 Ancient RomansAncient Romans

First to organize medical care by First to organize medical care by providing care for injured soldiersproviding care for injured soldiers

Later hospitals were religious and Later hospitals were religious and charitable institutions in monasteries and charitable institutions in monasteries and convents convents

First public health and sanitation systems First public health and sanitation systems by building sewers and aqueductsby building sewers and aqueducts

Galen established belief that the body was Galen established belief that the body was regulated by four body humors; blood, regulated by four body humors; blood, phlegm, black bile, and yellow bilephlegm, black bile, and yellow bile

Life span was 25-35 yearsLife span was 25-35 years

AD 400 – AD 800 AD 400 – AD 800 Dark AgesDark Ages

Emphasis on saving the soul and Emphasis on saving the soul and study of medicine was prohibitedstudy of medicine was prohibited

Prayer and divine intervention were Prayer and divine intervention were used to treat illness & diseaseused to treat illness & disease

Monks and priests provided Monks and priests provided custodial care for sill peoplecustodial care for sill people

Medications were mainly herbal Medications were mainly herbal mixturesmixtures

Average life span was 20-30 yearsAverage life span was 20-30 years

AD 800 – AD 1400 AD 800 – AD 1400 Middle AgesMiddle Ages

Renewed interest in medical practices Renewed interest in medical practices of Greek and Romansof Greek and Romans

Bubonic Plague killed 75% of Bubonic Plague killed 75% of population in Europe and Asiapopulation in Europe and Asia

Major diseases included smallpox, Major diseases included smallpox, diptheria, tuberculosis, typhoid, the diptheria, tuberculosis, typhoid, the plaque, and malariaplaque, and malaria

Arabs began requiring physicians pass Arabs began requiring physicians pass examinations and obtain licensesexaminations and obtain licenses

Average life span was 20-35 yearsAverage life span was 20-35 years

AD 1350 – AD 1650 AD 1350 – AD 1650 RenaissanceRenaissance

Dissection of body led to increased Dissection of body led to increased understanding of anatomy and understanding of anatomy and physiologyphysiology

Invention of printing press allowed Invention of printing press allowed medical knowledge to be sharedmedical knowledge to be shared

First anatomy book was published by First anatomy book was published by Andreas Vesalius (1514-1564)Andreas Vesalius (1514-1564)

Average life span was 30-40 yearsAverage life span was 30-40 years

1616thth and 17 and 17thth Centuries Centuries

Cause of disease still not known – Cause of disease still not known – many people died from infectionsmany people died from infections

Invention of the microscope allowed Invention of the microscope allowed physicians to see disease-causing physicians to see disease-causing organisms.organisms.

Apothecaries (early pharmicists) Apothecaries (early pharmicists) made, prescribed, and sold made, prescribed, and sold medicationsmedications

Ambroise Pare (1510-1590), a French Ambroise Pare (1510-1590), a French surgeon, known as the Father of surgeon, known as the Father of Modern Surgery established use of Modern Surgery established use of ligatures to stop bleedingligatures to stop bleeding

Average life span 35-45 yearsAverage life span 35-45 years

1818thth Century Century

Gabriel Fahrenheit (1686-1736) Gabriel Fahrenheit (1686-1736) created the first mercury created the first mercury thermometerthermometer

John Hunter (1728-1793), John Hunter (1728-1793), established scientific surgical established scientific surgical procedures and introduced tube procedures and introduced tube feedingfeeding

Benjamin Franklin invented bifocalsBenjamin Franklin invented bifocals Average life span 40-50 yearsAverage life span 40-50 years

19th Century19th Century

Rapid advancements due to Rapid advancements due to discoveries of microorganisms, discoveries of microorganisms, anesthesia, and vaccinationsanesthesia, and vaccinations

Infection control developed once Infection control developed once microorganisms were associated with microorganisms were associated with diseasedisease

Formal training for nurses beganFormal training for nurses began Women became active participants in Women became active participants in

health carehealth care Average life span 40-60 yearsAverage life span 40-60 years

20th Century20th Century

Increased knowledge about the role of blood Increased knowledge about the role of blood in the bodyin the body

ABO blood groups discoveredABO blood groups discovered Found out how white blood cells protect Found out how white blood cells protect

against diseaseagainst disease New medications were developedNew medications were developed

Insulin discovered and used to treat diabetesInsulin discovered and used to treat diabetes Antibiotics developed to fight infections Antibiotics developed to fight infections Vaccines were developedVaccines were developed

New machines developed New machines developed Kidney Dialysis Machine Kidney Dialysis Machine Heart Lung Machine Heart Lung Machine Surgical and diagnostic techniques developed to Surgical and diagnostic techniques developed to

cure once fatal conditionscure once fatal conditions

20th Century (continued)20th Century (continued)

Organ TransplantsOrgan Transplants Test tube babiesTest tube babies Implanted first artificial heartImplanted first artificial heart Health Care Plans developed to help Health Care Plans developed to help

pay the cost of carepay the cost of care Medicare and Medicaid marked the Medicare and Medicaid marked the

entry of the federal government into entry of the federal government into the health care arenathe health care arena

HMOs provided an alternative to HMOs provided an alternative to private insuranceprivate insurance

Hospice organizedHospice organized

2121stst Century Century

The first totally implantable artificial The first totally implantable artificial heart was placed in a patient in heart was placed in a patient in Louisville, Ky. In 2001Louisville, Ky. In 2001

The threat of bioterrorism lead to The threat of bioterrorism lead to smallpox vaccination of the military smallpox vaccination of the military and first responders in 2002and first responders in 2002

The Netherlands became the first The Netherlands became the first country in the world to legalize country in the world to legalize euthanasia in 2002euthanasia in 2002

The Human Genome Project to identify The Human Genome Project to identify all of the approximately 20,000 to all of the approximately 20,000 to 25,000 genes in the human25,000 genes in the human

2121stst Century Century

Stem cells were used in the treatments of Stem cells were used in the treatments of disease early in the 2000’s and lead to disease early in the 2000’s and lead to increased research in the treatment of cancer increased research in the treatment of cancer and other diseasesand other diseases

President George W. Bush approved federal President George W. Bush approved federal funding for research using only existing lines funding for research using only existing lines of embryonic stem cells in 2001of embryonic stem cells in 2001

Advanced Cell Technology announced it Advanced Cell Technology announced it cloned a human embryo in 2001 but the cloned a human embryo in 2001 but the embryo did not surviveembryo did not survive

The U.S. FDA approved the use of the The U.S. FDA approved the use of the abortion pill RU-486 IN 200abortion pill RU-486 IN 200

2121stst Century Century

The standards for Privacy of The standards for Privacy of Individually Identifiable Health Individually Identifiable Health Information, required under the Health Information, required under the Health Insurance Portability and Insurance Portability and Accountability Act (HIPPA) of 1996, Accountability Act (HIPPA) of 1996, went into effect in 2003went into effect in 2003

The Medicare Prescription Drug The Medicare Prescription Drug Improvement and Modernization Act Improvement and Modernization Act was passed in 2003was passed in 2003

Vaccinations for cervical cancer and Vaccinations for cervical cancer and herpes zoster (shingles) in 2006herpes zoster (shingles) in 2006

Potential for 21Potential for 21stst Century Century

Cures for AIDS, cancer, and heart Cures for AIDS, cancer, and heart disease disease

Genetic manipulation to prevent Genetic manipulation to prevent inherited diseaseinherited disease

Nerves in the brain and spinal cord Nerves in the brain and spinal cord are regenerated to prevent paralysisare regenerated to prevent paralysis

Antibiotics are developed that do Antibiotics are developed that do not allow pathogens to develop not allow pathogens to develop resistanceresistance

Average life span 90-100 yearsAverage life span 90-100 years

Individual Individual ContributionsContributions

Hippocrates Hippocrates (460 – 377 BC)(460 – 377 BC)

Greek physician known as the Greek physician known as the “Father of Medicine“Father of Medicine

Authored code of conduct for Authored code of conduct for doctors known as the “Hippocratic doctors known as the “Hippocratic Oath” that is the basis of medical Oath” that is the basis of medical practice todaypractice today

Believed illness was not caused Believed illness was not caused by evil spirits and stressed by evil spirits and stressed importance of good diet, fresh importance of good diet, fresh air, cleanliness, and exerciseair, cleanliness, and exercise

Anton van Leeuwenhoek Anton van Leeuwenhoek (1632-1723)(1632-1723)

Invented the microscope Invented the microscope lens that allowed lens that allowed visualization of organismsvisualization of organisms

Scraped his teeth Scraped his teeth

and observed the and observed the

bacteria that bacteria that

causes tooth causes tooth

decaydecay

Benjamin Franklin Benjamin Franklin (1706-1790)(1706-1790)

Invented bifocalsInvented bifocals

Found that colds could Found that colds could

be passed from person be passed from person

to personto person

Ephraim McDowell (1771 -1 Ephraim McDowell (1771 -1 1830)1830)

Surgeon from Danville, Ky.Surgeon from Danville, Ky. Performed the first ovariotomy -Performed the first ovariotomy -

(surgical removal of the ovary) - (surgical removal of the ovary) - to remove a 22 pound tumor to remove a 22 pound tumor

Edward Jenner Edward Jenner (1749-1823)(1749-1823)

Developed a vaccination for Developed a vaccination for smallpox in 1796smallpox in 1796

Rene Laennec Rene Laennec (1781-1826)(1781-1826)

Invented the stethoscope in Invented the stethoscope in 18191819

First stethoscope was made of First stethoscope was made of woodwood

Elizabeth Blackwell Elizabeth Blackwell (1821-1910)(1821-1910)

First female physician in the First female physician in the United States in 1849United States in 1849

Florence Nightingale (1820-Florence Nightingale (1820-1910)1910)

Known as the “Founder of Known as the “Founder of Modern Nursing”Modern Nursing”

Established efficient and Established efficient and sanitary nursing units during sanitary nursing units during the Crimean War in 1854the Crimean War in 1854

Invented the call bell system Invented the call bell system and use of dumbwaiters to and use of dumbwaiters to deliver mealsdeliver meals

Begin the professional Begin the professional education of nurseseducation of nurses

Louis Pasteur (1822-1895)Louis Pasteur (1822-1895)

Known as the “Father of Microbiology”Known as the “Father of Microbiology” His germ theory proved that His germ theory proved that

microorganisms cause diseasemicroorganisms cause disease Proved that heat can be used Proved that heat can be used to destroy germs through a to destroy germs through a process called pasteurizationprocess called pasteurization Created a vaccine for rabies in Created a vaccine for rabies in 18851885 Founded the basic rules for Founded the basic rules for sterilizationsterilization

Joseph Lister (1827-1912)Joseph Lister (1827-1912)

Used carbolic acid on wounds to Used carbolic acid on wounds to kill germskill germs

First doctor to use an antiseptic First doctor to use an antiseptic during surgery during surgery

Clara Barton (1821-1912)Clara Barton (1821-1912)

Volunteer nurse for wounded soldiers during the Volunteer nurse for wounded soldiers during the Civil WarCivil War

After Civil War, established a bureau of records After Civil War, established a bureau of records to search for missing mento search for missing men

Campaigned for the USA to sign Campaigned for the USA to sign the Treaty of Geneva, which the Treaty of Geneva, which provided relief for sick and provided relief for sick and wounded soldierswounded soldiers Formed American Red Cross Formed American Red Cross in 1881 and served as its first in 1881 and served as its first presidentpresident

Robert Koch (1843-1910)Robert Koch (1843-1910)

Developed the culture plate Developed the culture plate method to identify pathogensmethod to identify pathogens

Isolated the bacterium Isolated the bacterium

that causes tuberculosisthat causes tuberculosis

Wilhelm Roentgen (1845-1923)Wilhelm Roentgen (1845-1923)

Discovered Discovered roentgenograms roentgenograms (X-rays) in 1895(X-rays) in 1895

Let doctors see Let doctors see inside the bodyinside the body

X-rayed wife’s X-rayed wife’s handhand

Sigmund Freud (1836-Sigmund Freud (1836-1939)1939)

Discovered the Discovered the conscious and conscious and unconscious part of unconscious part of the mindthe mind

His studies were the His studies were the basis for psychology basis for psychology and psychiatryand psychiatry

Sir Alexander Fleming Sir Alexander Fleming (1881-1955)(1881-1955)

Discovered penicillin in 1928 Discovered penicillin in 1928 which is considered one of the which is considered one of the most most

important important

discoveries of discoveries of

the twentieth the twentieth

centurycentury

Jonas Salk (1914-1995) Jonas Salk (1914-1995) Albert Sabin (1906 – 1993)Albert Sabin (1906 – 1993)

Discovered polio vaccineDiscovered polio vaccine Saved many people from Saved many people from

this virus that paralyzed this virus that paralyzed

thousands of adults and thousands of adults and

children each year.children each year.

Francis Crick (1916 – 2004) Francis Crick (1916 – 2004) James WatsonJames Watson (1928 - )(1928 - )

Described the structure of DNA and Described the structure of DNA and how it carries genetic information in how it carries genetic information in 19531953

Built a three-dimensional Built a three-dimensional

model of the molecules model of the molecules

of DNA of DNA Shared the Noble Prize Shared the Noble Prize

in 1962in 1962

Christian BarnardChristian Barnard (1922 – 2001)(1922 – 2001)

Performed first successful heart Performed first successful heart transplant in 1968transplant in 1968

Robert JarvikRobert Jarvik

Creator of the first artificial heartCreator of the first artificial heart

On December 2, 1982, it was On December 2, 1982, it was implanted into Barney Clark, who implanted into Barney Clark, who lived for the next 112 dayslived for the next 112 days

The second patient, William The second patient, William Schroeder, lived for 620 daysSchroeder, lived for 620 days

Ben Carson (1951 - )Ben Carson (1951 - )

Famous for his surgeries to Famous for his surgeries to separate Siamese twins separate Siamese twins

Currently Director of Currently Director of Pediatric Neurosurgery Pediatric Neurosurgery at John Hopkinsat John Hopkins He has refined He has refined hemispherectomy, a hemispherectomy, a surgery on the brain surgery on the brain to stop seizuresto stop seizures

Current Trends in Current Trends in Health CareHealth Care

Cost ContainmentCost Containment

Cost of health care began rising due to:Cost of health care began rising due to: Technological advancesTechnological advances Aging populationAging population Health-related lawsuitsHealth-related lawsuits

Cost Containment measures include:Cost Containment measures include: Diagnostic related groups (DRG)Diagnostic related groups (DRG) Combination of servicesCombination of services Outpatient servicesOutpatient services Mass or bulk purchasingMass or bulk purchasing Early intervention and preventive servicesEarly intervention and preventive services

Health care facilities specialized Health care facilities specialized to include:to include: Home health careHome health care Hospice careHospice care Geriatric careGeriatric care

Types of facilitiesTypes of facilities Omnibus Budget Reconciliation Act Omnibus Budget Reconciliation Act

(OBRA)(OBRA) TelemedicineTelemedicine

Emphasis on promoting wellness Emphasis on promoting wellness of the whole individual:of the whole individual: Physical wellnessPhysical wellness Emotional wellnessEmotional wellness Social wellnessSocial wellness Mental and intellectual wellnessMental and intellectual wellness Spiritual WellnessSpiritual Wellness Holistic HealthHolistic Health

Alternative and Complementary Alternative and Complementary Methods of Health CareMethods of Health Care Chinese medicine practitionersChinese medicine practitioners ChiropractorsChiropractors HomeopathsHomeopaths HypnotistsHypnotists NaturopathsNaturopaths

National Health Care PlanNational Health Care Plan Has become a leading topic of Has become a leading topic of

debate due to the increasing debate due to the increasing number of uninsured Americansnumber of uninsured Americans

Education and preparation for a Education and preparation for a potential pandemicpotential pandemic Due to the high rate international Due to the high rate international

travel, the possibility for a travel, the possibility for a devastating pandemic has devastating pandemic has increasedincreased