History of Medicine PDF

HISTORY OF MEDICINE OUTLINE:  Introduc on to History of Medicine  Goals of Modern Medicine  Medicine in An quity  Primi ve Medicine  The Super Natural Theory of Diseases  Indian, Chinese, Egyp an, Mesopotamian, Greek and Roman Medicine  Middle Age, Medieval Period, Dawn...

HISTORY OF MEDICINE OUTLINE:  Introduc on to History of Medicine  Goals of Modern Medicine  Medicine in An quity  Primi ve Medicine  The Super Natural Theory of Diseases  Indian, Chinese, Egyp an, Mesopotamian, Greek and Roman Medicine  Middle Age, Medieval Period, Dawn and Revival of Medicine  Sanitary Awakening, Rise of Public Health, Germ Theory of Disease  Birth of Preven ve Medicine, Modern Medicine and Social Medicine  Sample Ques ons  INTRODUCTION TO HISTORY OF MEDICINE From time in memorial, man has been trying to control diseases. The medicine man, the priest, the herbalist and the magician all undertook the various way to cure mans disease and bring relief to the sick. In an almost complete absence of scientific medical knowledge, it would not be fair to say that the early medicine practitioners contributed nothing towards the alleviation of man suffering from disease, in fact medical knowledge has been derived from intuitive and observational proposition and cumulative experiences of the past. HISTORY OF MEDICINE THEREFORE CONTRIBUTES A REVIEW OF 1. Accomplishments and Errors 2. False theories and Misinformation 3. Mistaken interpretation It is also a study of the evolution of man and human knowledge down the ages of BIOGRAPHIES OF EMINENT INDIVIDUALS who developed medicine, it is also the study of the discoveries and invention in different historical period and of the ever changing goals and objective of medicine. In the course of its evolution which was fore- seeded by ages with advances and challenged, medicine has drawn richly from THE TRADITIONAL CULTURE which it is a path and later BIOLOGICAL & NATURAL SCIENCES and more recently from SOCIAL & BEHAVIORAL SCIENCE. Medicine is therefore build on the best of the past. The exploration during the 20 th century has made medicine more complex and treatment more costly, but the benefit of modern medicine has not yet penetrated the social periphery of many countries. The clear contrast in the state of health between the developed and underdeveloped countries, between the urban and rural areas, rich and poor have attracted worldwide criticism as a social injustice. The commitment of all countries under the banner of WHO is to address the inequality in the distribution of health resources and services. GOALS OF MODERN MEDICINE The Goals of modern medicine is no longer Treatment of diseases, the more and more important goals are; 1. Prevention of diseases 2. Promotion of health 3. The Improvement of quality of life of individuals and groups or communities. This is to say that the scope of medicine has been broaden during the recent years and is an essential element of social economic development. MEDICINE IN ANTIQUITY In ancient time, health and illness were interpreted in a COSMOLOGICAL & ANTHROPOLOGICAL perspective. Medicine were dominated by magical and religious beliefs, which were an integral part of ancient culture and civilization. ARES and SIGERIE the medical historians stated that “Every culture has developed a method of medicine, and medical history is but one aspect of the history of culture.” DUBOST goes one step further and said that “Ancient medicine was the mother science and play a large role in the integration of early culture.”  PRIMITIVE MEDICINE It has been truly said that medicine was conceived in sympathy and born out of necessity and thus THE FIRST DOCTOR WAS THE FIRST MAN AND THE FIRST WOMAN WAS THE FIRST NURSE. The prehistoric man motivated by feeling of sympathy and kindness was always trying to provide relief in times of sickness and suffering. Since his knowledge was limited, the primitive man attributed diseases and in fact all human suffering and other calamities to the wrath of God, The invention of bodies by evil spirits and the malevolent influence of stars and planets. THE SUPER NATURAL THEORY OF DISEASE The concept of disease in which the ancient man belief in is known as The Super Natural Theory of Disease. As a logical sequence, the medicine he practiced consisted in appeasing God by prayer, rituals and sacrifices drawing out evil spirit from the human body by witch craft and other crude means and using charms and amulets to protect himself against the influence of evil spirit. The administration of certain herbs and drugs whose effect is doubtful or nil but hopefully harmless may also be liken to a certain kind of magic ritual associated with a need to do something. There is a strong evidence that the prehistoric man improvised strong and flint instrument which with he performed circumcision, amputation and trepenate skull. It is also obvious that medicine in the prehistoric time {5000BC ago} was guided by superstition, religion, magic and witchcraft. Primitive medicine is timeless and the rudiment of primitive medicine still exist in many part of the world. The super natural theory of disease in which the primitive man beliefs in is as new as today. Although the primitive man may be extinct, but his progeny the so called traditional healer are found everywhere. They live close to the people and the treatment are based off combination of religion, magic and emphericisim.  INDIAN MEDICINE The Medical System that are truly Indian in origin are AYURVEDA and SIDDHA system. Ayurveda is practiced throughout India but the Siddha is practiced in the Tamil speaking area of southern India. The two systems do not differ in various way both in theory and practice. AYURVEDA: IMPLIES THE KNOWLEDGE OF LIFE OR HOW LIFE CAN BE PROLONGED. ORIGIN: THIS SYSTEM DATES FAR BACK TO {500BC VEDIC TIME} DURING THIS PERIOD, MEDICINE WAS ASSOCIATED WITH MYTHOLOGICAL FIGURES, SAGES AND SEERS. DHANV: THE HINDU GOD OF MEDICINE IS SAID TO BE BORN AS A RESULT OF THE CHURNING OF OCEANS DURING A TUG OF WAR WITH GOD AND DEMON AND HIS NAME IS DHANV. ATHARVAVEDA: ACCORDING TO SOME AUTHORITY, THE MEDICAL KNOWLEDGE IN ATHARVAVEDA (one of the four VEDA) GRADUALLY DEVELOPED INTO THE SCIENCE OF AYURVEDA. IN ANCIENT INDIA, THE CELEBRATED AUTHORITY IN AYURVEDIC MEDICINE ARE: 1. ATREYA 2. CHARAKA 3. SUSRUTA 4. VAGHVATT  ATREYA {800BC} He was acknowledged as the first great Indian physician and teacher. He lived in an an- amt university TAKSHASHILA about 20miles west of RAWALPILGI. He witness tremendous growth and development during the buddist time. King Ashoka (226BC) and the other bodies king patronized Ayurveda as the state medicine and established schools of medicine and public hospitals. CHARAKA {200AD} The most popular name in Ayurvedic medicine was a court physician in a bodies King Kaniska. Based on the teaching of Atreya, charaka compiled his famous treaties in medicine known as THE CHARAKA SAMHITA. The charaka samhita mentioned some 500 drugs. The indian snake root Rauwaoltik was used for centuries by indian physician, rasaphin was extracted from root and found effective for the treatment of Hypertension. SUSRUTA Among the prominent names of indian medicine, susruta stands out in prominent. He compiled the surgical knowledge of his time known as THE SUSRUTA SAMHITA. It is believed it was complied between 800BC – 400AD. He is believed to be THE FATHER OF INDIAN SURGERY. Even though his work is mainly devoted to surgery, it contained medicine, anatomy, ophthalmology, hygiene, pathology, bedside manner, midwifery etc. The early indians repaired fractures, performed amputation, removed tumors, repair hernia and excel in cataract operation and plastic surgeries. It is stated that the british physicians learn the art of RHINOPLASTY from indian surgeon in the days of the EAST INDIAN COMPANY. However during bodies time, indian medicine suffered a setback due to the DOCTRINE OF AHIAIS (non-violence). DOSHAS THEORY OF DISEASE The Theory of TRIDOSHA is of importance in Ayurvedic medicine and it is also known as the THEORY OF DISEASE. The Doshas are; 1. VATA {wind} 2. PITTA {gall} 3. KAPHA {mucus} DOSHA THEORY OF DISEASE Explains that “DISEASES OCCUR AS A RESULT ON A DIS-BALANCE OR IMBALANCE IN THE 3 DOSHAS. WHEN THIS DOSHAS ARE IN PERFECT BALANCE AND HARMONY A PERSON IS SAID TO BE IN PERFECT HEALTH AND HEALTHY.” Medical historians believed that there was a free express of thought between the Hindu, Arab, Persian, Greek and Jew scholars. The samhita of CHARAKA and SUSRUTA were translated into Arabic and Persian in around (800AD). Hygiene was given an important trait in ancient indian medicine, THE COURT OF MA-NU were a court of personal hygiene. Archaeological escalations at MOHELJO-DARO and HARAPPA in the Hindu valley uncovered cities of over 2000 years old which revealed advanced knowledge of sanitation, water supply and engineering.  THE GOLDEN AGE OF INDIAN MEDICINE WAS BETWEEN 800BC – 600AD During the moghul period and subsequent years, Ayurveda declined due to lack of support from the state. Medical historians admit that indian medicine has played in Asia same as Greek in the west, for it has spread in indo-chinese, Indonesia, Tibet, central Asia and as far japan and exactly as Greek medicine has in west and as far as Arab countries. Other indigenous system of medicine include;  UNANI-TIB  HOMOEOPATHY UNANI-TIB Its origin is traced to the ancient Greek medicine and was introduced into india by the Muslim ruler about 10 century AD, by the 15th century it was entrenched in certain towns and cities notably DELHI, ALIGARH, LUCKLNO AND HYDERABAD. It enjoyed state support under successful Muslim ruler until the british intervened in the 18thcentury. HOMOEOPATHY It was co-founded by SAMUEL HALIMEMAN (1755 – 1846) of Germany who gained foothold in india during 1810 and 1839. it is a system of PHARMACO-DYNAMIC base on the treatment of disease by use of small amount of drug that a healthy person produce symptoms similar to those of a disease being treated. Homoeopathy is practiced inn several countries but india claim to have the largest practitioner of the system in the world. The india system of medicine including unani-tib and Homoeopathy are still alive till date and have become part of india culture and in fact have become an important source of medical care in rural population.  CHINESE MEDICINE IS ALREADY ILL BUT SOMEONE WHO TREAT A PERSON YET TO BE ILL”. The chinese have great faith in their traditional medicine which is fully integrated with modern medicine. The chinese system of treatment barefoot and acupuncture has attracted world wide attention in recent years.  EGYPTIAN MEDICINE Egypt had one of the oldest civilization in about 2000BC. Alot is known about the ancient Egypt because they invented the PICTURE WRITING and they recorded their doings on PAPYRUS. In egyptian times, their act of medicine was mingled with religion, egyptian physicians were co-equal with priest trained in school using the temples. They often helped the priest care for the sick who were brought to the temple for treatment. There was no practical demonstration in anatomy for the egyptian enjoy strict preservation of the HUMAN BODY. Egyptian Medicine reached its peak in the day of IMHOTEP [2800BC] who was famous as a statesman, architect, builder of the state pyramid at saqqarah and a physician. The Egyptian worshiped many god, IMHOTEP WAS CONSIDERED BOTH A PHYSICIAN AND DIVINITY. Specialization prevailed in egyptian times. There were eye doctors, head doctors and tooth doctors. All this doctors were officially paid by the government. Homer speaking of the doctors of the ancient world considered the Egyptians to THE BEST OF ALL. The Edwin Smith Papyrus: The oldest treatise on surgery, accurately describes partial paralysis following cerebral lesions in skull fractures. The Ebers Papyrus: It was written 3400 years ago, gives an extensive description of Egyptian medical science, including isolation of infected surgical patients. The Ebers papyrus which was found with a mummy on the banks of the Nile, is a unique record of some 800 prescriptions based on some 700 drugs. Castor oil, tannic acid, opium, turpentine, gentian, senna, minerals and root drugs were all used by the Egyptian physicians. A great number of diseases are reported in the papyri such as;  worms  eye diseases  diabetes  rheumatism  polio  schistosomiasis Unfortunately, these ailments are still present in modern Egypt. In the realm of public health also, the Egyptians excelled: They built planned cities Public baths and underground drains which even the modern might envy They had also some knowledge of inoculation against smallpox The value of mosquito nets and the association of plague with rats. The Egyptian GOD OF HEALTH was HORUS. Egyptian medicine occupied a dominant place in the ancient world for about 2,500 years when it was replaced by Greek medicine.  MESOPOTAMIAN MEDICINE Contemporarily with ancient civilization in the land which lies between the Euphrates and Tigris river, Mesopotamian [now part of IRAQ] often called the CRADLE OF CIVILIZATION AS LONG AS 6000 YEARS AGO. In ancient Mesopotamia, the basic concept of Medicine were religious and taught were practiced by HERB DOCTORS KNIFE DOCTORS and SPELL DOCTORS. A classification that parallels internist, surgeon and psychiatrist. Mesopotamia was the origin [cradle] of magic and necromancy. Medical students were busy in the classification of “demon” as the cause of diseases. The following were the characteristic of their MEDICAL LORE:  Geomancy  The interpretation of dreams and  Hepatoscopic divination [“THE LIVER WAS CONSIDERED THE SEAT OF LIFE”] Sumerians, Babylonians and Assyrians were the authors of medical astrology which flourished in the whole of Eurasia. Prescriptions were written on tablets and in cuneiform writing. The oldest medical prescription comes to us from Mesopotamia, dating back to 2100BC. CODE OF HAMMURABI Hammurabi, a great king of Babylon who lived around [2000BC] formulated a set of drastic Laws Known as code of hammurabi. These were codes that govern the conduct of physicians and provided for health practices. The codes of hammurabi include the following;  Doctors whose proposed therapy proved wrong ran the risk of being killed.  Laws relating to medical practice included fees payable to physicians for satisfactory services and penalties for harmful therapy. The Babylonian Code of Hammurabi, was the very first codification of medical practice. While the code of Hammurabi reflected a high degree of social organization, the medicine of his time was devoid of any scientific foundation.  GREEK MEDICINE [460-136BC] The classic period of Greek medicine was the year 460 -136 BC the Greeks enjoyed the reputation “the civilizes of the ancient world”. They taught men to think in terms of 'Why' and 'How'. An early leader in Greek medicine was Aesculapius [1200BC]. Aesculapius bore two daughters which were; Hygiea and Panacea. HYGIEA: Hygiea was worshiped as the GODDESS OF HEALTH. PANACEA: Panacea as the GODDESS OF MEDICINE. Panacea and Hygiea gave rise to dynasties of healers (curative medicine) and hygienists (preventive medicine) with different philosophies. Therefore, the dichotomy between curative medicine and preventive medicine began early and it remains true today. Hygiea (prevention) is at present fashionable among the intellectuals, but Panacea (cure) gets the cash. Aesculapius is still cherished in medical circles, “His staff, entwined by a serpent, continues to be the symbol of medicine”. His staff, the staff of medicine is called CADUCEUS. Aesculapius is said to have performed many acts of healing and later achieved a god- like status. He was worshiped in hundreds of temples throughout Greece, the remains of which can be seen in Epidaurus, Cos, Athens etc. To these resorts or hospitals were established for which sick persons went for the healing ritual of ‘incubation’ or temple sleep. They lay down to sleep in the dormitory, or abaton, and were visited in their dreams by Asclepius or by one of the priests, who gave advice. In the morning the patient is often said to have departed cured. Diet, baths and exercises played a part in treatment and the resorts were located in a peaceful spot with gardens and fountains with theaters for amusement and stadium for athletic conquests. Hippocrate's lectures and writings, as compiled later by Alexandrian scholars into the "Corpus Hippocraticum", encompassed all branches of medicine. This 72 volume work contains the first scientific clinical case histories. Some of the sayings of Hippocrates later became favorites with physicians, such as;  “Life is short the art (of medicine) long, opportunity fleeting, experience treacherous and judgment difficult”  “Where there is love for mankind, there is love for the art of healing”. HIPPOCRATIC OATH His famous oath, [The Hippocratic oath], has become the key stone of medical ethics. It set a high moral standard for the medical profession and demand absolute integrity for doctors. Hippocrate was also an epidemiologist. Since he distinguished between disease which were EPIDEMIC and ENDEMIC. He was in fact the first epidemiologist and he was constantly seeking the cause of diseases. He studied things such as climate, water, clothing, diet, habits of eating and drinking and the effect they had in producing diseases. His book “AIR, WATER AND PLACES” is considered a treatise on social medicine and hygiene. The Hippocratic concept of health and disease stressed the relation between man and his environment. Greek gave a new direction to medic thought. They rejected the super natural theory of disease and looked upon disease as a natural process not visitation from a god of immolation. The greeks believe that matter was made up of four element which were; earth air fire water. These element had the corresponding qualities of being COLD, DRY, HOT and MOIST and were represented in the body by four humors which are;  phlegm  yellow bile  blood  black bile This is similar to the Tridosha theory in Ayurveda. The greeks postulated that; “Health prevailed when the four humors were in equilibrium and when the balance was disturbed, disease was the result.” They believed that the human body was assumed to have powers of restoration of humoral equilibrium, and it was the physicians primary role to assist in this healing process. While the humoral theory of Hippocrate was based on incorrect foundations, the concept of the innate capacity of the body of responding to disturbances in equilibrium that constitute health is highly relevant to medicine.  ROMAN MEDICINE By the first Century BC the centre of civilization shifted to Rome. The Romans borrowed their medicine largely from the Greeks whom they had conquered. While the politics of the world became Roman, medicine remained Greek. In the political philosophy of the Romans, the State and not the individual was supreme. Although the contribution of Rome to the practice of medicine was negligible compared to that of Greece, in matters of public health the Romans set the world a great example. The Romans were a more practical-minded people than the Greeks. They had a keen sense of sanitation. Public health was born in Rome with the development of baths, sewers and aqueducts. The Romans did the following that set them apart;  They made fine roads throughout their empire  Brought pure water to all their cities through aqueducts  Drained marshes to combat malaria  Built sewerage systems and established hospitals for the sick.  The army had its medical officers  Public physicians were appointed to attend to the poor and hospitals were built. An outstanding figure among Roman medical teachers was GALEN [130-205 AD]. He was born in the Greek city of Pergamon in Asia Minor (now Turkey). He was physician to the Roman emperor, Marcus Aurelius. His important contributions were in the field of comparative anatomy and experimental physiology.  MIDDLE AGES The period between [500 -1500AD] is generally known as the MIDDLE AGE and the fall of the roman empire. The medical schools established in the roman times also disappeared. Europe was ravaged by disease and pestilent like plague, smallpox, TB, leprosy. The practice of medicine reverted back to primitive medicine dominated by superstition and dogma. Rejection of the body and glorification of spirit became the accepted pattern of behavior, It was regarded as immoral to see ones body. Consequently, people seldom bath, dissection of human body was prohibited. THERE WAS NO PROGRESS OF MEDICINE.  MEDIEVAL PERIOD It is also called The dark ages of medicine a type of great strive, of socio-political changes and progression. When Europe was passing through dark ages the Arab took over civilization in medicine. They translated Greek-roman medical literature into Arabic, and help preserve the ancient knowledge borrowing likely from Greek and roman they develop their own system of medicine known as UNANI SYSTEMS OF MEDICINE. The founded school of medicine and hospital in Baghdad, Damascus, Cairo, and other Islamic capital. Leaders in Arabic medicine were Persians  ABU BECR [865-925AD] also known as Al-Rhazi (Rhazes) in the west.   IBN SINA [982-1037] also known as Avicenna. Rhazes was a dictator of a large hospital in Baghdad and whole physician as well, noted for keen observation and inventiveness, he was first to  observe pupillary reaction to light  to use mercurial fungatives  And to publish the first known book on children disease. However his work that is highly regarded today was his book on smallpox and measles which he distinguish clinically. Ibn sina was intellectual, he compiled 21 volume encyclopedia called THE CANON OF MEDICINE, which has left it’s mark on medical theory and practices. He responsible for elevating Islamic medicine to it is zenith in the middle age. The greatest contribution of Arabs in general was in the field of pharmacology. Seeking the elixir of life, they develop pharmaceuticals chemistry, introducing a large number of drugs, herbal and chemicals. Pioneer in pharmacology they invented;  The art of writing prescription, an art inherited by our modern pharmacy.  They introduce a wide range of syrups, oils, plasters, pills, powders, alcoholate and aromatic water.  The words alcohol, syrups and sugar comes from arabic. The Golden Age Of Arabian Medicine Was Between 800-1300 AD. During turbulent middle ages Christianity exerted a wholesome influence. The spread of Christianity lead to establishment of hospitals, early medieval hospitals really specialized in fragment usually the sicks were received for the purpose body ones and catering of their spiritually. The first hospital on record in England was built in YORK in 937AD with growth of medicine, a chain of hospital sprang up from Persia to Spain and there were more than 60 in baghdad and 33 in in cairo. Some hospital like Cairo's Al-Mansur have; Separate department for various disease Ward for both sexes Fountain to cool patient Library musician and story tellers for sleepless patient. During the middle ages, religious institution known as monasteries headed by monks, saints and abbot also came up. This monasteries admitted men and women from all rank including king and queen. They not only help preserve the ancient knowledge but also rendered medical care to the sicks.  DAWN OF SCIENTIFIC MEDICINE The period following 1500AD was marked by revolution, political, industrial, religious and medical. Political revolution took place in France and America, people claiming their are just right. The industrial revolution in the west brought great benefit leading to improvement in the standard of living among people. With advance degree of civilization, medicine also evolved. REVIVAL OF MEDICINE For many historians, the revival of medicine encompassed the period from [1453-1500AD] it was an age of individual scientific endeavour. The distinguished personality during this period are: 1. Paracelsus [1493-1541AD] He was one of those who revived the medicine, he was born at a time when Europe stretch her limbs, after a sleep of thousand year in a bed of darkness, he was genius by some and quack by others, Swiss born Paracelsus publically burnt the works of Galen and Avicenna and attack superstition and dogma, and help turned medicine toward rational research. 2. Fracatorius [1483-1553] An italian physician enunciated The Theory of Contagion, he mentioned that transfer of infection is via minor invisible particle and explain the concept of epidermic. Fracatorius recognize that syphilis was transferred from person to person during sexual contact. He became the founder of Epidermology. 3.Vasalius [1514-1564] He did a lot of dissection on human body and demonstrated some Galen's errors. He raised the study of anatomy to science and become the first man of modern science. vasalius great work FABRICA become a classical text in medical education.  4. Ambroise Pare [1510-1590] What vasalius did for anatomy, amproise pare a French army surgeon DID FOR SURGERY and earned the title Father of surgery. 5. John Hunter [1728-1793] Pare advance the art of surgery but john hunter taught the science of it. In 1540, the united company of barber surgeon was established in england, which later became Royal college of surgeon. 6. Thomas sydenham [1624-1689] Another great name in clinical medicine is that of thomas sydenham, the english hippocrates who set the example of true clinical method. He made differential diagnosis of scarlet fever, malaria, dysentery and cholera. Sydenham is also regarded as first to distinguish epidemiology. The 17th and 18tha century were full of even more exciting discoveries example Harvey's discovery of circulation of blood (1628) leeuwanhoek's microscope (1670) Jennies vaccination against smallpox (1796) However, the progress in medicine as well as surgery, during the 19th century will not have been possible for MORGAGNI [1682-1771] who focused a new branch of medical science called Pathological Anatomy. SANITARY AWAKENING The great cholera epidemic of 1832 led Edwick Chadwick (1800-1890) a lawyer of england to investigate health of the inhabitants of the large town with a view to improve the condition under which they live. Chadwick's report on the sanitary condition of the laboring population in great Britain a landmark in the history of public health, set London and other cities on the way to improve housing and working condition. Chadwick's report focused the attention of the people and government on the urgent need to improve public health. Filth was recognized as the man's greatest enemy and with this began anti-filth crusade, the "Great sanitary awakening" which led to the enactment of the public health act of 1848 in England. A new thinking began to take shape that is state has direct responsibility for the health of the people. RISE OF PUBLIC HEALTH The above event led to the birth of public health concept in England around 1840. Earlier, Johanna peter frank (1745-1821) a health philosopher of his time, conceived public health as good health laws enforced by the police and enunciated the principle that the state is responsible for the health of the people. The public health act of 1848 was a fulfillment of his dream about the state responsibly for the health of its people. Cholera which is often called the Father of public health appeared time and again in the western world during 19th century. An English epidemiologist John Snow studied the epidemiology of cholera in london from 1848-1854 and established; The role of polluted drinking water is the spread of cholera. In 1856 William Budd pioneer by careful observation of the outbreak of typhoid fever, in the rural north of england, concluded that; The spread is by drinking water not by miasma and sewer gas. This two discoveries were all the more remarkable when one considered that causative agent of typhoid and cholera were not identified. Then came the demand from people for clean water. At that time the demand was both a source of clean drinking water and depository of sewage. A comprehension piece of legislation was brought into force in england, for public health act of 1875 for The control of man’s physical environment. The torch was already lit by Chadwick, but the man who was actually responsible more than any other for sanitary reforms was Sir John Simone (1816-1904) the first medical This three countries in 1920 presented the typical picture of the under-developed world. Today there are quite advance in public health. While public health made a rapid strike in the western world, its progress has been slow in the developing countries where the main problems continue to be those faced by western world hundreds years ago. The establishment of the WHO provided a health charter for old people and provided a great help to the public health movement of this countries.  GERM THEORY OF DISEASES For long man was growing in darkness about the causation of disease. Several theories were advanced from time to time to explain disease causation such as; 1. Supernatural theory of disease 2. The theory of humor by Greeks and Indians. 3. The theory of contagion 4. The miasmatic theory (which attributed disease to noxious air/vapour) 5. Theory of spontaneous generation. The breakthrough came in 1860 when the french bacteriologist Louis Pasteur (1822- 1895) demonstrated the presence of bacteria in air. He disprove the theory of spontaneous generation. In 1873 Pasteur developed THE GERM THEORY OF DISEASE In 1877 Robert Koch (1843-1910) showed that anthrax is caused by bacteria. The discovery of Pasteur and Koch confirmed the Germ theory of disease and it was golden age of bacteriology. Microbes after microbes were discovered in quick succession example; Gononcoccus(1847) Typhoid bacillus Pneumococcus 1880 Tubercule bacillus 1882 and so on These discoveries and a lot of others at the turn of century marked turning point in our etiological concept. All attention was focused on microbes and their role in disease causation. The germ theory of disease came to the fore front compared to the earlier theory of disease causation. Medicine finally shape the rag of dogma and superstition and put on the ropes of scientific knowledge. BIRTH OF PREVENTIVE MEDICINE Edward Jenna (1749-1823) of great Britain a pupil of John Hunter discovered vaccination against smallpox in 1796. This two discoveries Marked the beginning of new era, the era of disease prevention by specific measure. Preventive medicine got a firm foundation only after the discovery of causative of disease and the establishment of the germ theory of disease. The later part of 19th century was marked by such discoveries in preventive medicine such as; Pastuers anti rabies treatment 1883 Cholera vaccine 1892 Diphtheria antoxin1894  MODERN MEDICINE Genetic Environmental Psychological factors which are equally important Most of these factors are linked to man’s lifestyle and behavior. The germ theory of diseases gives place to a usual cause of newer concept of diseases that is Multi-factorial Causation.  In fact it was Pattem Kofer of Munich 1819-1901 who first brought the concept of multifactorial causes of disease but his idea was lost in bacteriological era. The concept of multifactorial causation of disease was revived by epidemiologist who have contributed significantly to our present day understanding of multifactorial causation of disease. The development of modern medicine may be revived under the following: Curative medicine Preventive medicine Social medicine CURATIVE MEDICINE Although curative medicine is thousand years old, modern medicine has we known today is hardly 100 years old. It’s primary objective is removal of disease from the patient (rather than from the mass it implores various modality to accompany this e.g diagnostic technique and treatment. Over the years, the truth of diagnosis has become sophisticated and numerous. In the middle of 20th century, profound evolution was brought in; ALLOPHATIC MEDICINE: which has been define as the treatment of disease by the use of drugs which produce a reaction which is self neutralize to the disease by the introduction of anti bacteria and anti-biotic agents.  PREVENTIVE MEDICINE Preventive medicine developed as a branch of medicine distinct from public health. By definition preventive medicine is applied to healthy people. Its primary objective is prevention of disease and promoting of health. The early trions of preventive medicine was in the field of bacteria vaccines and anti- seral at the turn of the century which lead to the concrete of the wild spectrum of disease. Decline took place in morbidity, mortality from diphtheria, tetanus, typhoid fever and others. Preventive medicine did not confine it self to Vaccination and Quarantine. Discoveries into the field of Nutrition have added a new dimension to preventive medicine. New strategies have been develop for converting specific deficiency e.g Nutrition blindness (Vit A), iodine deficiency disorder (goiter). The recognition of the role of vitamin, protein, minerals and other nutrients and more recently dietary fibers emphasize the nutrition component of preventive medicine. Another glorious chapter in the history of preventive medicine is the discovery of; [DDT, HCH, Melathios and others insecticides], they have broad fundamental strategy in the control of vector borne diseases which are the most important worldwide health problems for many years. Another notable development in the 20th century is the development of screening of diagnosis of diseases in presymptomatic stage. SOCIAL MEDICINE he called SOCIAL PATHOLOGY. Development in the field of social sciences [Social psychology and social anthropology] rediscover that man is not only a biological animal but also a social being and disease has Social causes, Social consequences and Social therapy. CHANGING CONCEPTS IN PUBLIC HEALTH DISEASE CONTROL PHASE [1880-1920]: Public health in the 19th century was largely a matter of sanitary regulation and sanitary reforms aims at the control of man’s physical environment e.g water supply, sewage disposal e.t.c clearly this measures were not aimed at the control of any specific disease for what is needed is technical knowledge. However, this measures vastly improve the health of the people due to disease and death controls. HEALTH PROMOTION PHASE [1920-1960]: At the beginning of 20th century, a new concept the concept of the promotion began to take shape. It was realized that public health had neglected citizen as an individual and that the state ha direct responsibility for the health of the individuals. Consequently, in addition to disease control activities one more goal was added to public health that is health promotion of individuals. It was initiated as a personal health services such mother and child health services, school health services, industrial health services, mental health and rehabilitation services. SOCIAL ENGINEERING PHASE [1960-1980]: With the advance in preventive medicine and practice of public health, the pattern of disease of change in the developed world. Many of the acute illness problems have been brought under control. However as old problems are solved, new health problems in the form of chronic disease began to emerge e.g cancer, diabetes, cardiovascular diseases, drug addiction especially in affluence society. This problems cannot be tackled by the physicians approach to public health such as isolation, immunization and disinfection nor could be explained on the basis of germ theory of disease. A new concept of the risk factors ‘as determinant of disease came into existence. The consequences of this diseases result in chronic burden in the society. This problems brought new challenge to public health which needed reorientation more toward social objectives. Public health enters new phase in 1960, described as “Social engineering phase” social and behavioral activities of disease were given new priority. Public health moves into the preventive and rehabilitative aspect of chronic disease and behavioral in this process the goal of public health and preventive medicine which had considerably overlapping become identical namely prevention of disease promotion of health and prolongation of life. HEALTH FOR ALL [1981-2000AD]: As centuries have been folded the glaring contrast in the picture of health in the developed and developing countries came into sharper focus, despite advances in the medicine. Most people in the developed countries and elite of developing countries enjoyed all determinant as good health e.g adequate income, nutrition, education, sanitation, health drinking water and comprehensive healthcare in contrast, only 10-20% of population in the developing countries enjoyed ready access to health of any kind. Death claims 60-250 of every 1000 live birth within the first year of life and all the life experience is 30% lower than the developing countries. The global conscience was scaled leading to a new awakening that the health gap between the rich and poor within countries should be developed was narrowed and ultimately eliminated. It was considered that the neglected 80% of the world’s population too have an equal right to healthcare, to protection from the killer disease of childhood, primary health care for mother and children, to treatment from those ills that mankind has long ago learnt to control if not to cure. Against this background the members of the WHO pledged themselves to an ambitious target to provide health for all by the year 2000, that is alternative of a level of health that will permit all people “To lead socially and economically productive life”. Currently public health with other medical science and other health related sectors are engaged in this broad field of effort.