# A Textbook of Community Medicine/Printable version

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# History of Medicine

All human societies have medical beliefs that provide explanations for, and responses to birth, death, and disease. Throughout the world, illness has often been attributed to witchcraft, demons, averse astral influence, or the will of the gods, ideas that retain some power, with faith healing and shrines still common, although the rise of scientific medicine in the past two centuries has altered or replaced many historic health practices.

## Ancient Egyptian Medicine

The Ancient Egyptians, like the Ancient Greeks and Romans, have provided modern historians with a great deal of knowledge and evidence about their attitude towards medicine and the medical knowledge that they had. This evidence has come from the numerous papyrus found in archaeological searches.
Like prehistoric man, some of the beliefs of the Egyptians were based on myths and legend. However, their knowledge was also based on an increasing knowledge of the human anatomy and plain common sense.
In Ancient Egypt, the treatment of illnesses was no longer carried out only by magicians and medicine men.Archaeological digs have also found evidence of men titled physicians.
Physicians lived even earlier in Ancient Egypt. Imphotep was the physician to King Zozer and lived in about 2600 BC. Imphotep was considered so important that he was, after his death, was worshipped as a god of healing.
Almost all of our knowledge about Ancient Egyptian medical knowledge comes from the discoveries of papyrus documents. The very dry atmosphere in Egypt has meant that many of these documents have been very well preserved despite their age. Numerous papyrus documents have come from the era 1900 BC to 1500 BC. It is from these documents that we know that the Ancient Egyptians still believed that the supernatural caused some disease.
When there was no obvious reason for an illness, many Ancient Egypt doctors and priests believed that disease was caused by spiritual beings. When no-one could explain why someone had a disease, spells and magical potions were used to drive out the spirits.The Ancient Egyptians also had a god who would frighten away evil spirits – Bes.
Despite this use of remedies that come from a lack of knowledge, the Ancient Egyptians also developed their knowledge as a result of education. Ancient papyrus inform us that the Ancient Egyptians were discovering things about how the human body worked and they knew that the heart, pulse rates, blood and air were important to the workings of the human body. A heart that beat feebly told doctors that the patient had problems.The document actually gives names to organs such as the spleen, the heart, the anus, the lungs etc., so they must have known that these exist. One papyrus, the Edwin Smith Papyrus, has a detailed description of the brain in it so this organ was also well researched by the standards of the time. It is probable that this knowledge came as a result of the practice the Ancient Egyptians had of embalming dead bodies.

# History of Community Medicine

Community Medicine is a new branch of medicine. It is often considered synonymous with Preventive and Social Medicine(PSM), Public Health, and Community Health. All these share common ground, i.e., prevention of disease and promotion of health. In short, Community Medicine provides comprehensive health services ranging from preventive, promotive, curative to rehabilitative services. The importance of the speciality of Community Medicine has been very well recognised and emphasized repeatedly from grass root to international levels, not only in health sector but in other related sectors too. The scope of medicine has expanded during the last few decades to include not only health problems of individuals, but those of communities as well. If we want to achieve Health For All, Community Medicine will definitely be the key factor during the next millennium.

## Evolution and Development

A branch of medicine that is concerned with the health of the members of a community, municipality, or region. The emphasis in community medicine is on the early diagnosis of disease, the recognition of environmental and occupational hazards to good health, and the prevention of disease in the community The industrial revolution of the 18th century while bringing affluence also brought new problems - slums, accumulation of refuse and human excreta, overcrowding and a variety of social problems. Frequent outbreaks of cholera added to the woes Chadwick’s report on ‘The Sanitary Conditions of Labouring Population (1842)’ focussed the attention of the people and Government on the urgent need to improve public health. Filth and garbage were recognised as man’s greatest enemies and it lead to great sanitary awakening bringing Public Health Act of 1848 in England, in acceptance of the principle that the state is responsible for the health of the people. The act was made more comprehensive in 1875 when Public Health Act 1875 was enacted. The public health movement in USA followed closely the English pattern. The organised professional body, American Public Health Association was formed in 1872.
Public Health is defined as the process of mobilising local, state, national and international resources to solve the major health problems affecting communities and to achieve Health For All by 2000 AD.
While Public Health made rapid strides in the western world, its progress has been slow in the developing countries where the main health problems continue to be those faced by the western world 100 years ago. The establishment of the World Health Organisation (WHO) providing a Health Charter for all people provided a great help to the public health movement in these countries.
Many different disciplines contributed to the growth of Public Health; physicians diagnosed diseases; sanitary engineers built water and sewerage systems; epidemiologists traced the sources of disease outbreaks and their modes of transmission; vital statisticians provided quantitative measures of births and deaths; lawyers wrote sanitary codes and regulations; public health nurses provided care and advice to the sick in their home; sanitary inspectors visited factories and markets to enforce compliance with public health ordinances; and administrators tried to organise everyone within the limits of the health departments budgets. Public Health thus involved Economics, Sociology, Psychology, Law, Statistics, and Engineering as well as biological and clinical sciences. Soon another important and emerging branch of medicine i.e., Microbiology became an integral part of Public Health. Public Health during the 19th Century was around sanitary regulations and the same underwent changes.
Community Medicine developed as a branch of medicine distinct from Public Health. By definition, Community medicine is applied to ‘healthy’ people, customarily by actions affecting large numbers or populations. Its primary objective is prevention of disease and promotion of health. The development of laboratory methods for the early detection of disease was a further advance.
Community Medicine has been defined as that speciality which deals with populations, and comprises those doctors who try to measure the needs of the population, both sick and well, who plan and administer services to meet those needs, and those who are engaged in research and teaching in the field.
Decades old concept of health care approach has experienced a dramatic change. Today health is not merely an absence of disease; it is related to quality of life instead. Health is considered a means of productivity. Thus health development is essential to socio-economic development as a whole. Since health is an integral part of development, all sectors of society have an effect on health. Scope of medicine has extended from individual to community. Study of health and disease in population is replacing study of disease in man. Germ theory of disease gave place to newer concepts - multi-factorial causation. Social and behavioural aspects of the disease have been accorded a new priority. Contemporary medicine is no longer solely an art and science for the diagnosis and treatment of diseases. It is also the science for the prevention of disease and promotion of health. Today technical sophistication of modern medicine is not an answer to everyday common ailments of the vast poor in the country. Appropriate technology and cheaper interventions like Oral Rehydration Solution (ORS), immunisation, etc., are increasingly being applied as life saving measures and for disease prevention in community health care. Physicians’ role is no longer confined to diagnosing and treating those who come to the clinic. He is also responsible for those who need his service but can not come to the clinic. Health of the people is not only the concern of health care providers. It is the responsibility of the community also to identify and solve their own health problems through their active participation.
All these changes in concept and ideas of health and health care system are embodied in community health care. The spate of new ideas and concepts, for example, increasing importance given to social justice and equity, recognition of crucial role of community participation called for the new approaches to make medicine in the service of humanity more effective.
In 1978, the UN's Alma-Ata Declaration of Health for All by 2000 specified that Primary Health Care approaches are the means of achieving their goal of Health For All by 2000 AD. The Primary Health Care approach stressed that “essential health care should be made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and the country can afford”.

# Medical Epidemiology

According to John M Last, Epidemiology is the study of the distribution and determinants of health-related states and events in specified populations and application of this study to the control of those health problems.
It is a scientific, systematic and data driven study of all health related states or events, not disease alone. Distribution of health related states in terms of time, place and person are studied. In other terms when and where the health related states occur and what are the characteristics of those affected. Magnitude of those health related states or events in terms of incidence and prevalence are studied. Determinants of the health related states and events include causes and risk factors of those conditions. Findings of the study is applied in controlling those health related states or events.

## References

* ↑ Last JM, editor. Dictionary of epidemiology. 4th ed. New York: Oxford University Press; 2001. p. 61.
* ↑ Principles of Epidemiology in Public Health Practice, Third Edition. An Introduction to Applied Epidemiology and Biostatistics, Centre for Disease Control and Prevention

# Primary Health Care

Primary Health Care (PHC) includes a number of essential components

## Health Education

* Teaching people how to live healthy lives.
* Teaching people services offered by the local healthcare system.
* Ensuring knowledge of how to contact emergency services is commonplace.
* Expanding first aid training to laypeople.
* Spreading accurate and timely information about likely health threats to the community.
** Dispelling myths, misinformation, and other social barriers to proper treatment.

## Mother and Child Health

* Ensuring safe pregnancy and childbirth
* Ensuring children receive adequate medical care.

## Nutrition

* Encouraging healthy diets among the populace.
* Preventing malnutrition.
** Assist those currently suffering from undernutrition to ensure a safe recovery.
*** Simply feeding food to an undernourished patient can be dangerous.
** Encourage active lifestyles in food rich communities to prevent overnutrition.
* Assist those suffering from Diabetes or other medical conditions in finding a suitable diet.

## Expanded Program of Immunization

* Vaccination drives, particularly against diseases which are likely to threaten patient or community health.
* Ensure access by considering cost, time, etc of the populace.

## Safe water and Sanitation

* Reduces or eliminates the spread of waterborne diseases.
* Safe water generally increases community health.
* Proper sanitation easily reduces or prevents a number of diseases.
** A modern sewage system using technology such as contained sewage lines, treatment plants, or septic tanks will typically prevent the average person from having contact with potentially infectious sewage.

## Control of Endemic Diseases

* Contact Tracing
* Vaccination when available.

## Treatment of Endemic Diseases

* Most epidemic diseases have established treatment practices.
* In a novel disease, proper treatment practices may not be possible.
** Even so, it is usually possible to reduce the pain or suffering of the patient.

## Provision of Essential Drugs

* A number of medicines are considered essential, and should be on hand in any community.
** Local medical personnel should be versed in the correct application of these drugs.
** A system should be in place to allow for 24/7 access to these drugs in the event of an emergency.
** Ensure access by considering cost, time, etc of the populace.

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