UNIT-1

INTRODUCTION TO COMMUNITY
MEDICINE

Dr.P.KARNAN
PROFESSOR
 INTRODUCTION
 Community medicine is comparatively a newcomer among academic disciplines of medicine.
Previously it was taught to medical students as hygiene and public health. This name was later
changed to preventive and social medicine when it was realized that the subject encompassed
much more than merely the principles of hygiene and sanitation and public health engineering.

 The name preventive and social medicine emphasizes the role of:

 (a) disease prevention in general through immunization, adequate nutrition, etc. in addition to
the routine hygiene measures and

 (b) social factors in health and disease. The modern day message is that the discipline
variously labeled in the past as public health or preventive and social medicine cannot be
divorced from health care, including clinical care of the community.

 It is in recognition of this wider role that the Medical Council of India has recently decided to
label the discipline as Community Medicine in place of Preventive and Social Medicine
 The history of medicine is both a study of medicine throughout history as well as a
multidisciplinary field of study that seeks to explore and understand medical practices,
both past and present, throughout human societies.

 The history of medicine is the study and documentation of the evolution of medical
treatments, practices, and knowledge over time.

 Medical historians often drawn from other humanities fields of study including
economics, health sciences, sociology, and politics to better understand the institutions,
practices, people, professions, and social systems that have shaped medicine.

 When a period which predates or lacks written sources regarding medicine, information
is instead drawn from archaeological sources.

 This field tracks the evolution of human societies' approach to health, illness, and
injury ranging from prehistory to the modern day, the events that shape these
approaches, and their impact on populations
 Early medical traditions include those of Babylon, China, Egypt and India.

 Invention of the microscope was a consequence of improved understanding, during the

Renaissance. Prior to the 19th century, humorism (also known as humoralism) was thought to
explain the cause of disease but it was gradually replaced by the germ theory of disease,
leading to effective treatments and even cures for many infectious diseases.

 Military doctors advanced the methods of trauma treatment and surgery. Public health
measures were developed especially in the 19th century as the rapid growth of cities required
systematic sanitary measures.

 Advanced research centers opened in the early 20th century, often connected with major
hospitals. The mid-20th century was characterized by new biological treatments, such as
antibiotics.

 These advancements, along with developments in chemistry, genetics, and radiography led to
modern medicine. Medicine was heavily professionalized in the 20th century, and new careers
opened to women as nurses (from the 1870s) and as physicians (especially after 1970).
A 12th-century manuscript of the Hippocratic Oath in Greek, one of the
most famous aspects of classical medicine that carried into later er as.
Yarrow, a medicinal plant found in human-occupied caves in the
Upper Palaeolithic period
 PREHISTORIC MEDICINE
 Prehistoric medicine is a field of study focused on understanding the use of medicinal plants,
healing practices, illnesses, and wellness of humans before written records existed.

 Although styled prehistoric "medicine", prehistoric healthcare practices were vastly different
from what we understand medicine to be in the present era and more accurately refers to
studies and exploration of early healing practices.

 This period extends across the first use of stone tools by early humans c. 3.3 million years ago
to the beginning of writing systems and subsequent recorded history c. 5000 years ago.

 As human populations were once scattered across the world, forming isolated communities and
cultures that sporadically interacted, a range of archaeological periods have been developed to
account for the differing contexts of technology, sociocultural developments, and uptake of
writing systems throughout early human societies.

 Prehistoric medicine is then highly contextual to the location and people in question, creating
an ununiform period of study to reflect various degrees of societal development.
 Without written records, insights into prehistoric medicine comes indirectly from interpreting evidence
left behind by prehistoric humans. One branch of this includes the archaeology of medicine; a discipline
that utilizes a range of archaeological techniques from observing illness in human remains, plant fossils,
to excavations to uncover medical practices.

 There is evidence of healing practices within Neanderthals[10] and other early human species.
Prehistoric evidence of human engagement with medicine include the discovery of psychoactive plant
sources such as psilocybin mushrooms in c. 6000 BCE Sahara to primitive dental care in c. 10,900 BCE
(13,000 BP) Riparo Fredian (present-day Italy) and c. 7000 BCE Mehrgarh (present-day Pakistan).

 Anthropology is another academic branch that contributes to understanding prehistoric medicine in

uncovering the sociocultural relationships, meaning, and interpretation of prehistoric evidence.

 The overlap of medicine as both a root to healing the body as well as the spiritual throughout
prehistoric periods highlights the multiple purposes that healing practices and plants could potentially
have.

 From proto-religions to developed spiritual systems, relationships of humans and supernatural entities,
from Gods to shamans, have played an interwoven part in prehistoric medicine.
 ANCIENT MEDICINE

 Ancient history covers time between c. 3000 BCE to c. 500 CE, starting from evidenced
development of writing systems to the end of the classical era and beginning of the post-
classical period.

 This periodisation presents history as if it were the same everywhere, however it is

important to note that socioculture and technological developments could differ locally
from settlement to settlement as well as globally from one society to the next.

 Ancient medicine covers a similar period of time and presented a range of similar healing
theories from across the world connecting nature, religion, and humans within ideas of
circulating fluids and energy.

 Although prominent scholars and texts detailed well-defined medicial insights, their real
world applications were marred by knowledge destruction and loss, poor communication,
localized reinterpretations, and subsequent inconsistent applications.
 Ancient Mesopotamian medicine
 The Mesopotamian region, covering much of present-day Iraq, Kuwait, Syria, Iran, and
Turkey, was dominated by a series of civilisations including Sumer, the earliest known
civilisation in the Fertile Crescent region, alongside the Akkadians (including Assyrians
and Babylonians). Overlapping ideas of what we now understand as medicine, science,
magic, and religion characterised early Mesopotamian healing practices as a hybrid
naturalistic and supernatural belief system.

 The Sumerians, having developed one of the earliest known writing systems in the 3rd
millennium BCE, created numerous cuneiform clay tablets regarding their civilisation
included detailed accounts of drug prescriptions, operations, to exorcisms. These were
administered and carried out by highly defined professionals including bârû (seers),
âs[h]ipu (exorcists), and asû (physician-priests).

 An example of an early, prescription-like medication appeared in Sumerian during the

Third Dynasty of Ur (c. 2112 BCE – c. 2004 BCE).
 Following the conquest of the Sumerian civilisation by the Akkadian Empire and the empire's
eventual collapse from a number of social and environmental factors, the Babylonian
civilisation began to dominate the region.

 Examples of Babylonian medicine include the extensive Babylonian medical text, the
Diagnostic Handbook, written by the ummânū, or chief scholar, Esagil-kin-apli of Borsippa, in
the middle of the 11th century BCE during the reign of the Babylonian king Adad-apla-iddina
(1069–1046 BCE).

 This medical treatise presented great attention to the practice of diagnosis, prognosis, physical
examination, and remedies. The text contains a list of medical symptoms and often detailed
empirical observations along with logical rules used in combining observed symptoms on the
body of a patient with its diagnosis and prognosis.

 Here, clearly developed rationales were developed to understand the causes of disease and
injury, supported by agreed upon theories at-the-time of elements we might now understand as
natural causes, supernatural magic and religious explanations.
 Most known and recovered artefacts from the ancient Mesopotamian civilisations centre
on the neo Assyrian (c. 900 - 600 BCE) and neo-Babylonian (c. 600 - 500 BCE) periods,
as the last empires ruled by native Mesopotamian rulers.

 These discoveries include a huge array of medical clay tablets from this period, although
damage to the clay documents creates large gaps in our understanding of medical
practices.

 Throughout the civilisations of Mesopotamia there is a wide range of medical innovations

including evidenced practices of prophylaxis, taking measures to prevent the spread of
disease, accounts of stroke, to an awareness of mental illnesses.
 Indian medicines are mainly Ayurveda and Siddha. Ayurveda is traced back to the Vedic times
about 5000 B.C. (Park 2015). The medical history was associated with mythological figures, sages
and seers.

 Ayurveda by definition implies the “knowledge of life” witnessed tremendous growth and
development during the Buddhist times. King Ashoka and the other Buddhist kings patronised
Ayurveda as the state medicine and established schools of medicine and public hospitals.

 Disease was explained as a disturbance in the equilibrium of the three humors such as vata (wind),
pitta (gall) and kapha (mucus). This theory of disease is similar to the theory of Greek medicine of
four humors. In ancient Indian medicine, hygiene was given an important place.

 It was also mentioned that the Indus Valley revealed advanced knowledge of sanitation, water
supply and engineering.

 Likewise, the other indigenous system of medicines namely, Unani- Tibb and Homoeopathy were
introduced into India by the Muslim rulers during 10th century A.D. Today, Unani-Tibb and
Homoeopathy have become part of Indian medical treatment options.
 Chinese Medicines is based on two principles-the yang (an active masculine) and
the yin (a negative feminine principle).

 The balance of these two opposing forces meant good health.

 The Chinese were early pioneer of immunisation where they practiced variolation
to prevent smallpox.

 They have great faith in their traditional medicine which is fully integrated with
modern medicines.

 The practice of ‘barefoot doctors’ and ‘acupuncture’ are famous worldwide in

recent years.
 Egyptian Medicine was far from primitive. Diseases were treated with a wide range of
drugs. In the realm of public health, they excelled as they built planned cities, public
baths and underground drains. They had knowledge of inoculation against small pox,
mosquito nets, etc.

 Greek Medicine from early times to this day has applied the dichotomy between
curative medicine and preventive medicine. The greatest physician Hippocrates (460-
370B.C.) who is also known as the “Father of Medicine” studied and classified diseases
based on observation and reasoning.

 Thus, Greeks gave a new direction to medical thought by rejecting the supernatural
theory of disease. But later the glorious Greek civilisation failed due to poor scientific
knowledge though their method was scientific , and thus was succeeded by the Roman
civilisation.
 Roman Medicine was largely borrowed from Greeks. Public Health was born in Roman period with the
development of baths, sewers and aqueducts.

 There were fine roads throughout their empire, they brought pure water to all their cities through
aqueducts, drained marshes to combat malaria, built sewerage systems and established hospitals for the
sick.

 Middle ages is the period between 500 and 1500 A.D. Due to fall of Roman Empire, the medical
schools of Roman times disappeared. This period is known as ‘Dark Ages of Medicine’.

 When Europeans were facing the Dark Ages, Arabs took over and developed their own system of
medicines known as the Unani system of medicine. The greatest contribution of Arabs was in the field
of pharmacology. They developed pharmaceutical chemistry, introducing a large number of drugs,
herbal and chemical.

 Later there was a turbulence in middle ages, where Christianity exerted a wholesome influence. The
spread of Christianity led to establishment of hospitals. The first hospital on record in England was built
in York in 937A.D.
 EVOLUTION OF COMMUNITY MEDICINE
 Community medicine, also known as public health or preventive medicine, has evolved
significantly over time to address changing health needs and societal challenges. Here's
a brief overview of its evolution:

 The period from 1453-1600 A.D. was the vital period for medicine in the world. The
17th and 18th centuries were the period of discoveries of circulation of blood by
Harvey in1628, Leeuwenhoek’s microscope in 1670 and vaccination against smallpox
by Jenner, 1796 who had founded a new area in evolution of public health.

 During the industrial revolution of the 18th century, there were several problems like
creation of slums, overcrowding with all its ill-effects, accumulation of filth in cities
and towns, high rates of sickness and death especially among women and children,
infectious diseases like tuberculosis, industrial and social problems which deteriorated
the health conditions of the people.
 The ‘great sanitary awakening’ in the midnineteenth century which took place in England was
another historic milestone in the evolution of public health. It had a tremendous impact in
modifying the behaviour of people.

 The great cholera epidemic of 1832 led Edwin Chadwick to investigate the health of the
inhabitants of the large towns with a view to improve their conditions.

 Thus, ‘The sanitary conditions of the labouring 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 conditions. In19th century, cholera which was often called the ‘father of public health’
appeared time and again especially in the western world.

 John Snow(1848), an English epidemiologist studied the causes of cholera and established the
role of polluted drinking water in the spread of cholera.

 William Budd, in1856 observed the outbreak of typhoid fever in the rural north of England
which spread due to polluted drinking water. After these two discoveries, legislation was
brought into force in England namely, the Public Health act of 1875.
 Sir John Simon (1816-1904) was the first medical officer of health of London and was
one of the prominent sanitary reformers. His efforts were directed entirely towards
general cleanliness, and disposal of garbage.

 His system of public health in England was admired and followed in different
countries. This early phase (1880-1920) of initiative in public health is addressed as
“the disease control phase’. The development of the public health movement in
America closely follows the English pattern.

 France, Spain, Australia, Germany, Italy, Belgium and the Scandinavian countries
subsequently developed their public health.

 By the beginning of the 20th century, there was a broad foundation of public health-
clean surroundings; clean water, proper housing conditions, control of offensive trades,
etc., were laid in all the countries of the western world.
 The concept of “Germ Theory of Disease” breakthrough came in1873, when the French
bacteriologist Louis Pasteur (1822-1895) demonstrated the presence of bacteria in air. He
advanced the ‘germ theory of disease’.

 In 1877, Robert Koch (1843-1910) showed that anthrax was caused by bacteria. Thus, the
discoveries of Pasteur and Koch confirmed the germ theory of disease. It was the golden
age of bacteriology.

 Microbes were also discovered in quick succession-gonococcus in 1847; typhoid

bacillus, pneumococcal in 1880; tubercle bacillus in 1882; cholera vibrio in1883;
diphtheria bacillus in1884, etc.

 All attention was focused on microbes and their role in disease causation. Thus, it stopped
the dogma and superstition and put on robes of scientific knowledge.
 MEDICINE IN THE OLDEN DAYS

 Ancient Egypt:

 Ancient Egyptians had a deep understanding of anatomy, as evidenced by their mummification

practices. They believed that the body consisted of channels through which fluids flowed, similar to
the modern concept of the circulatory system.

 They used various herbs, minerals, and animal substances for medicinal purposes, often combined
with magical rituals and spells.

 Ancient Greece:

 Hippocrates, often referred to as the "Father of Medicine," laid the foundation for Western medicine.
He emphasized the importance of observing and documenting symptoms and advocated for natural
explanations for diseases rather than attributing them to supernatural causes.

 Greek physicians used techniques such as bloodletting and herbal remedies. They also believed in the
concept of the four humors (blood, phlegm, black bile, and yellow bile) and sought to balance them to
maintain health.
 Ancient China:

 Traditional Chinese Medicine (TCM) originated thousands of years ago and is still
practiced today. It is based on the belief that the body's vital energy, called Qi, flows
along meridians. Imbalances in Qi are believed to cause disease.

 TCM utilizes various practices, including acupuncture, herbal medicine, massage (tui
na), and dietary therapy.

 Ancient India:

 Ayurveda, the traditional medicine system of India, is one of the oldest healthcare
systems in the world. It emphasizes the balance between mind, body, and spirit and
categorizes individuals into different constitutional types (doshas): Vata, Pitta, and
Kapha.

 Ayurvedic treatments include herbal remedies, dietary adjustments, yoga, meditation,

and cleansing practices.
 Medieval Europe:

 During the Middle Ages, medical knowledge in Europe was heavily influenced
by religious beliefs and superstitions.

 Physicians often relied on Galenic medicine, based on the teachings of the

ancient Greek physician Galen.

 Practices like bloodletting, purging, and the use of herbal remedies were
common. Medical care was often provided by clergy, barber-surgeons, and
herbalists.
 DIFFERENT SYSTEM OF MEDICINE IN DIFFERENT PARTS OF WORLD

 Traditional Chinese Medicine (TCM): Originating in ancient China, TCM focuses

on balancing the body's vital energy, or qi, through practices such as acupuncture,
herbal medicine, massage (Tui na), dietary therapy, and qigong exercises.

 Ayurveda: Developed in ancient India, Ayurveda emphasizes balance in bodily

systems and uses herbal remedies, dietary changes, yoga, meditation, and purification
techniques (such as Panchakarma) to promote health and prevent illness.

 Unani Medicine: Also known as Greco-Arabic medicine, Unani traces its roots to
ancient Greece and was later developed by Persian and Arab physicians. It utilizes a
combination of herbal medicine, dietary interventions, exercise, and spiritual practices
to maintain health and treat diseases.
 Traditional African Medicine: Practices vary widely across the African continent, but they
often involve herbal remedies, spiritual rituals, divination, and the use of symbols and objects
believed to possess healing powers. Traditional healers, such as herbalists and diviners, play
key roles in these systems.

 Native American Medicine: Indigenous peoples of North and South America have their own
healing traditions, which often involve herbal medicine, ceremonial rituals, sweat lodges, and
storytelling. Healing practices are deeply interconnected with cultural beliefs and spiritual
traditions.

 Kampo: Derived from traditional Chinese medicine but adapted to Japanese culture, Kampo is
a system of herbal medicine that has been practiced in Japan for centuries. It combines Chinese
medicinal herbs with unique Japanese formulations and diagnostic methods.
 Siddha Medicine: Originating in ancient Tamil Nadu, India, Siddha medicine is
based on the concept of maintaining the balance of the three doshas (humors) and
utilizes herbal remedies, minerals, and metals, as well as dietary and lifestyle
interventions.

 Homeopathy: Developed in Germany in the late 18th century by Samuel

Hahnemann, homeopathy is based on the principle of "like cures like" and the use
of highly diluted substances to stimulate the body's self-healing abilities. It is
practiced worldwide and includes individualized treatment based on a person's
symptoms and constitution.
 Modern medicine has revolutionized healthcare in the 21st century.

Modern medicine is a healthcare branch that uses scientific knowledge, technology, and evidence-

based practices to diagnose, treat, and prevent illnesses.

 Since its inception in the 19th century, modern medicine has undergone tremendous changes in

diagnostic techniques, medical technology, pharmaceuticals, and treatment protocols.

 Over the years, modern medicine has evolved into a multi-disciplinary field involving various

healthcare professionals, such as doctors, nurses, dentists, pharmacists, and allied health professionals.

 The advances in modern medicine have made it possible for healthcare professionals to diagnose and

treat a wide range of medical conditions and illnesses more effectively than ever before. In addition,

modern medicine has been instrumental in improving the overall quality of life of individuals and

populations across the globe.

 With the rise of evidence-based medicine, modern medicine has become more patient-centric and

tailored to each patient’s needs. Modern medicines have resulted in better outcomes and improved

quality of care for patients, enabling them to lead healthier lives.

 ORIGIN OF MODERN MEDICINE

 The origin of modern medicine is a complex and multifaceted story that spans millennia and
involves contributions from various cultures and civilizations. While it's challenging to
pinpoint a single origin, we can trace the development of modern medicine through key
milestones and advancements:

 Ancient Civilizations: Medicine has roots in ancient civilizations such as Mesopotamia,

Egypt, India, China, and Greece. These cultures developed early medical practices, herbal
remedies, surgical techniques, and anatomical knowledge.

 Hippocratic Medicine: In ancient Greece, the Hippocratic Corpus, attributed to the physician
Hippocrates (circa 460–370 BCE), laid the foundation for Western medicine. Hippocrates
emphasized the importance of observing and recording symptoms, ethical medical practice,
and the belief that diseases had natural causes rather than being caused by supernatural forces.

 Galenic Medicine: Galen (circa 129–200 CE), a Greek physician in the Roman Empire,
further expanded on Hippocratic teachings. His anatomical studies and theories on physiology
dominated Western medicine for over a millennium.
 Islamic Golden Age: During the Islamic Golden Age (8th to 14th centuries), scholars in the
Islamic world made significant advancements in medicine. They translated and preserved
classical Greek and Roman texts, expanded on Greek medical knowledge, and made original
contributions in fields such as pharmacology, surgery, and anatomy.

 Renaissance and Scientific Revolution: The Renaissance period (14th to 17th centuries)
saw a resurgence of interest in ancient medical texts and a shift toward empirical observation
and experimentation. Figures like Andreas Vesalius (1514–1564) revolutionized anatomy
through detailed dissections, while William Harvey (1578–1657) described the circulation of
blood.

 Development of Scientific Method: The Scientific Revolution of the 17th century, with
figures like Francis Bacon (1561–1626) and René Descartes (1596–1650), laid the
groundwork for the modern scientific method. This emphasis on observation,
experimentation, and systematic inquiry transformed medical practice.
 Discovery of Microorganisms and Germ Theory: In the 19th century, scientists like Louis
Pasteur (1822–1895) and Robert Koch (1843–1910) discovered the role of microorganisms in
causing diseases, leading to the development of germ theory. This revolutionized
understanding of infectious diseases and laid the foundation for modern preventive medicine
and microbiology.

 Advancements in Surgery and Anesthesia: The 19th century also saw significant
advancements in surgical techniques and anesthesia, pioneered by figures like Joseph Lister
(1827–1912) and William Morton (1819–1868), respectively. This made surgery safer and
more effective.

 Modern Medical Specializations and Technologies: The 20th and 21st centuries have
witnessed rapid advancements in medical technology, including diagnostic imaging,
pharmaceuticals, genetics, and minimally invasive surgical techniques. Specialized fields such
as cardiology, oncology, neurology, and psychiatry have emerged, providing targeted
treatments for various diseases and conditions.