Medicine in Ancient Times

Ancient Egyptians (3000 -300 BC) believed that the gods would heal disease, priests were trained as physicians who believed that the body was a system of channels (air, blood, tears, urine) that could be healed by leeches and blood letting.

Ancient Greeks (1200 – 200 BC)  Hippocrates (4th c. BC)  was considered the father of western medicine.

• doctor separate from religious leader
• observation of patient
• record observations
• natural cause of disease rather than supernatural

Prior to Hippocrates health care was done by a witch doctor, evil spirits as the cause, life span was 20 years.

Aristotle (384 – 324 BC) was known as the father of anatomy, he began dissecting animals for study and believed that diet and hygiene were factors preventing disease.

Ancient Egyptians (3000 -300 BC) believed that the gods would heal disease, priests were trained as physicians who believed that the body was a system of channels (air, blood, tears, urine) that could be healed by leeches and blood letting.

Ancient Romans (753 BC – 410 AD) were the first to organize health care by providing treatment to soldiers. They had a system of public health and sanitation (aqueducts/sewers), and drained wetlands to reduce the spread of malaria. Life expectancy was 35 years.

In the Dark Ages (400 – 800 AD) science and medicine was prohibited. Treatment of illness was prayer and divine intervention. Herbal remedies were provided by monks. Life expectancy was 20 to 30 years.

The Middle Ages (500 – 1500 AD) major diseases were smallpox, diphtheria, tuberculosis, typhoid, malaria and the bubonic plague (killed 3/4 of population in Europe and Asia.  Barbers performed surgery, amputations and blood letting. Regulation and licensing began to be introduced for male physicians, though most caregivers were religious orders.  Life expectancy was 20 to 35 years.

The Renaissance (1300 – 1600 AD), also known as the Age of Enlightenment, saw the advancement of scientific method, invention of the microscope, study of human anatomy, publishing of medical texts (invention of the printing press).

Pre-Industrial America

The Industrial Revolution (1700 – 1800s) medical advances included the discovery of the smallpox vaccine (1796), the invention of the stethoscope (1819), the ability to view microorganisms, and the discovery of capillaries. By 1885, French chemist Louis Pasteur identified microorganisms as the cause of disease, developed pasteurization of milk and produced the rabies vaccine. British surgeon Joseph Lister introduced antiseptics and disinfectants to reduce infection in surgery. Florence Nightingale, the British social reformer, known as the founder of modern nursing, trained and managed nursing care of soldiers during the Crimean War (1853-1856). German physicist, Robert Koch established the science of pathology in the late 1800s with the discovery of pathogens. Anesthesia was first demonstrated dentist William Morton at Massachusetts General Hospital in 1846.

But from the birth of the nation to the end of the nineteenth century, health care in the United states lagged behind Europe. Medical training was not scientific and health care was very primitive. Family members were more likely to care for their own sick, women served as midwives to family and friends, and only occasionally was there a “physician” in the community.

Hospitals that were situated in cities only, had poor sanitation and hygienic practices.  Staff were untrained and unskilled.

Work houses, also called poor house or almshouse, were institutions that housed destitute individuals and families and provided a very low level of basic nursing care for the sick. 

Asylums were the early state run institutions that preceded today’s inpatient mental health facilities.  Staff were often abusive, with no medical or psychiatric training.

Pest houses were set up more or less as quarantine facilities to serve people with infectious diseases such as cholera, typhoid, yellow fever and smallpox.

Dispensaries were the precursor to outpatient clinics and pharmacies, where free care and drugs were dispensed to people who could not pay.

Medical training was more of an apprenticeship than any form of university training. There were only about 42 inadequate medical schools in the US in 1850, about six months training with apprenticeship over 2 years. In 1849, Elizabeth Blackwell became the first female physician.

Medical practice was primitive and unregulated, often a local barber or other town professional. Care was not based on science and were very unsanitary. By the mid 1800s, surgery and the use of ether as anesthesia became more widely practiced.

After the Civil War (1861-1865) the US population started to shift to cities.  By 1900, the population in urban areas increased from 11% (1840) to 40%. Medical care began to be driven by science and technology.

Post-Industrial America

At the start of the 20th century, populations began to organize into multi-level societies.  State and county levels of government began to provide regulation of medical training and medical services. Medical professionals began to become licensed.  The health care organization, the American Medical Association, formed and lobbied to keep physician control of prescription authorization, health insurance to pay only if physician monitored.

With the accidental discovery of Xrays in 1895 Germany, the use of diagnostic technology would lead to CT scans and MRIs in the 1970s. In 1920, the discovery of penicillin radically changed the treatment of infectious diseases. Radium was discovered as a treatment for cancer. Prior to the first successful kidney transplant in 1954, eye and skin transplants had been performed. The first successful in vitro fertilization occurred in 1978. More recent advances in laser, micro and computerizes (robotic) surgeries were among the avalanche of emerging technologies in medical treatment. Life expectancy for an American born in 1900 was 50 years of age, by 1925 it was 63 years, by 1950 it was 78 years and has remained fairly constant up to 2010.

With the advances in technology that came with the industrial revolution, physicians could no longer afford equipment or facilities. Hospitals and physicians began to form alliances to keep patients in hospital and policy began to inform patient care. While physicians were not employed by the hospitals they did have considerable input into the operations and policies.

In addition to urbanization, scientific advancement led to increased health care costs and a new shift to specialization versus general practice. Medical education reform elevated the power and prestige of the medical community. This led to the organization of a medical political interest group (AMA) who would control medical education, support licensing laws and oppose national health insurance proposals to pursue entrepreneurship of physicians.

Early Attemps at National Health Care

In 1910, Workers Compensation was enacted in to law to support employees injured on the job.

This led to a continuous political debate over government sponsored health insurance, which failed in 1916-1918.

As a result of the Great Depression,  Blue Shield was instituted to provided physician services insurance in 1939.

In 1940 Blue Cross was adopted as the first hospital insurance for inpatient treatment.

In order to support workers during and after World War II, tax benefits were signed into law to enable employer-based health insurance, aimed at preventing inflation after the war (1948-1954).

In 1974 Blue Cross and Blue shield merged.

National health insurance was first rejected in WWII because Americans did not want to emulate Germans who had “socialized” medicine.

The AMA fought President Franklin Delano Roosevelt’s health insurance initiatives because it would limit profits. President Truman appealed again, in 1946 national health insurance was again rejected. During the Clinton administration, 1993, the first lady proposed National Health Insurance which was again struck down by the Republican legislature. Finally, in 2010, President Barack Obama signed into law a compromised version of National Health Insurance. (It is not truly national health insurance, but a mandate to participate in private insurance with some government subsidies available). So why do Americans reject health care?  Conservative values maintain the notion that “socialized” medicine is un-American and interferes with free enterprise (health care industry profits).

The Adoption of Public Health Insurance

Medicare and Medicaid

President John F Kennedy proposed a form of National Health Insurance targeted at the elderly and the indigent in 1957, but was unable to pass the laws before his assassination in 1963. (The AMA discredited the proposal of Medicare and Medicaid).

His successor, President Johnson, signed into law Medicare and the Medicaid in 1965. Medicare covers persons 65 and older, persons on Social Security disability and persons with end-stage renal disease.  Medicaid covers persons at the very lowest levels of household income (welfare). Medicaid covers all services, but Medicare covers a major portion of hospital and health care, but not all costs.

Both Medicare and Medicaid are financed by states and federal government under Titles 18 and 19, respectively, of the Social Security Act.

The New Age of Corporate Health Care