Dr.
Muhammad Tahir Khan
Assistant Professor
School of Public Health
Objectives
• To have broader understanding of history of
public health
• Understand concept of development of
public health
• To know about important landmarks of
history of public health
• To learn about important events in history
of public health especially in last two
centuries
Outline
• 1500 BC : Leviticus and Code of Hammurabi
• 500 BC -500 AD: Hippocrates
• 500 AD – 1500 AD : Middle Ages and Bubonic Plague
• 1500-1700 : Renaissance
• 1700-1800 : Miasma Theory, Germ Theory, Edward Jenner, Germ Warfare, Yellow Fever,
• 1800-1900 : Edwin Chadwick, Jhon Snow, Robert Kock, Louis Pasteur,
• 1900-1920 : Influenza Epidemics, Typhoid Mary, Family Planning
• 1920-1940 : Penicilli, Tuskeegee Syphilis Experiment
• 1940-1960 : WHO, CDC, Fluoridation, Thalidomide, Polio Vaccine
• 1960-1980 : The Pill : Birth Control Pill, Growth of Environmentalism, Tobacco Declared a Hazard, Civil Rights
Movement, Small Pox Eradication,
• 1980 : AIDS
• 1990 : Food Labelling and Genome Project
• MMR and Autism Controversy
• Covid Pandemic
• Future Public Health Challenges
Plague Pandemics effecting Eurasia
in 6th, 14th and 19th centuries
1500 BC
Leviticus and Code of Hammurabi
Leviticus
• It is the third book of the Hebrew Bible, and the third of five books of
the Torah
• Leviticus is believed to be the first written health code in world.
• The book dealt with personal and community responsibilities and
included guidance regarding the cleanliness of body, sexual health
behaviors, protection against contagious diseases and the Isolation of
lepers.
Code of Hammurabi
• The Code of Hammurabi, created by the King of Babylon is one of the earliest sets of
laws found.
• It shows rules and punishments if those rules are broken: , property damage, women's
rights, marriage rights, children's rights, slave rights, murder, death, and injury.
• The punishment is different for different classes of offenders and victims. The laws do
not accept excuses or explanations for mistakes or fault: the Code was openly
displayed for all to see, so no man could plead ignorance of the law as an excuse.
• Few people, however, could read in that era (literacy mainly being the domain of
scribes).
• The document a code of conduct for physicians and health practices. Before 500 BC
there was also evidence of bathrooms and drains in homes as well as written medical
prescriptions.
500Bc-500AD : Hippocrates
• Hippocrates (460 BC-380 BC) was the founder of Western medicine.
• He manifested an amazingly modern perspective in his treatise entitled
On Airs, Waters, and Places that was published in the fifth century.
• Here are some excerpts:
• Whoever wishes to investigate medicine properly, should proceed thus in the
• first place to consider the seasons of the year, and what effects each of them
produces.
• We must also consider the qualities of the waters and the mode in which the
inhabitants live, and what are their pursuits, whether they are fond of drinking
and eating to excess, and given to indolence, or are fond of exercise and labor,
and not given to excess in eating and drinking.
500Bc-500AD : Hippocrates .
Continued
• Also during this period, Greeks were active in the practice of
community sanitation. Romans improved upon Greek engineering in
the building of aqueducts to protect water supplies.
Romans : Pioneers of Public Health
500-1500 AD
• Middle Ages
• Black Plague
Islamic Era
• In Egypt, the al-Mansur Qalawun Complex in Cairo includes a hospital,
school and mausoleum. It dates from 1284-85.
• Concept of Modern Hospital
A common structure of Bimaristan (hospital),
in 14th century AD, Baghdad
https://www.aramcoworld.com/Articles/March-2017/The-Islamic-Roots-of-the-Modern-Hospital
Bimaristan of Arghun
Concept of Quarantine in Islam
Middle Ages in Europe
• The Middle Ages were also known as "The Dark Ages”.
• During this time, there was an ending of Roman ideology. Health
problems were considered to have spiritual causes and solutions.
• Illness was considered to be the result of sin thus stigmatizing the
victim.
• Bloodletting and alchemy were common practices. Most importantly,
this failure to consider the role of the environment in health led to
epidemics and the inability to control them.
Black Plague
• The black Plague or Black Death was also known as the bubonic plague.
• It reappeared in Europe in 1348 after nearly a 1000 year absence.
• Up to 2/3rds of the population in major European cities succumbed in
the first two years of the pandemic.
• The pandemic was approached by both scientists and the religious
community and by 1350 A.D. there were many new public health
initiatives
• developed to stop the spread of the deadly disease.
• An interesting historical footnote is that some scholars contend that
corpses were used for biological warfare
1500-1700
1500-1700 : Renaissance
• During the Renaissance, there was rebirth of thinking about nature
and humans.
• Careful accounts of disease outbreaks showed that saints as well as
sinners got sick and critical observations led to more accurate
descriptions of symptoms and outcomes.
• World exploration led to exposure to different world views on health.
• The rise of mercantilism highlighted the value of a healthy and
productive population, leading to advances in occupational health.
• There was also an increased concern about infant mortality as a
threat to long term availability of a productive working society.
1700-1800
1700-1800 : Epidemics, Migration
and Discovery
• The 18th Century saw a growth in industrialization that brought more
and more people to cities in search of work.
• While this led to overcrowding, poor sanitation and subsequent
epidemics, there was a growing recognition of the nature of disease.
• There were two prevailing views of the causes of epidemics – Miasmic
and Contagion. Both have public health implications.
Miasma (Bad air) Theory
• Miasmic: This theory held that epidemics stemmed from certain
atmospheric conditions and from miasmas rising from organic
materials.
Germ/Contagion Theory
• Contagion: This theory held that epidemics resulted from
transmission of germs.
1500 BC-1800 AD : Germ/Biological
Warfare
• Hittite texts (1500-1200 BC): Victims of tularemia were driven into enemy lands, causing an epidemic.
• First Sacred War (590 BC): Athens and the Amphictionic League poisoned the water supply of the
besieged town of Kirrha with the toxic plant hellebore.
• Scythian archers (4th century BC): Dipped their arrow tips in decomposing cadavers or blood mixed with
manure, supposedly contaminating them with dangerous bacterial agents.
• Mongol Empire (1347): Catapulted plague-infested bodies over the walls of the Black Sea port of Caffa,
potentially starting the Black Death pandemic
• In 1763 in the New World, smallpox infected blankets were distributed to Native Americans starting an
epidemic which killed thousands.
• Controversy still exists as to whether this was deliberate bioterrorism or a tragic mistake, though there
were several instances of this happening.
1700-1800 : Edward Jenner
• 1n 1796, Edward Jenner (1749-1843) published his first paper on the
potential for inoculation, which led to the development of the small
pox vaccine.
1700-1800 : Yellow Fever
• Yellow Fever appeared in the U.S. in the late 17th century.
• The deadly virus continued to strike cities, mostly eastern seaports
and Gulf Coast cities, for the next two hundred years, killing hundreds
sometimes thousands in a single summer.
• In 1793, Philadelphia was the scene of one of the worst outbreaks.
• The city was the capitol then and the epidemic forced the evacuation
of many of most prominent citizens, including
1800-1900
• Edwin Chadwick
• In 1842 social reformer, Edwin Chadwick, published his landmark report :
Report on the Inquiry into Sanitary Conditions of the Laboring Population of
Great Britain.
• This report outlined the major public health challenges facing England at the
time leading to the beginnings of reform.
1800-1900 : Cholera and John Snow
• Cholera first came to Sunderland, England in 1831-32.
• Several epidemics appeared overtime throughout England eventually
killing more people than the Black Plague.
• This could be directly attributed to the conditions of poverty and
rapid urbanization.
• London took on the name the Great Stink.
• It was not until the epidemic of 1854 that John Snow began to unravel
the mystery of transmission.
Infamous water pump. Handle of this
pump was removed by John Snow to
decrease the spread of cholera
John Snow
John Snow
John Snow
• The science of epidemiology was founded by John Snow's
identification of a polluted public water well as the cause of an 1854
cholera outbreak in London.
• Dr. Snow believed in the germ theory of disease as opposed to the
prevailing miasma theory.
• Although miasma theory taught correctly that disease is a result of
poor sanitation, it was based only upon the prevailing theory of
spontaneous generation. Microorganisms
• The modern era of public health did not begin until the 1880s, when
the culmination of Robert Koch's germ theory and Louis Pasteur's
production of artificial vaccines revolutionized the study of infectious
disease.
1800-1900 : Robert Koch
• German scientist, Robert Koch , was one of the founders
of bacteriology.
• In the process of discovering the causes of anthrax,
cholera and tuberculosis (1882-1883) he developed
methods and technical procedures still used by
epidemiologists.
• Koch asserted that four criteria must be fulfilled to
establish a causal relationship between a parasite and a
disease.
• These criteria are known as Koch’s Postulates.
• Koch was awarded the Nobel Prize for Physiology or
Medicine in 1905.
1800-1900 : Louis Pasteur
• French microbiologist, Louis Pasteur ,conducted experiments that
supported the germ theory and effectively debunked the theory of
spontaneous generation.
• His work involved the development of systems of inoculation including
the first vaccine for rabies.
• He is best known, however, for his work in studies on fermenting
beverages.
• He found that micro-organisms could develop during this process.
• He invented a process in which liquids such as milk were heated to kill all
bacteria and moulds.
• This was first test on April 20, 1862. This process was soon afterwards
known as
• pasteurization.
1900-1920
• Frequent Epidemics most common cause of death
• Influenza outbreak of 1918 killed over 600, 000 and did not subside
till 1950s.
• Concept of Healthy Carrier : Mary Malon aka Typhoid Mary ☠
• Major childhood disease included polio as well as bone deformity due
to poor nutrition leading to Pellagra and Rickets
• Meat Inspections
• Child Labor
• Family Planning
1920-1940
• Penicillin
• Tuskegee syphilis Study
1940-1960
• Foundation of CDC
• Foundation of WHO
• Fluoridation of water
• Thalidomide Disaster
• Polio Vaccine
• The first effective polio vaccine was developed by Jonas Salk (1914-1995),
although it was the vaccine developed by Albert Sabin (1906-1993) that was
used for mass inoculation.
• The first inoculations of children against polio began in Pittsburgh,
Pennsylvania on February 23, 1954. Through mass immunization,
1960-1980
• The Pill : Birth Control Pill
• Growth of Environmentalism
• Tobacco Declared a Hazard
• On January 11, 1964, Luther L. Terry, M.D. 1911-1985), Surgeon General of
the U.S. Public Health Service, released the report of the Surgeon General's
Advisory Committee on Smoking and Health.
• Civil Rights Movement
1960-1980 : Continued
• Global Impact of Vaccines
• International Smallpox Eradication Program was established in 1966. It was
led by the U.S. Public Health Service. The worldwide eradication of smallpox
was accomplished in 1977.
• The WIC Program
• The Special Supplemental Nutrition Program for Women, Infants, and
Children, commonly referred to as WIC, is a Federally funded nutrition-
intervention program administered by the food and Nutrition Service of the
U.S. Department of Agriculture.
1980-2000 and till now
• AIDS : deadly new virus
• 1990 : Human genome project
• 1990 : Food Labelling
• MMR and Autism Controversy
• Climate Change
• Bioterrorism
• SARS, Bird Flu, MERS, Ebola,
• Social Determinants of Health
• COVID-19 Pandemic
Pandemics of last 100 years
Pandemics of
last 100
years
Home Assignment for next session
• Discuss the role of arthropod borne diseases especially ones spread
by mosquitoes.
