Evolution of Health Care Delivery


Evolution of Health Care Delivery


On completion of this chapter, you should be able to:

• List the main contributions to medicine from ancient Egypt, India, China, and Greece.

• Describe the medical practice of the ancient Hebrews.

• Outline the teachings of Hippocrates.

• Describe the effect of Christianity on medicine.

• List events during the Renaissance that were significant in the progress of medicine.

• Describe important advances in medicine from the eighteenth and nineteenth centuries.

• List the significant developments in medicine during the twentieth century.

• Indicate trends in medicine for the twenty-first century.

• Describe the major issues in medicine at the present time.

• Define disease.

• List the top 15 causes of death in the United States.

• Compare mortality rates among various groups.

• List the primary disabling conditions present in U.S. society.

• List diseases that have been eradicated or are targeted for elimination.

• Explain the significance of emerging infectious diseases.

• List key social forces that affect the health care system.

• Discuss the dominant ethical issues in medicine today.

• Explain the impact of an aging population on health care delivery.

• Describe the nation’s health care expenditures.

• Explain prospective payment.

• Correlate defensive medicine, medical malpractice, and health care costs.

• Give the top five causes of death, and list the associated risk factors.

• Describe a typical wellness program.

• Describe the advantages of giving up smoking.

• Link poor diet to major causes of death.

• Outline dietary guidelines for good health.

• Discuss the role of the radiologic technologist in patient education.

• List alternate health care practices.

• Describe the overall goals of Healthy People 2010.

Prehistoric and ancient medicine

The history of medicine abounds with tales of cooperation and confrontation with nature. Disease was present on earth long before human life, and we can only speculate about the human practice of prehistoric medicine. Fractures were probably common injuries. Egyptian mummies and radiographic images of the ice man show characteristics of arteriosclerosis, pneumonia, urinary infections, stones, parasites, cavities, teeth erosion, abscesses, pyorrhea, arthritis, and tubercular disease of the spine. Prehistoric people probably treated their wounds similarly to the way animals treat themselves: immersing themselves in cool water and applying mud to irritated areas, sucking stings, licking wounds, and exerting pressure on wounds to stop the bleeding.

Until well into the nineteenth century, medical treatment was intertwined with religion and magic (Fig. 4-1). Some cultures treated their sick, elderly, and disabled with kindness. Other cultures, during times of famine, sent the elders out into the unsheltered environment; some even killed and ate disabled tribe members. Disease was thought to be caused by gods and spirits, and magic was used to drive away evil forces. Tribal healers held high political and social positions and were responsible for performing religious ceremonies and protecting the tribe from bad weather, poor harvests, and catastrophes. Along with sucking, cupping, bleeding, fumigating, and steam baths, medicinal herbs were used to treat wounds. Surgery was used to treat bone fractures and to sew up wounds. The Mesopotamians studied hepatoscopy, which is the detailed examination of the liver. They believed the liver was the seat of life and the collecting point of blood. Although gods and magic still played an important role in medicine, rational thought about nature’s relationship to health began to increase.

The ancient Hebrews still considered disease to be divine punishment and a mark of sin. Plagues and epidemics such as leprosy were often mentioned in the Bible, as were medications such as balsams, gums, spices, oils, and narcotics. Surgery was performed only under ritual circumstances.

Hebrew medicine was influenced by the Greeks around the fourth century bc with an emphasis placed on anatomy and physiology, diet, massage, and drugs. Disease was considered an imbalance of the four humors of the body: phlegm, blood, yellow bile, and black bile.

Ancient Egypt

The deities of ancient Egypt were associated with health, illness, and death. Isis was the healing goddess; Hathor was the mistress of heaven and the protector of women during childbirth; Keket ensured fertility.

The embalming practices of the Egyptians have provided much of our knowledge of ancient medicine. The most elaborate embalming practice required that the liver, lungs, stomach, and intestines be preserved in stone jars so that they could function for eternity. Cranial contents were removed with hooks through the nostrils. The skull and abdominal cavities were washed with spices; soaked for 70 days in a solution of clay and salts of carbonate, sulfate, and chloride; and then washed. The corpse was then coated with gums and wrapped in fine linen.

The ancient Egyptians linked anatomy and physiology with theology—each body part had a special deity as its protector. They believed that the body was composed of a system of channels, with the heart at the center. They thought air came in through the ears and nose, entered the channels, went to the heart, and was then delivered to the rest of the body. They believed the channels also carried blood, urine, feces, tears, and sperm.

Although the main water source, the Nile River, was probably clean in ancient Egypt, public health was also a concern. Egyptian homes were immaculate, and personal hygiene was practiced regularly. The prevalent diseases included intestinal ailments, malaria, trachoma, night blindness, cataracts, arteriosclerosis, and epidemic diseases. Diagnoses were made by probing wounds with fingers, taking the pulse, and studying sputum, urine, and feces. Religious rituals were still part of the healing process, as were drugs administered in the forms of pills, cake suppositories, enemas, ointments, drops, gargles, fumigations, and baths. Drugs were made from vegetable, mineral, and animal substances; and imported materials such as saffron, cinnamon, perfumes, spices, sandalwood, gums, and antimony.

Ancient China

In ancient China, harmony was considered to be a delicate balance between yin and yang, and Tao was considered the way. Illness was seen as a result of disregard for Tao or acting contrary to natural laws. Chinese medicine focused on the prevention of disease (Fig. 4-2). Because Confucius forbade any violation of the body, dissections were not performed in China until the eighteenth century. According to Nei Ching, five methods of treatment were available: cure the spirit; nourish the body; give medications; treat the whole body; and use acupuncture and moxibustion, which is a treatment similar to acupuncture in which a powdered plant is burned on the skin. Treatment came in the forms of exercise, physical therapy, massage, and administering medicinal herbs, trees, insects, stones, and grains. By the eleventh century, the Chinese had developed an inoculation against smallpox.

Ancient Greece

In the sixth century bc, the Greeks built the healing temples of Asclepios in Thessaly. The temples contained a statue of a god to whom gifts were often given as a sign of worship. Usually, a round building, the tholos, encircled a pool or sacred spring of water for purification. The abaton was a building considered to be an incubation site, where the cure took place. The patient went to sleep there until visited and cured by the god. The temples usually consisted of a theater, a stadium, a gymnasium, inns, and temporary housing. Healing rituals began after sundown and often involved fasting or abstinence from certain foods or wine.


During the sixth, fifth, and fourth centuries bc, the Greeks advanced medicine with their understanding of the place of humanity within the cosmos. Pythagoras, Empedocles, and Democritus approached harmony with the universe in an objective, scientific manner. Mathematics, atomic theory, and the basic elements of nature were used to describe health and disease.

During this period, Hippocrates established himself as the father of medicine. His approach revolutionized medicine from the ancient past and began turning it into an objective science. Born around 460 bc, Hippocrates believed that people practicing medicine should be pure and holy. He taught that one should (1) observe all, (2) study the patient rather than the disease, (3) evaluate honestly, and (4) assist nature.

“He employed few drugs and relied largely upon the healing powers of nature…. The treatment of disease for him was to assist and, above all, not to hinder nature. If succeeding generations had followed his precepts, patients would have been spared countless unnecessary operations and an enormous number of nauseous, disgusting, ineffectual and frequently harmful medicines” (Major, 1954).

Hippocrates’ writings addressed mental illness, anxiety, and depression. His teachings reached a peak in Alexandria and then eventually penetrated the Roman Empire.


The dawn of Christianity changed many attitudes about medicine. Christians sought to bring the healing message of Christ to those in need. The Church dominated medicine during the Dark Ages, and practices involved prayer, exorcism, holy oil, relics of saints, supernaturalism, and superstition. At the same time, medical schools separate from the Church were established and soon became part of major universities.

During Jesus’ personal ministry and that of his immediate followers, healing was not differentiated into physical, mental, or spiritual categories. The author of one of the Gospels was known as Luke the physician. The content of the Christian faith, with its emphasis on compassion, forgiveness, and concern for the unfortunate and the dispossessed, led the followers of Christianity to provide facilities for the care of the orphaned, elderly, outcast, and poor.

The Roman Emperor, Constantine, founded a hospital in the fourth century. Others were established by Christian communities in Caesarea, Edessa, and Bethlehem during the same century.

With the Crusades came the distribution of disease. In the twelfth century ad, Europe was inundated with leprosy, typhus, and smallpox. In 1347, bubonic plague spread through Europe and claimed nearly one fourth of its population.

The Renaissance

The Renaissance brought new beginnings in medicine. Paracelsus, the father of pharmacology, combined alchemy with the treatment of disease to produce a new science. Jean Fernel professed that physiology, pathology, and therapeutics were the standard disciplines of medicine; he was also the first to suggest that gonorrhea and syphilis were two separate diseases. Ambroise Paré was a forerunner in clinical surgery. An explosion of knowledge of human anatomy was led by Andreas Versalius; his dissections and drawings prompted his designation as the father of anatomy.

The seventeenth century was an age of scientific revolution. Latrochemistry, a combination of alchemy, medicine, and chemistry, was practiced by the followers of Paracelsus. Jan Baptista van Helmont made the first measurement of the relative weight of urine by comparing its weight with that of water. Galileo presented the laws of motion in a mathematical manner that could be applied to life on earth; Isaac Newton discovered gravity. William Harvey found that a continuous circulation of blood was present in a contained body system. Christian Huygens developed the centigrade system of measuring temperature; Gabriel Daniel Fahrenheit developed the system named after him for measuring temperature. Marcello Malpighi and Anton van Leeuwenhoek were forerunners in the invention of the microscope (Fig. 4-3). Quinine was discovered as a treatment for malaria. Leonardo da Vinci explored human anatomy through dissection; his anatomic sketches disseminated his findings.

Eighteenth century

Significant discoveries continued into the eighteenth century. Albrecht von Haller did in-depth studies of the nervous system, discovered the relationship of the brain cortex to peripheral nerves, and became the founder of modern physiologic theory. Lazzaro Spallanzani discarded the theory of spontaneous generation and became a pioneer in experimental fertilization. Stephen Hales demonstrated the dynamics of blood circulation, stressed the importance of the capillary system, and became the first person to record blood pressure with a manometer.

The father of pathology, Giovanni Battista Morgagni, correlated anatomy with pathology. His research and writings laid the foundation for much of modern pathology.

Edward Jenner formulated the smallpox vaccination, which was considered one of the greatest discoveries in medical history. William Hunter, a specialist in obstetrics, founded the Great Windmill Street School of Anatomy, the first medical school in London. His brother, John Hunter, was a giant of the eighteenth century. An experimental surgeon, John Hunter developed a method of closing off aneurysms, thus eliminating many unnecessary amputations. Hunter turned surgery into a respected science and became a pioneer in comparative anatomy.

The eighteenth century also saw dramatic changes in the care and treatment of mentally ill patients, with Phillippe Pinel demanding that a more humane regimen be instilled at Asylum de Bicêtre near Paris.

Nineteenth century

Autopsies were the major focus of medicine during the nineteenth century. Carl Rokitansky was the most outstanding morphologic pathologist of his time. Rudolf Virchow professed that “all cells come from other cells” and revolutionized the understanding of cells. Claude Bernard was the founder of experimental physiology and discovered the principle of homeostasis, clarified the multiple functions of the liver, studied the digestive activities of the pancreas, and was the first to link the pancreas with diabetes. He pioneered and established the specialty of internal medicine.

René-Théophile Hyacinthe Laennec contributed to the pathologic and clinical understanding of chest diseases including emphysema, bronchiectasis, and tuberculosis. He was also a pioneer in the invention and use of the stethoscope.

Surgery advanced in Paris during the French Revolution and Napoleonic wars. Ephraim McDowell performed the first successful abdominal operation to remove a huge cyst from an ovary. J. Marion Sims laid the foundation for gynecology and founded the Women’s Hospital of the State of New York, the first institution of its kind. He also invented the Sims position and later the speculum and catheter.

By 1831, ether, nitrous oxide gas, and chloroform had been discovered but not yet applied to medical practice. After Joseph Priestley had discovered nitrous oxide gas, Humphry Davy suggested that it be used in surgery, but he was ignored. Although Crawford W. Long used sulfuric ether during surgery in 1842, he did not publicize its use. When anesthesia finally entered the world of surgery, surgical procedures multiplied in number and complexity. Joseph Lister discovered that bacteria were often the origin of disease and infection; thus safe surgical procedures were introduced to minimize the risks of surgery. Louis Pasteur discovered that the decay of food could be forestalled by heating the food and destroying harmful bacteria; he formulated the germ theory of disease and explained the effectiveness of asepsis and antisepsis.

Robert Koch performed extensive research into microorganisms and founded bacteriology. Psychiatry gained considerable respect from the work of Benjamin Rush, the first American psychiatrist. Based on his involved clinical studies of the human gastrointestinal tract, William Beaumont became the first prominent American physiologist. The foundation of modern genetics was laid by Gregor Mendel in 1886 with his experiments involving the heredity of plants.

November 8, 1895, is a date that forever changed the course of diagnoses of disease and injury. As will be explained more fully in Chapter 5, Wilhelm Roentgen discovered and described x-ray films. Within months, the significance of these new kinds of rays in medicine was realized. Pierre and Marie Curie discovered radium 3 years later and provided the foundation for the use of radioactivity in the treatment of diseases.

Incredible as the discoveries of the previous centuries were, the twentieth century took medicine far beyond the dreams of the heartiest optimists of the past.

Twentieth century

Remarkable developments continued as the century turned and were built upon previous achievements. Major Walter Reed led a U.S. Army board in discovering the cause of yellow fever, and this led to its eradication. Paul Ehrlich became the father of chemotherapy, which would have ramifications throughout the century. Pavlov conducted extensive research not only about the conditioned response but also about the process of digestion.

In 1913, Abel, Rowntree, and Turner invented the first artificial kidney, and this led to kidney dialysis. World War I provided the opportunity to explore wound infection in detail and advanced the prevention of surgical infections. Willem Einthoven made the first electrocardiogram, and Hans Burger used similar technology to invent the electroencephalogram. Lind, Eijkman, Hopkins, Szent-Gyorgyi, and Funk defined and isolated vitamins and described their role in the life process. This development would have a profound effect on diet and, late in the century, on the possible prevention and treatment of chronic diseases.

Surgical techniques were refined, and diagnostic procedures became more accurate. The invention of the electron microscope in 1930 (Fig. 4-4) made possible the study of viruses and advances in the fields of biochemistry, biophysics, physical chemistry, and immunology.

The Salk vaccine virtually eliminated the scourge of poliomyelitis (polio). Watson and Crick won a Nobel Prize in 1962 for accurately describing the deoxyribonucleic acid (DNA) molecule as a double helix and identifying its components. In 1967, Christiaan Barnard performed the first successful human heart transplant. In the ensuing years, other organs were successfully transplanted, adding another valuable tool to improving and saving lives.

Microminiaturization, which was invented for space travel, soon found its way into medicine. Coupled with evolving computer technology, the final four decades of the century vastly extended our abilities to diagnose and treat an entire array of medical conditions. Such electronics are used to monitor heart and brain activity with extreme accuracy. The marriage of computers and imaging equipment has provided digital radiography, computed tomography, and magnetic resonance imaging, and it has enhanced nuclear medicine and medical sonography. Treatment planning for radiation therapy is incredibly precise because of the use of computers.

Major organ transplants involving the heart, liver, lungs, and kidneys are performed today. Coronary bypass surgery is commonplace. Arthroscopic surgery works in the joint spaces of the body without major incisions. Laparoscopic surgery became commonplace for incisions into the abdomen for conditions affecting the gallbladder, kidneys, adrenal glands, and female reproductive system. Lithotripsy allows the painless passing of stones from the urinary system by first blasting them with sonic waves. Lasers are used routinely in countless procedures as a clean, painless way of removing growths; their accuracy allows their use in areas of the body where precision is indispensable.

Artificial hips and knees are inserted to replace those that are degenerating as a result of age or arthritis or that have been destroyed by injury. Plastic surgery allows the reconstruction of most areas of the body that have been disfigured as a result of disease or injury; it is also used extensively for elective cosmetic procedures.

Twenty-first century

The second millennium ad continues with a rapid expansion of technology and information. The accumulation of knowledge accelerates at an unprecedented pace, doubling every 15 to 18 months. Balancing this technologic explosion in medicine, a trend has emerged toward a more personal aspect of health care. The need for the human touch, caring, and concern has never been more important. More personal aspects of care such as the hospice movement for the terminally ill and the reemergence of family practice as a specialty are but a couple of examples (Fig. 4-5). As you begin your studies in this intriguing profession, keep in mind that the human aspect of patient care and quality service must be ever present in your practice.

Research into genetics has greatly expanded our knowledge about heredity. The entire DNA code has now been deciphered, and this has opened a new era in the treatment and prevention of disease. The unfortunate affliction of Alzheimer disease has prompted extensive research; its cause remains elusive, and treatment, though still in its infancy, is progressing. The prevention and treatment of human immunodeficiency viral (HIV) infection and acquired immunodeficiency syndrome (AIDS) have increased in importance as both conditions have become global.

Biotechnology has opened frontiers in treatment that were unimagined when this text was first published. Increasing numbers of surgeries and other interventional procedures are being made obsolete by the introduction of biotechnology into mainstream health care. Robotic surgery permits more precise incisions and excisions than ever before possible. Carefully guided by three-dimensional video, the surgeon probes deep into the body with a small computer-assisted hand

Mar 2, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Evolution of Health Care Delivery

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