What is hypertension? Hypertension is either a sustained systolic blood pressure of greater than 140mm Hg or a sustained diastolic blood pressure of greater than 90mm Hg. What causes hypertension? peripheral vascular arteriolar smooth muscle tone arteriolar resistance Types of Hypertension • Primary hypertension (essential) capacitance of the venous system Elevated BP due to family history (genetics) or lifestyle issues (environmental). 80-90% of cases. • Secondary hypertension types: - Renovascular hypertension which is associated with renal bruits. - Pre-eclampsia = mild hypertension in pregnancy • Malignant hypertension is like chronic hypertension - It is the most severe = leads to organ damage - Abrupt increase in BP of a hypertensive patient or sudden increase in normotensive patient What is a renal bruit? The narrowing of a renal artery due to atherosclerosis • Isolated systolic hypertension Systolic BP > 210 mmHg or a Diastolic BP > 150 mmHg • White coat hypertension or episodic hypertension Anxiety induced hypertension associated with tachycardia and night sweats. Symptoms of Pheochromocytoma which is a hormone secreting tumour in the adrenal glands • Resistant hypertension BP is persistently > 140/90 mmHg despite taking three drug regimen which includes a diuretic in combination or full doses. What is Blood Pressure? Measure of force that the heart uses to pump blood around the body Force exerted by the heart against the resistance of the arteries to keep the blood flowing through the body Pressure of circulating blood on the walls of the vessels How can I measure blood pressure? - Mercury Sphygmomanometer and stethoscope Aneroid Digital Conditions for measurement: o o o Size of cuff: 12 cm Bladder should cover 80% of arm Width of bladder to cover 2/3 of arm o Cuff should not be more than 2 cm away from elbow crease o Cuff to big = underestimation o Cuff to small = overestimation The patient must be quiet Bladder of the cuff is placed over the brachial artery Arm must be bare and at heart level No caffeine, alcohol, or smoking 30 min prior to measurement No vigorous effort for 30 min before measurement Room temperature Seated and relaxed Feet flat on floor Korotkoff Sounds: Phase 1: The first appearance of a faint, repetitive, clear tapping sound which gradually increase in intensity first 2 consecutive beats = systolic blood pressure Phase 4 (IV): The distinct abrupt muffling of sounds which become soft and blowing in quality. Phase 5 (V): All sounds disappear = diastolic blood pressure Heart features of long standing hypertension: - 4th sound has a gallop = left ventricle non-compliant - 2nd sound has a loud aortic component - Apex beat Global Burden of Disease Diseases are classified into 3 groups: 1. Group 1 i. Communicable diseases = disease caused by micro-organisms TB, pneumonia, measles, malaria, diarrhoea, STD’s ii. Maternal and perinatal diseases Maternal haemorrhage and birth trauma iii. Nutritional conditions Obesity, kwashiorkor, protein-energy deficiency 2. Group 2 Non-communicable diseases = chronic disease not causes by infectious agents Hypertension falls in this category 3. Group 3 External causes of mortality such as accidents, homicide and suicide What is the difference between mortality and morbidity? Mortality is the number of people who died from a disease where as Morbidity is the number of people living with the disease. Leading cause of death in SA? 1. TB 2. Strokes (cerebrovascular disease) 7. Hypertension There are 2 types of risk factors of Hypertension Modifiable • Smoking • Diet = NaCl and Alcohol intake • Sedentary life style • Stress • Abdominal Obesity Men ≥ 94 cm and Women ≥ 80cm Non-modifiable • Gender • Age Men > 55 and Women > 65 • Post-menopausal state • Family history of early onset of Cardio Vascular Disease • Dyslipidaemia o o total cholesterol > 5.1 mmol/L LDL > 3 mmol/L o HDL men < 1 and women < 1.2 mmol/L • Hyperlipidaemia o fat content in blood Target Organ Damage and Complications Blood vessels Atherosclerosis Coronary heart disease Heart failure Heart: Left Ventricular Hypertrophy (thickening of muscular walls of the heart) based on ECG ✓ Sokolow-Lyons > 38 mm ✓ Cornel > 2440 mm.ms May be associated with breathlessness, loud second heart sound Kidneys: Microalbuminuria: albumin creatine ratio 3-30 mg/mmol Slightly elevated creatinine: ✓ men 115-133 μmol/L ✓ women 107-124 μmol/L Chronic kidney disease: ✓ albuminuria > 30mg/mmol OR ✓ creatinine men > 133 μmol/L ✓ creatinine women >124 μmol/L Stroke or TIA. Peripheral arterial disease. Advanced retinopathy: ✓ Grade 3: haemorrhages OR ✓ exudates; ✓ grade 4: papilloedema. Indications of coarctation of the aorta = Radio-femoral pulse delay, BP in legs and precortical systolic bruits Renal enlargement = polycystic kidneys Renal artery stenosis = abdominal bruit Routine investigations for hypertensive patients should include: o o o o o o BMI calculations Ideal BMI < 25 𝒌𝒈/𝒎𝟐 Urine dipsticks for PROTIEN and BLOOD Overweight BMI 25-30 𝒌𝒈/𝒎𝟐 Obese BMI > 30 𝒌𝒈/𝒎𝟐 Fasting blood for LIPIDS and GLUCOSE Serum urea, creatinine and electrolytes ECG = provides information about HEART RATE and RHYTHM Investigation for secondary causes. Symptoms of Hypertension ➢ ➢ ➢ ➢ ➢ ➢ “Silent Killer” = mostly asymptomatic Occipital headaches Palpitations = a heart-beat is skipped or added and thus the heart is racing Sweating Restlessness Insomnia = inability to sleep which leads to nocturia Expitaxis = bleeding from nasal cavities What is a Fundoscopy or ophthalmoscopy? o Examination of the eyes Keith-Wagner classification of Fundoscopies: Grade 1: Silver wiring - Tortuosity which is twisted blood vessels which lead to increased reflectiveness Grade 2: Grade 1 + arteriovenous nipping - Which occurs when the thickened retinal arteries pass over retinal veins. Grade 3: Grade 2 + flame shaped haemorrhages and soft exudates - Caused by small infarcts = small areas of dead tissue due to loss of blood supply Grade 4: Grade 3 + papilledema - Blurring if the margins of the optic disc WHAT ARE THE STAGES OF HYPERTENSION? CLASSIFICATION SYSTOLIC BP (mmHg) DIASTOLIC BP (mmHg) Ventricles contact Ventricles relax Normal 120 - 129 80 – 84 High normal 130 - 139 85 - 89 STAGE:1 140 - 159 90 – 99 STAGE: 2 160 - 179 100 – 109 STAGE: 3 ≥ 180 ≥ 110 HYPERTENSION The 4 mechanisms of hypertension: 2. 3. 4. 5. Volume or Salt overload systemic vascular resistance central drive which increases BP sympathetic nervous system The flow-resistance-relationship The blood pressure is directly proportional to the cardiac output and the total peripheral resistance. BP = CO X TPR CO = HR X SV The cardiac out however is also directly proportional to the heart rate and stroke volume. BP = HR X SV X TPR Thus, pharmacological intervention aims at: • systemic vascular resistance • heart rate • circulating volume Therapeutic Strategies in Hypertension aims at preventing further disease by: → Lowing prehypertension through education + the adoption of healthy lifestyles → Treating mild hypertension with one or more drugs to achieve BP control Individual care in hypertension This refers to the fact that certain hypertensive patients react more efficiently to drug treatments than other hypertensive patients. ∆ Black patients = diuretics + calcium channel blockers ∆ Elderly patients = diuretics, calcium channel blockers + ACE inhibitors Levels of Prevention Primary Prevention – Before patients develop the disease ∆ Educational campaigns which promote healthy lifestyles by using SNAP Secondary Prevention – 2 Scenarios a) Patient has the disease, but it has not yet been diagnosed - Screen for multiple risk factors b) Patient been diagnosed with hypertension ˣ Administer medication to prevent complications such as kidney failure, heart failure, eye problems or stroke. Tertiary Prevention - The patient has developed complications ∆ Prevent further damage and help the patient make full use of the remaining abilities by giving physiotherapy and occupational therapy while on medication. CAD – Management after a coronary event CHF – Management after a heart attack Anti-Hypertensive Drugs Mechanisms for controlling BP The sympathetic nervous system and baroreceptors ∆ Short term BP control through baroreceptor reflex ∆ Moment to moment regulation of BP 1. BP 2. sympathetic input + parasympathetic input 3. heart rate + stroke volume 4. cardiac output 5. BP BP sympathetic input to blood vessels Vasodilation total peripheral vascular resistance 5. BP 1. 2. 3. 4. Renin-Angiotensin-Aldosterone System ▪ Long term control of BP ▪ Kidneys control blood volume Effects of these drugs Anti-hypertensive drugs act upon the following sites: • Kidneys • Sympathetic nervous system • The renin-angiotensin-aldosterone axis • Vascular smooth muscle • • • • Potassium Cardiovascular Cholesterol measurements Mechanisms Diuretics = fluid pills • Help to remove excess sodium (electrolyte) and water ˣ the pressure in the vascular system ˣ extracellular volume = stroke volume ˣ cardiac output and renal blood flow ˣ BP • Long term treatment = plasma volume approaches normal but peripheral resistance decreases Act on the kidneys 1st line drug therapy in low doses Classification of diuretics Low ceiling thiazides - Hydrochlorothiazide Low ceiling excluding thiazides – Chlortalidone High ceiling loop – Furosemide Potassium sparing agents – Spironolactone Side effects of diuretics → → → → → → → Hypokalaemia = potassium Hypomagnesemia = magnesium Hyperuricemia = uric acid content Acute gout attacks Severe renal or hepatic impairment Gastrointestinal disturbance Type 2 diabetes Thiazides are the most common diuretic treatment BUT patients with: - Diabetes - Renal dysfunction - Kidney issues Should not take them 𝜷-Adrenoceptor Blockers First line drug therapy when another related disease is present ▪ heart rate = cardiac output ▪ Blocks the β-Adrenoceptors in the heart, bronchi, peripheral vasculature, pancreas and liver. ▪ in sympathetic outflow from CNS ▪ Release of renin is inhibited from kidneys ▪ formation of angiotensinogen 1 and 2 ▪ vasoconstriction ▪ secretion of aldosterone Classification of β-Adrenoceptor Blockers Non-selective = Propranolol Cardio-selective = Atenolol di = 2 thus 𝛼 + 𝛽 Alpha and beta blocking agents = Carvedilol Side Effects of β-Adrenoceptor Blockers ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ Asthma Bradycardia Gangrene Type 1 diabetes Liver disease Left ventricular failure Mental depression Peripheral vascular disease 2nd or 3rd degree heart block End in OLOL How β-Adrenoceptor Blockers Shortcut Stress 1. 2. 3. 4. Enter bloodstream through GI tract Prevent adrenaline from attaching to the hearts receptor cells Fight or flight reaction can’t occur Thus, normal heart rate Recommended when first line drugs are ineffective or contraindicated Calcium Channel Blockers ∆ Blocks calcium access to cells causing: ˣ contractility of the myocardium ˣ conductivity of the heart ˣ O2 demand ˣ contractility vascular smooth muscles ˣ Vascular smooth muscles relax = arterioles dilate NB! Veins do not dilate Classification of calcium channel blockers SELECTIVE Vascular Effects Amlodipine Side effects of calcium channel blockers ✓ ✓ ✓ ✓ ✓ ✓ ✓ Constipation Oedema Palpitations Nausea Headache Bradycardia Flushing Cardiac Effects Verapamil Angiotensin Converting Enzyme (ACE) Inhibitors • Total peripheral vascular resistance without: ˣ Cardiac output ˣ Cardiac rate ˣ Cardiac contractility • Inhibits the conversion of angiotensin 1 into angiotensin 2 Classification of ACE Inhibitors ❖ ACE inhibitor = Captopril ❖ Class II ACE inhibitor = Enalapril CELLA ❖ Class III ACE inhibitor = Lisinopril ❖ Angiotensin II Receptor = Lorsartan → Inhibit the effect of angiotensin II on its receptor → Angiotensin II induced arteriolar vasoconstriction is blocked ❖ Renin Inhibitors = Aliskiren → Block conversion of angiotensinogen to angiotensin I Side Effects of ACE Inhibitors ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ Cough and taste disturbances Oedema Dizziness Orthostatic hypotension Headache Skin rash Urticaria Myalgia Gastrointestinal effects Side effects of renin inhibitors o Diarrhoea o Cough o Angio-oedema o Hyperkalaemia What is a Stroke? AOFND This is the acute onset focal neurological deficit of the central nervous system (Above the foramen magnum excluding the spinal cord) which is understood to imply vascular pathology. 4 types of strokes 1. Completed stroke: neurological deficit is present > 24H 2. Transient Ischemic Attack (TIA): acute onset of neurological deficit followed by a speedy recovery of 5-20 min. 3. Stroke in Evolution: focal neurological deficit occurs in a stepwise fashion. 4. Reversable Ischemic Neurological Deficit (RIND): a completed stroke with minimal residual signs after 3 weeks or 21 days. Complications of strokes Intracerebral Complications ∆ Depressed level of consciousness ∆ Coma ∆ Seizures ∆ Trans tentorial herniation Extracerebral Complications Aspiration Pneumonia Dehydration Deep vein thrombosis Bed sores Contractures Urinary tract infections The left hemisphere is most dominant hemisphere of the brain. Aspirin is the first line drug treatment for stroke-reoccurrence. It prevents the re-occurrence of stroke with approximately 25% Assessment of a stoke patient includes - Power grading Grade 0: no power Grade1: flicker of movement Grade 2: horizontal movement without gravity Grade 3: move against gravity Grade 4: move against gravity but cannot overcome resistance Grade 5: Normal power - Reflexes Grade 0: No reflex Grade 1: Hyporeflexia = muscles cannot contract enough to move a joint Grade 2: Normal reflex = muscle contact to move joints Grade 3: hyperreflexia = muscle contraction is enough to move the join but extends to other joints Grade 4: hyperreflexia with more than 2 repetitive movements at a joint - Tone Normal tone Hypertonia = Flaccidity = soft and hanging loosely Hyperreflexia which includes spasticity and rigidity What is spasticity? What is rigidity? Velocity dependant Muscle selective Involves the cortico-spinal tracts Velocity independent Muscle unselective Involves the extrapyramidal tracts. - Sensation Physiotherapy in Stroke Patients ▪ People who survive a stroke have a form disability. ▪ Through early rehabilitation they can make significant improvements, prevent secondary complications such as bed scores and contractures and help the patient motivated. ▪ Rehabilitation has a functional approach. When impairments are permanent, we compensate for deficits According to the National Stroke Association: → → → → 10% of stroke survivors recover almost completely 25% recover with minor impairments 40% experience moderate-to-severe impairments that require special care 10% require care in a nursing home or other long-term facility The clinical process of stroke rehabilitation includes o o o o Assessment Goal setting Intervention (Treatment) Reassessment Ultimate Goal: Community re-integration It is advised that care-givers and family be trained in: o Manual handling skills o Facilitation of activities of daily living (ADL’s) o Simple nursing tasks Main focus: Mobility and Strength of impaired side ❖ Passive motion (Initial) = exercises aided by the physical therapist ❖ Active motion =exercises the patient performs unassisted Bed mobility includes bridging, rolling and shifting on bed (up, down and sideways. Occupational Therapy in Stroke Patients Goal Enable people to participate in activities of daily life An assessment will be conducted as soon as possible to determine the patient’s abilities and weaknesses. Thereafter, each Patients receives an individualised programme tailored to their needs. In the bed phase correct positioning used to: - Prevent contractures and pressure sores - Influence muscle tone - Inhibit abnormal reflexes While in bed the patient first rolls, then supine to sit is facilitated and then the patient can wash his face, eat etc. Assistive devices and adaptations to a patient’s home environment are prescribed to improve independence in ADL’s Splints are prescribed to keep the hand in optimal position for function, but it is removed when exercises and activities are performed The patient’s family is asked about patient’s activity profile before discharge to incorporate activities into treatment that are important for the patient. Stroke patients can be discharged when: - They are medically stable - When caregivers are prepared for coping in home environments. A follow up appointment is arranged in the discharge process - Vocational rehabilitation facilitates the patient’s return to work. Speech and Language Pathology in Stroke Patients Dysarthria = motor speech disorder which is characterised by poor articulation - Respiration Phonation Articulation Resonance Prosody The 5 subsystems of speech may be affected Apraxia = motor speech disorder characterised by difficulty in translating conscious speech plans into motor plans Aphasia = language disorder which affects the ability to communicate through speaking, singing or writing. - AAC (Augmentative and Alternate Communication) is used as therapy. Dysphagia = difficulty in swallowing - Often accompanied by aspiration which is when food or fluids enter the airways below the vocal chords. Role of a Dietician in Stroke Patients Follow the South African Food Based Dietary Guidelines After a stroke the patient’s dietary textures are altered to: - Full fluid diet - Puree diet - Soft diet Dependant on swallowing and chewing abilities • NG (nasogastric tube feeding) within 24 if unable to take in fluids orally and it is short term. • PEG (percutaneous endoscopic gastrostomy) = longer than 2-3 weeks ➢ ➢ ➢ ➢ ➢ Reduce salt intake to less than 5g a day (1 teaspoon or 2000mg of sodium) Sodium free = < 5mg of sodium per serving Very low sodium = 35mg or less per serving Food naturally low in sodium: Low sodium = < 140mg per serving - Fruit + Veg High sodium = 350mg or more per serving - Milk Unsalted Nuts Psychosocial aspects of Hypertension What is the goal of hypertensive therapy? To bring the blood pressure down to 140/85 mmHg in the general population and to even lower levels in diabetics, African Americans, and people with certain chronic kidney diseases. Psychological approaches to hypertension include: - Good Rapport Comprehensive history taking Relaxation training = meditation Biofeedback Psychotherapy What does good rapport consist of? 1. Empathy 2. Congruence 3. UPR The principles of psychotherapy: ∆ Listening skills: The attempt to understand both the content of the problem and the emotions that relate to their problem in order to offer good advice. ∆ Resistance: A change in human behaviour doesn’t follow a linear pattern and is difficult and tangible process. ∆ Respect: Slippage in this principal occurs due to inadequacy trained, overstressed and overworked people. ∆ Empathy: To listen and understand the feeling and perspective of the client. ∆ Positive reward: Unconditional respect ∆ Clarification: Restating information, confrontation and interpretation are more advanced techniques in therapeutic intervention ∆ Transference: The patient directs their feeling onto the therapist. ∆ Countertransference: The emotional and perception reactions of the therapist towards the client. It can include the therapist’s emotional entanglement. Evidence Based Medicine (EBM) What is EBM? It is the judicious use of the current best evidence in making decisions regarding patient care which integrating science, experience and knowledge about the client and society. There was a shift from AUTHORITARIAN (opinion based) to AUTHORITIVE (evidence based) information. 4 Advantages of EBM: 1. 2. 3. 4. Greater efficiency and quality of decisions Reduces the gap between research and clinical practice Promotes self-directed learning Produces effective and efficient clinicians Why do we use EBM? To deal with uncertainty, the explosion of information and to meet the public demand for quality physicians. STEPS OF EBM 1. Formulate an answerable question using PICO - P = patient - I = intervention - C = comparison - O = outcome 2. Obtain best evidence 3 levels of significance: 3. Critically appraise evidence 1. Statistical 4. Apply findings 2. Clinical 3. Personal 5. Audit the intervention Hierarchy of Evidence from worst to best: 1. Anecdotes Stories without any evidence found in magazine, newspapers and dictionaries 2. Case-Report This is the study of interesting or rare condition of an individual 3. Cross-Sectional study A snapshot in time where the case and exposure are measured at a point in time. It is thus used to determine PREVALENCE O E 4. Case-Control study Retrospective study where the outcome is known. Group of people in an area with the outcome are compared to a group of people in the area without the outcome to determine the exposure. 5. Cohort Study E O Prospective study without intervention where the exposure is known. A group of people that are exposed to a certain factor are compared to a group of people whom were not exposed to determine the outcome. 6. Randomised Control Trail An experimental study to compare therapies and thus there is an intervention. Th outcome of group of people who receive a drug is compared to a group of people who receive a placebo to test the effectiveness thereof. Found on Medline, Embase and Pubmed. 7. Systematic-Review Summarise the results of a randomised control trial without statistical evidence. Which online database can systematic reviews be found on? The Cochrane library 8. Meta-Analysis A statistical technique that summaries a group of studies. Virology and Microbiology What are micro-organisms? They are small, microscopic organisms, found in various environments that can be harmful or harmless. They can be found in found in humans, animals and plants Pathogenic micro-organisms = disease causing Normal flora = micro-organisms naturally found in the host The classification of bacteria id based on: ✓ Size ✓ Structure ✓ Method of reproduction Morphology of bacteria: o Cocci = spherical shape Bacilli = rod shape Spirilla = spiral shaped Mycology = The study of fungi → Superficial fungal infection occurs = skin, nails and hair → Subcutaneous fungal infection occurs = under the skin → Systemic fungal infection occurs = internal organs (dimorphic fungi) Parasitology = study of protozoa and metazoa Virology = study of viruses ▪ Very small ▪ Intracellular parasites ▪ Released from cells through the process of budding ▪ Consist of either RNA or DNA, never both Viral classification is based on: ▪ Nucleic acid ▪ Morphology ▪ Replication strategy ▪ Host species ▪ Disease caused Stages of viral replication 1. 2. 3. 4. 5. 6. 7. Absorption Entry Uncoating Transcription Synthesis of components Assembly Release Transmission Routes of Diseases Faecal-oral Transmission can be water or food borne ˣ Cholera ˣ Polio ˣ Gastro-enteritis ˣ Hepatitis A ˣ Typhoid Inhalation ˣ TB ˣ Pneumonia ˣ Flu Haemorrhagic fever viruses include: Ebola, Congo fever, Lassa fever Direct Contact ˣ Skin: warts and scabies ˣ Sexual: HIV, syphilis and genital ulcers ˣ Eye: Pink eye with discharge ˣ Blood or bodily fluids: HIV, hepatitis B, hepatitis C, Syphilis, haemorrhagic fever viruses Vector Transmission - Mosquito: Malaria, Yellow fever ˣ Tick: Congo fever, rash and bleeding and haemorrhagic fever viruses Infection Prevention: ❖ Disinfection = reduces microbes e.g. hand washing ❖ Sterilisation = kills all microbes ❖ Environmental sanitation = waste removal and correct disposal ❖ Protective clothing and gear Medical Humanities What is medical anthropology? A subfield of anthropology that interprets sickness, its distribution, treatment and prevention in terms of social, cultural, biological, and linguistic beliefs of people. ▪ TB is spread through crowding and lack of access to health care however the: - Xhosa people attribute TB symptoms to lack of hygiene and witchcraft - Batswana people attribute TB symptoms due to hard work in mines ▪ An individual’s natural and social environments can influence their health - Women working in rice fields in China have an increased risk of hookworm infections - In areas of poor sanitation and inadequate natural resources such as running water, Cholera infections are prevalent. - Women in traditional practices often find it difficult to access health care due to lack of financial power ▪ Psychological effects and hope related to disease: - Social application of this principal is ritual or religious healing - A medical application of this principal is the placebo effect. ▪ Poverty is a factor that plays a large role in the spread of diseases like HIV/AIDS and malnutrition Cultural norms and practices: - The belief that illness is sanctioned and caused by supernatural factors is common amongst black South Africans - ‘magical’ medicines are used in social contexts for good fortune etc. - Negative attitudes towards condoms and polygamy increase the spread of disease - Amongst the North-Sotho people sexual contact during menstruation or first 3 weeks of pregnancy causes fever to sanction them from illness. Their healers then treat the fever with rituals known as Hlapisa. - Batswanna people use crocodile skin to treat fever - Idliso (poisoning) is treated by inducing vomiting - Praying, sacrifices and the lighting of candles are religious practices used in healing. History of Medicine African Medicine Colonisation is a process of settling among and establishing control over the indigenous people of an area. The scramble for Africa began in the 19th century (1870-1900) when Western Europeans colonised the continent. The Berlin/Congo conference was held in West Africa (1884-1885) by Otto von Bismarck, the first Chancellor of Germany. Mano of Liberia = developed names for organs and differentiated between normal and abnormal anatomy Banyoro of Uganda are renowned for their surgical skills A Hausa (Nigerian) manoeuvre to test for impotence: An individual is stripped and lies on his back. A pin or thorn is rubbed over the inside of his thigh. If the scrotum doesn’t move, the individual is considered impotent. The Masai surgeons successfully treated pleurisy and pneumonitis by creating a partial collapse of the lung by drilling holes into the chest of the sufferer. The Zulus know the medicinal uses of +/- 700 plants Traditional medicine is the sum of knowledge and practices based on the theories and beliefs indigenous to different cultures that are used to maintain health as well as to prevent and treat illnesses. Greek Medicine ❖ Home to the first advanced civilisations in Europe and thus the birthplace Western civilisation ❖ Homer = provided information about Greek medicine to Pre-Hippocrates ❖ Illnesses = Divine punishments ❖ Healing = Gift from the Gods ❖ Hygieia = Deity of Health and thus prevents disease ❖ Panacea = Deity of Treatment Asclepios is their father ❖ Tholos = Contains purified water ❖ Abaton = Place where people slept until they were visited by the God’s ❖ Thales = "Father of Science" - First true scientist-philosopher - The basic element in all animal and plant life is water ❖ Hippocrates = “Father of Medicine” - His collection of 72 books and 59 treaties = Corpus Hippocraticum. These writings established how medicine ought to be practiced and what doctors should try to be. - Disease is a natural process and symptoms are a reaction to disease - Hippocratic medicine is based on the Doctrine of The Four Humours which reflects health balance. - Born on the Island of Cos 4 Elements 1. Earth 2. Fire 3. Air 4. Water 4 Seasons 1. Summer 2. Autumn 3. Winter 4. Spring 4 Humours 1. Blood 2. Phlegm 3. Yellow bile 4. Black bile Egyptian Medicine The Egyptians had 2 sources of information 1. Papyri 2. Stones and clay tablets Important papyri discovered: → The Kahun papyrus (± 1900 B.C.) Dealing solely with obstetrics and gynaecology → The Edwin Smith papyrus (± 1700 B.C.) The world’s first surgical textbook → The Ebers papyrus (± 1500 B.C.) Textbook of internal medicine Religious incantations as well as 700 remedies for afflictions ranging from crocodile bites to pain in the toenail. → The Chester Beatty papyrus (late 1300 B.C.) Dealing almost entirely with treatment of diseases of the anus. → The Berlin papyrus early 13th century B.C. The first paediatric handbook → The Hearst papyrus (± 1600 B.C.) → The London papyrus (early 1400 B.C.) → Book on vessels of the heart → The physicians secret → Expelling of the Wehedu Egyptian evil spirit that causes disease Egyptian physiology and anatomy ∆ The human body has a system of channels called metu ∆ The heart was at the centre of the system ∆ Imbalances within metu was the cause of pain and illness ∆ Air was carried in through the nose, ears and other channels and delivered to the heart. Then the rest of the body. ∆ The metu carry blood, air, urine, tears, sperm and faeces. ∆ In the anal region the channels came together like collecting system so that contents of the rectum could also enter the system. The Nile Theory o The Egyptians related how the body works and the reasons why people get sick to the natural environment. o The channels in the body are like a river carrying a mixture of blood and air. o The mixture flows from the centre (heart) to the extremities. o Disease is caused by the blockages of these channels which prevents normal flow. Causes of disease: - Rotting food - Letting of gas ▪ Sunus (GP) = functionaries appointed by state to ensure all citizens had medical attention ▪ Herodotus = “Father of History” Deities of Egyptian Medicine ➢ Ra = Sun god who held the highest position in Pantheon ➢ Isis = Healing Goddess, a primal earth-mother ➢ Osiris = Isis’ brother whom was dismembered by his brother Seth. He was restored by Isis ➢ Horus = Osiris’ son ➢ Evil Seth = Bringer of disease to man ➢ Imothep = Special God of medicine “cometh in peace” Roman Medicine Roman medicine is based on the writings of 2 encyclopaedists: 1. Cornelius Celsus 2. Caius Pliny the Elder ∆ In 295 BCE a plague ravaged Rome and the Romans recruited the services of the Greek God of Medicine. ∆ The Greek medical deity, Asclepios was introduced into Rome in the form of a snake ∆ Caduceus is the symbol of medicine ∆ Many Roman practitioners were freed slaves ∆ Archagathos of Sparta = 1st well known Greek physician to come to Rome - Brilliant surgical procedures = wound healer Overenthusiasm lead to failures = the butcher Abandoned the doctrine of the four humours The body is composed of atoms between which flowed body fluids ∆ Themison = a pupil of Asclepiades founded methodism - Health = dependant on the motion of atoms - Sickness = disordered motion of atoms ∆ Soranus = Principal field of work was in obstetrics and diseases of women - Best gynaecologist of antiquity ∆ Aelius Galenus or Claudius Galenus = “Prince of physicians”
