History of Nursing

• Unit i

Nursing as an Art
• Definition of History
• Continuous record of important public events, past events, and study of these is called history.
• Definition of Nursing
• Nursing is the process of recognising, understanding and meeting the health needs of any person or society and is based upon a constantly changing body of scientific knowledge.
• Definition of health
• The WHO definition health is a state of physical, mental, social and spiritual well being and not merely the absence of disease of infirmity.
• Factors that influenced nursing during Ancient Civilization into the Present day
• Nursing in prehistoric Period
Prehistoric main interest was in the mysteries of life, birth, disease and death.
His life was simple. He lived close to nature and soon associated spiritual values to natural objects.
Prehistoric man believed that a thing in nature like tree or river had a spirit or soul. Such a religion as Animism.
The things in nature became friends or jobs according to main ability to control them. Water and trees were friends, while storms and poisonous plants were enemies.
This leads to a form of worship. They thanked friendly things for their help and tried to make peace with the unfriendly.
Disease appeared to be associated with sorcery, magic, breaking a tatoo and bodily invasion by a spirit.
To get rid of these evil spirits dwelling in the body, the body had to be made unpleasant for them. Thus starving, beating and nauseous medicines were used. Loud noises, magic, trites and ceremonies and sudden fright were also tried.
If the evil spirit was through to live in a special part of the body, holes were made to allow it to escape.
In the excavated graves of prehistoric man skulls with holes made by trepanation have been found (Trepanation-cutting a circular hole with saw have been found).
The ‘medicine man’ was one who paid close attention to signs and symptoms and he knew what to do in some conditions. He attracted attention by wearing strange costumes, using magic words and queer procedures.
As his influence increased he took up the role of priest-pretending to understand and control the forces of health and disease. In this role he was known as the ‘priest-physician’. His word was law.
• Magic;
– White magic was used to attract good or helpful spirits.
– Black magic was used to drive away evil spirits or to bring harm to ones enemies.
From the primitive man’s belief in evil spirits they soon come to think that disease was caused by their failure to please the gods or by their sins.
This idea still exists, even among highly civilized intelligent people.
• Ancient Culture
and
Practices of Health Care
• BABYLONIANS / IRAQ
• Illness – cause by sun and anger by god.
• Temple – centre for medical care
• Obtained advices, diagnosis and treatment of diseases.
• Concoctions, in order to drive away the evil spirits from the rich persons.
• Sin was the causes by anger of god
• Team approach – to treat the sick persons.
• Physician directed the treatment
• Nurse carried out the case
• The pharmacies prepared the medicine
• Along with this spiritual care was also given
• They make medical tablets.
• They had a doctor for every disease.
• The patient had a choice as to whether he would use charm or medicine
• The prescriptions used included a great number of drugs
Treatment methods
• Poulticing
• Bandaging
• Massaging
• Sponging
• Dressing of wounds
• Enemata
• Suppositories
They provided to sick person
• Diet and rest
• Good personal hygiene
• In good order sanitation

• 1st Babylonian empire was great king Hammurabi
• He introduced The Legal Code of Hammurabi
• That included about The Legal Control of Medicine with the fees to be charge
• Babylonia / Mesapothemia / Iraq is in between two rivers – The Tigris and The Euphrates
• PERSIANS / IRAN
To the east of Babylonia, and running between the Persian Gulf and the Caspian sea, lay the Persia / Iran. The boundary of Persia eastward to the Indus River in India.
In to the religion the Persian brought belief in a God of goodness and a God of evil. Holy book or secret book of Persia is called Zend-Avesta. The authorship was to one Prophet Zoroaster.
The world, according to the Zend-Avesta, is ruled by two Creators, one making light and good, the other darkness and evil. This describes ceremonial rules of law for birth and death.
The knowledge we have of their medical works is derived from the Zend-Avesta, a collection of the teaching ascribed to Zoroaster. In the health care, Three types / classes of practitioner were their medical centers
• Knife doctor - Those who heal with the knife
• Herb doctor - Those heal with herbs
• Word doctor - Those with holy words
• Probably surgeon, physician and magicians.
• Palestine
• Hebrews – Palestinian
The best source book of the history of Hebrews, is the Old Testament of a Bible. The low ascribed to Moses is called the Mosaic code.
This code present a systematic organized method of practice of disease. It includes principle of;
• The practice of hygiene and sanitation
• Systematic prevention of disease
• Inspection of food
• Regulation of diet
• Slaughtering of animals for food
• Diagnosis and reporting of communicable disease
• Isolation and quarantine
Circumcision as a religious practice was ensured as a sanitary measure.
The high priest was “Priest Physician” and health inspector. House of hospitality forerunner of inns, hotel and hospital.
They practiced excellent hospitality, visiting and caring for the sick was religious duty. A nurse role includes a midwifery.
• Women held a relatively better position
• Ruth – exemplifies loyal friendship
• Deborah – a judge and a Joan of arch
• Delilah – utterly treacherous
• Rebekha – a heroine of decision and action
• Greece
Jutting out into the Mediterranean sea from the south eastern part of Europe is a peninsula that is the Greece.
The secret books of Greece are “The Iliad” and “The Odyssey” recorded by Homer.
“Apollo, God of the Sun, was also God of health and medicine, the supporter of health. Apollo’s son, Asklepios, was known as “The Blameless Physician”. Representation shows him holding the staff of the traveler, entwined with the
• Statue of Asclepius, the Greek god of medicine, holding the symbolic Rod of Asclepius with its coiled serpent
   Serpents of wisdom emblems still used by the medical profession in the caduceus. Asklepios’ wife, Epigone, shared his work, for she was revered as “The Soothing One”. One son was the possessor of hands
  which were an asset in surgical work. Another gave his attention to internal medicine. Of their daughters, Hygeia served as goddess of health, while Panacea presided over the administration of medicine and was known as the healer of all ills.
Temples devoted to the worship of Asklepios were the main center of medical work in Greece. Priests endeavored to inspire hope by assurance of the super-human skill of Asklepios. Evening worship was conducted, and after that he went to sleep.
   A message purporting to come from Asklepios was delivered to him during the night. Treatments defined by the dream oracle took, the form of warm baths, massage, inunctions, catharsis or blood letting with direct regulating and other hygienic measures.
The aid of the sacred serpent might also be invoked. Snakes of nonpoisonous variety moved at will among the patients and by licking wounds gave cleaning treatment which often helped them to heal.

The routing of care was largely hygienic and took full advantage of the sunlight and fresh air available in rural surroundings. Ample provision was made for instruction, Physical exercises, bathing and entertainment and also drugs and surgical operations.
A most celebrated temple of Asklepios, both from literature and from excavation, is that of Epidauros. It is about 30 miles from Athens and lies between two ranges of mountains. Its remains can still be seen by travelers, and it is said to have accommodated
about 500 patients, to have had wards and corridors, baths gymnasia, libraries, rooms for visitors and patients, and houses for priest and physicians. It was presided over by a head administrator.
There were two grades of priestesses in the temple hospitals, one of which assisted in the temple rites and ceremonies, and the other in the more practical duties. Women doubtless did much noble, if unnoticed work among the sick and they evidently found a sphere of usefulness in midwifery.
Greek civilization continue to progress and many changes took place. Many Asklepion temples had developed into medical schools. Most of world famous names belonge to the Greece like, Plato, Socrates, Aristotle and Hippocrates.
• The Greek physician Hippocrates (ca. 460 BCE – ca. 370 BCE), considered the father of medicine.
Hippocrates was known as “Father of modern medicine”. His father is a priest physician. In his medical teaching, Hippocrates rejected all the beliefs in the super-natural origins of disease, and taught that it was caused only by a break of natural laws. Hippocrates developed, ways of
doing physical examination and of taking histories. His treatments included;
Diet in acute diseases
Hot applications
Poultices
Cold sponging for fever
Fluids for kidney diseases
Mouth washes
He treatises the patient with
Wound of the head
Dislocations
Fracture – application of bandages
Ulcers
Epidemic diseases
He instructions to his disciplines on –
• The cleansing of the hands
• The care of the nails
• The use of boiled water or wine in the cleansing and dressing of wounds
The details of all above now we call “Nursing techniques”.
He stressed loyalty to one’s profession and responsibility for those depending on us. This is expressed in “Hippocratic OATH” used in medical schools today.
• This period (about 500 B.C.) marked more than Golden Age for Greece.
Legend places the birth date of this city Rome enwraps the event with the uncertainty of a variety of mythological interpretation. Its site on seven hills appears to have been the choice of twin brothers, Romulus and Remus, themselves indebted for life to the nourishment and care given them by a kindly wolf who found them on a mountain top, abandoned by a goddess mother.
Romans copied much system of medicine from Greeks. Many physicians were Greek slave, who did not believe in Roman superstition.
In Rome  a fairly good system of sanitation existed drainage system and severs were made, drinking water was brought in by large pipe or passage
of water called Aquaducts. Supplied the citizens of Rome with bathing facilities, like baths with heated water appeared in the homes. Paved roads and bridges were built. Sewers and drains and paving on the streets made cities clean. It has been said that public health practices began in Rome.
Notwithstanding what would seem to have been a big degree of civic and individual cleanliness, the city was the prey of frequent epidemics of disease, much of which was brought in with conquests. Moreover, the marshes surrounding the city persisted, in spite of drainage, and fostered the malaria to which history has ascribed Rome’s ultimate downfall.
For help when sickness came, the Romans clung to their Gods, to herbs or to superstition which might even include the keeping of snakes in their houses.

Although Greek physicians were allowed to do most of the medical works. Hippocratic medicine failed to make much headway. No great physicians arose among Roman scholars themselves before the first century.
The earliest hospitals were for soldiers and slaves. Army hospitals were conducted well and Roman soldiers received good care wherever they might be the dispensaries provided for the care of the public were badly managed weakness won contempt rather than pity.

Nursing was practiced by old women and men of good character.
Many instruments similar to modern surgical scalps, forceps, speculums, were used by Romans.
• Ancient China
Ancient china lay across the great range of the Himalaya mountains, far to the north-east of India. They developed another of the great civilizations. Sacred book also were written which compare with the ancient Papyri of Egypt and the Vedas and Upanishads of India.
Their earliest period is characterized, as with all other races, by plant-lore, demonic belief and faith healing. Shen Nung is venerated as the father of medicine. He was also a great ruler who was supposed to have reigned a period of 140 years. In most cities in china to this day a temple of medicine is dedicated to him.
Shen Nung was followed by Huang Ti, the yellow Emperor, who is said to have visited the immortals and to have obtained his knowledge of healing from them. He went to the two goddess, Scarlet and White, in the golden valley, and learned about the pulse and about the diagnosis of disease; and he made
nine varieties of needles for acupuncture, depending upon the size, type of point, and substance of which they were made. They could be used hot or cold, be pushed in a short distance by pressure of the hand or be driven in by a small mallet. Sometimes they were left in for days. There were
365 puncture points in the body, each having its own name and supposed relationship with internal organs.
China’s medical knowledge dates far back in her history. Before 2000 B.C. dissection was permitted. Studies of the circulation were made and great stress placed on behavior of
the pulse. Systematic methods of physical diagnosis were used, and four words were set as final guides for the physician, “Look, Listen, Ask, Feel”.
In common with other peoples the Chinese had their system of massage and they are said to have been willing to operators who were
blind. The bath was used for reduction of fever, and blood letting resorted to as a means of helping an evil spirit to escape from the prison of the body.
In dealing with any illness the Chinese physician took into conside- ration the physical temperament, the general condition, the state of mind,
the influence of the atmosphere, the time year or day, the positions of the stars and constellations, the color of the patient’s skin and other clinical features. The Chinese believed in a particular devil to cause each disease, in fact some diseases have separate devil to cause each symptom.
Most important of all was the pulse, the art of feeling this being most complicated and mysterious; and the nature, the location and the course and treatment of the disease often depended upon this alone.
With regard to pharmacy, the Chinese knew of 365 drugs, of which 240 were vegetable origin.

The personal hygiene of Chinese was quite good. For example, their habit of drinking tea instead of un boiled water protected them from developing parasitic and infectious intestinal diseases.
All the better class Chinese attached great importance to bath and the wearing of spotlessly clean linen.
In early the position of women as ultimately defined by custom and quite definitely by Confucius, was inferior to that of men. Mentioned
of women in connecting with attendance on the sick and midwife. The strict moral code handed down from very ancient times forbade the attendance of a male upon labouring women, so that this work was left to women.
After about few centuries another ideal of life was brought in to China from India. Buddhism became the religion of the populace. With its advent monasteries in charge of monks or nuns arose, and the Buddhist influence continues to be a strong one in China today.
India, in the form of a triangular peninsula with two great rivers, Indus and Ganges, lies in the southern part of the far eastern continent. The people of India are Hinduism and Aryan tribes. The Indus River has been yielding secret of past to archeological exploration.
Some where about 2000 B. C. a nomadic, Aryan speaking people who were in occupation of northern Persia and Afghanistan had comedown through the north-west passes into India. The ancient Indians lived were less fierce. Indian natural barriers rendered her comparatively secure from invasions.
They worshipped many gods, the chief of which was Brahma, The Sun - God until the coming of Buddhism in the 600 B.C. Brahma, a ‘Serpent God of a thousand heads’ rules of conduct spirit of the universe and all the wisdom of the earth.
One of there  legends tells that Brahma, in pity for the sufferings and sorrows of humanity, gave twin sons, Ayur and Veda, to the world, and endued them with all the wisdom and knowledge of this serpent god, that they might teach mankind ‘the way’.
Two collections about one hundred sacred books known as the “Vedas” and “Upanishad”. These are written in beautiful Sanskrit language, curative practice in medicine, surgery and pediatrics is discussed. Material medica and psychiatry are included.
A less picturesque version of the origin of Hindu medicine is known as the ‘Ayur-Veda’, or ‘science of Life’ / "the knowledge for long life”. It was compiled by a great physician named Susruta, a son of the famous warrior-sage, Visvamithra.
Susruta says, the physician, the patient, the drugs and the nurse are the four feet of medicine upon with the cure depends. He explains how each may be a true foot (pada). The nurse is a pada when he is kind hearted, without false shame, strong, trust worthy, and mindful of the physician’s orders.
• CHARAKA
The second of the famous physicians of ancient India. His knowledge and skills was said to have been revealed to him by the great god Indra through the medium of a Sage.
It enumerates over eleven hundred diseases arrange in two great classes, natural and supernatural; and mentions 760 medical plants among the medical and nursing treatments described are
• Baths
• Enemata
• Emetics
• Vaginal  and urethral injections
• Venesections
• Gargles
• Inhalations
• Cannabis indica and hyoschjamus as narcotics – Anaesthetics
• Methods of cataract extraction
• Excision of tumours
• Skin-grafting
• Ligatures
• Checked heamorrhage by pressure, cauterization and boiling oil
• They divided the supra-orbital nerve for neuralgia
• Performed laparotomy and suture of the bowel for intestinal obstruction and for injury.
• Plastic surgery - especially Rhinoplasty
• Described more than one hundred instruments
• The important of pre-natal influences and the care needed both before and after childbirth
• Their knowledge of anatomy and physiology was surprisingly full and accurate, and was based upon actual dissection.
• The Charaka Samhita recommends a tenfold examination of the patient.
• Constitution
• Abnormality
• Essence
• Stability
• Body measurements
• Diet suitability
• Psychic strength
• Digestive capacity
• Physical fitness
• Age
He warns his pupils against unintelligent repetition from books, the student who thus obtains his knowledge “is like an ass with a burden of sandal-wood, for he knows the weight but not he value thereof”.
• Charaka Samhita on nursing
"The Caraka (Vol I, Section xv) states these men should be, 'of good behavior, distinguished for purity, possessed of cleverness and skill, imbued with kindness, skilled in every service a patient may require, competent to cook food, skilled in bathing and washing the patient, rubbing and massaging the limbs, lifting and assisting him to walk about, well skilled in making and cleansing of beds, readying the patient and skillful in waiting upon one that is ailing and never unwilling to do anything that may be ordered."
The nursing of patients seemed to have devolved primarily, upon men, although in the very nature of things women must have carried on a great deal of unrecorded work. Nurse must be;
• Of good behavior
• Distinguished for purity
• Possessed of cleverness and skill
• Endued with kindness
• Skilled in every service a patient may require
• Competent to cook food
• Skilled in bathing and washing the patient
• Rubbing and massaging the limbs
• Lifting and assisting him to walk about
• Well skilled in the making and cleansing of beds
• Readying the Patient
• Skillful in waiting upon one that is ailing
• Never unwilling to do anything that may be ordered

• Plastic surgery - especially rhinoplasty
About 500 B.C. there was born in India a prince of Gautama, who was to become the father of another gentle and peaceful religion which, in the time, would spread over a large portion of Asia and to other parts of the world as well. Gautama, who was to be known as Buddha or the “Enlightened one”. Buddhism embodies the basic ethical concept of an endless cycle of rebirths and reincarnations until, through self-discipline, lives of good works and discovery of the truth, release from the “Wheel of Karma” is attained. Karma, operating as the law of moral cause and effect through successive lifetimes, determines the desirable or undesirable pattern of each inevitably, everyone buildup for himself either a good or a bad Karma. By disregarding caste Buddhism made possible fore everyone the practice of a system of self-education which would bring freedom from worldly evils and entrance into a mystical state of perfect peace or Nirvana. Complete renunciation of self with charity toward all men was further expression of a kindly religion to which India turned eagerly.
• King Asoka
King Asoka was one of the foremost rulers in history. He became a convert to Buddhism after identify the human suffering due to war. The wise rule of “Good King Asoka” brought prosperity. Improved buildings were provided for the use of travelers in India.
Hospitals were founded. King Asoka had shown interest in the education of women, and their status presents a sharp contrast to that to which they were to be reduced in later time doubtless women performed the duties of a nurse when sickness befell a member of her family. In institutions these duties were entrusted to old women and to men.
The greatest of all the monarchs of ancient India was King Asoka. He was the first person to improve the medical care in India.
• Built monasteries and houses for travelers
• The building of hospitals for both men and animals
• The growing of medicinal herbs
• Organized the digging of wells
• The founding of public gardens
• The planting of trees for shade
• Provision for the education of women
• Vast wealth to the Buddhist teaching orders
• Special hospitals being built to animals