the history and development of public health part1
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Dr Saadiyah Rao
Senior Lecturer
School of Public Health
Dow University of Health sciences
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To give overview of History of Pubic healthTo discuss time line from primitive medicine to birth ofPublic HealthTo review the evolution of Public Health in developed
countries
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Public health is not an invention of the 20th century, andthe issues we debate today have many parallels in history.
Brockington noted (1960) that,
public health in some form has existed as long ascivilisation. Inoculation against smallpox was practiced inIndia and China more than two thousand years ago.
Isolation of leprosy was enforced in the Roman Empirewhich built leprosaria; the first isolation hospitals, andmany religious abstentions concerned food and excretalpollution.
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Time line
Primitive societies
Ancient societies: before 500BC
Classical cultures: (500BC to 500 AD) Middle Ages: (500 to 15 00AD)
Renaissance period: (1500 to 1700 AD)
Eighteen century
Nineteen century Twentieth century
Twenty first century
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Public Health in Primitive Societies
Have a sense of community hygiene
bury excreta
burial of the dead tribal rituals for the diseased
temporary isolation for the sick
smoke for fumigation
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Public Health in Ancient Societies Before
500BC Indus Valley Civilization (2000BC): Excavations provide
evidence of:
bathrooms & drains in home Sewers below street levels
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Public Health in Ancient Societies
Middle Kingdom of ancient Egypt (2700-2000BC): Ruinsshowed the presence drainage system
knew more than 700 drugs
Sumerian clay tablet from 2100 B.C. contains prescriptionsfor drugs
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Public Health in Ancient Societies
Code of Hammurabi Babylon(1700-1800BC) : earliestwritten record concerning Public Health:
included laws pertaining to physicians & health practices :
Physicians provide a service to the society, and in return were
paid money but would be punished if the results of treatment
ended up killing the patient !
Mycenaeans in Crete-Greece (1600BC): had toilets,flushing system & underground drainage system
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Public Health in Ancient Societies
Hebrews wrote Book ofLeviticus in about 1500 B.C.
- the first written health code in the world
keep a clean body
protect against contagious diseases
isolation for lepers
disinfecting of home after an illness
sanitation of campsites protect food and water
hygiene of maternity
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Public Health in Classical
Cultures 500 B.C. to 500 A.D. Greeks began to travel to Egypt
Took information from other people
Included it in Greek philosophy of health and medicine
Active in the practice of community sanitation
Supplemented water of city wells and built cistern
Hippocrates (460-370 BC) In his book On Airs, Waters,Places; presented relations of disease to physical, social,
and behavioural settings
The first rational guide to the establishment of a science-based public health
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Public Health in Classical Cultures
Romans
Had extensive systems for public and private hygiene
Had extensive bath and wash houses
Brought clean water into their cities using aqueducts
Had system for getting rid of garbage and other wastes
Cloaca Maxima, still serves as part of the sewage of themodern Rome !
Street cleaning & repair system
Built the first hospital
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Public Health of the Middle Ages
(500-1500 A.D.) Period from end of Roman Empire to 1500AD
Most of knowledge was preserved in churches &monasteries
Medieval approach to health & disease was different fromRomans
Health problems were considered as to have spiritualcauses, hence spiritual solutions
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Public Health of the Middle Ages
Dark Ages (500-1000 A.D.): Western Europe experienced a periodof social and political disintegration. In Eastern Europe and Asiamedicine advanced and major hospitals established in Baghdad,and Cairo.
Western Europes condition: immoral to view ones own body
sanitation ignored; waste in streets
many pandemics
Blamed disease on supernatural causes St Augustine: taught that disease were caused by demons sent to
torture the human spirit and diseases were punishment for sins!
This is often called The spiritual era of Public Health
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Public Health of the Middle Ages
(500-1500 A.D.) During the 7th century A.D. Islam appeared
religion stressed cleanliness
"There is no disease that Allah has created, except that He
also has created its remedy."Volume 7, Book 71, Number 58 Taking proper care of one's health is the right of the
body.Bukhari as-Sawm 55, an-Nikah 89, Muslim as-siyyam 183, 193, Nisai
The Prophet (PBUH)not only instructed sick people totake medicine, but he himself invited expert physicians forthis purpose.D.o.H. p.50, As-Suyuti's Medicine of theProphet p.125
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http://www.usc.edu/dept/MSA/fundamentals/hadithsunnah/bukhari/071.sbt.htmlhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.usc.edu/dept/MSA/fundamentals/hadithsunnah/bukhari/071.sbt.html -
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There wereMobile dispensary
The concept ofquarantinewas first introduced in the 7thcentury A.D. by the prophet Muhammad (PBUM), who
warned against entering or leaving a region suffering fromplague.
Al-Razi wrote encyclopaedias of Medicine As early as the 10th century, Muslim physicians innovated
the use of isolation wards for individuals suffering withcommunicable diseases.
Also had public baths and sewage systems.
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Public Health of the Middle Ages
(500-1500 A.D.) Back to western world:
One of the earliest recorded epidemic disease was Leprosy :6th-15thcentury
- rules and regulations- leper houses
The deadliest plague epidemic 14th century---------plague wasnamed as black death killed 25 million people in Europe
Other epidemics : smallpox, diphtheria, measles, inf luenza(English Sweat), TB, and many other unidentifiable diseases
Last epidemic : syphilis appeared in 1492 & killed thousands
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Public Health in the Renaissance &
Exploration Period 1500-1700 A.D. Period characterised by rebirth of thinking about
nature & humankind : exploration & discovery
Led to great commercial, scientific, cultural, and
political development Effects of this period on Public Health were substantial
However, experience of the Dark Ages was notforgotten
People now asked how diseases arose?
not a punishment from God because
Growing belief was environmental factors that caused
disease 18Dr Saadiyah Rao- School of Public Health, DUHS
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Public Health in the Renaissance Period
(1500-1700 A.D.) Careful observations of symptoms & disease outcomes
led to the first recognition of separate diseases
Whooping cough, typus, scarlet fever, and malaria
Practically the conditions were not much changedfrom Dark ages
Explorers, traders and migrants took European
diseases and spread them to indigenous peoplesaround the world
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Public Health in the Renaissance Period
(1500-1700 A.D.) Three most important contributions to public health of
the Renaissance period:
The organization of boards of health : were responsible
for : determining of plague
quarantine
burial of plague victims
the fumigation
A model for nineteenth-century organization of publichealth activities
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Public Health in the Renaissance Period
(1500-1700 A.D.) The promulgation of a theory of contagion
Girolamo Fracastoro proposed that epidemic diseases arecaused by transferable tiny particles seeds of
disease,seminaria"He analysed diseases according to three specific modes of
dissemination
by contact,
through objects such as cloth (fomes),by distance
The earliest theoretical conceptualizations of somethingapproximating germ theory !
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Public Health in the Renaissance Period
(1500-1700 A.D.) The introduction of health statistics
The Italian boards of health instituted a system ofdeath registration
In 17th century (London) analysis of bills of mortalityby John Graunt (Natural and Political Observations
Made Upon the Bills of Mortality) laid the basis for the
modern use of statistics for the planning andevaluation of public health activities.
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Public Health in the Eighteenth
Century Beginnings of industrialization and urbanization
Although there had been a recognition of the role of theenvironment as a cause of disease, living conditionswere not conducive to good health
Significant milestone (1796), when Dr. Edward Jennerdemonstrated the process of vaccination as a protection
against small pox Before this: variolation
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Public Health in the Eighteenth Century
The first US census was taken in 1790: Average age atdeath was 29 years at that time !
US continued to face epidemics of small pox, cholera,
typhoid fever & yellow fever Hence, in 1798 Marine Hospital Service was formed to
deal with diseases on vessels
Several other governmental health agencies were
created to deal with epidemics, sanitation problems &protection of water
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Public Health in the Eighteenth
Century In Germany, J P Frank, published System of a Complete
Medical Policy: proposed a extensive scheme of governmental regulations and
programs to protect the population against disease and topromote health.
The actions that he advocated ranged from measures ofpersonal hygiene and medical care to environmentalregulation and social engineering.
In England, Jeremy Bentham in his Constitutional Code,proposed radical new legislation dealing with issues as prisonreform, the establishment of a ministry of health, birthcontrol, and a variety of sanitary measures.
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Public Health in the Nineteenth
Century Public health provision was completely transformed
as the 19th century progressed. Overcrowding, poverty and disease went hand in hand at
the century's start, but social reform had comprehensivelyturned things round
Initially living conditions remained unsanitary in Europe &England but realized that social and sanitary conditionsimpacted the economy
Parliament made reforms to improve the lives of men,women and children in the poorer sections of society.
Government involvement in welfare provision, and inregulating conditions of work in factories, workshops andmines.
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Public Health in the Nineteenth
Century General Registration (from 1837) gather statistics on
mortality for the whole of England and Wales. Edwin Chadwick 1842
Report on an Inquiry into the Sanitary Conditions of theLaboring Population of Great Britain Key conclusion: That the various forms of epidemic, endemic, and other
disease caused, ...... chiefly amongst the labouring classes...... by decomposing ...... substances, by damp and filth, and
close and overcrowded dwellings prevail amongst thepopulation in every part of the kingdom That the annual loss of life from filth and bad ventilation are
greater than the loss from death or wounds in any wars inwhich the country has been engaged in modern times.
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Public Health Act & General Board of Health forEngland 1848
1849 first annual report called for municipal action to:
eradicate slums and build model dwellings
public wash-houses
control the water supply
municipal cemetery drainage system with a permanent sanitary inspector
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Public Health Acts 1848 Public Health Act encouraged local Health Boards to
appoint Medical Officer, inspect lodging houses and check foodand provide sewers.
1855 Nuisance Removal Act overcrowded housing illegal
1864 Factory Act unhealthy conditions in factories illegal 1866 Sanitary Act local authorities responsible for sewers, water
and street cleaning.
1871 Vaccinations Act vaccinations were made compulsory (1853)
1875 Artisans Dwelling Act made the house owners responsiblefor keeping their properties in good order and gave localauthorities the right to buy and demolish slums if they were notimproved.
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Public Health in the Nineteenth
Century In 1848-49, 2nd cholera epidemic
John Snow 1849 : On the Mode of Communication ofCholera Predominant theory (contagious disease) : miasma
theory : Diseases were caused by the presence in the airof a miasma; a poisonous vapour
1853-54, 3rd outbreak of cholera
1854 He figured out the origins of cholera: the classicalstudy in Epidemiology
1850- Ignaz Semmelweiss- introduced hand washing
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Source: http://www.choleraandthethames.co.uk/
http://www.choleraandthethames.co.uk/http://www.choleraandthethames.co.uk/http://www.choleraandthethames.co.uk/ -
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Public Health in the Nineteenth
Century Theory of spontaneous generation: living organisms
could arise from inorganic or nonliving matter
equivocal generation considered that one type of
contagious microbe could change into another type. Pasteur (1862) proposed the germ theory of disease
Gave the death blow to the theory of spontaneousgeneration and radically changed the practice of medicine.
Later introduced pasteurization of milk
Joseph Lister (1867)- - antisepsis
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Public Health in the Nineteenth Century
Koch in (1876) establish a causal relationship throughhis postulates
4 postulates contributing to germ theory The disease agent must be found in all cases of the disease The disease agent must be isolated in pure culture Inoculation of this disease agent must produce the same
disease in healthy animals/people The disease agent must be re-isolated from the inoculated
animal/person
Developed ways of staining bacteria and identify thebacterial causes of anthrax (1877), tuberculosis (1882)and cholera (1883)
1875 to 1900 The Bacteriological Period of PublicHealth
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Shattuck Report -US 1850 19th Century America:
Population increased
Epidemics common
Lemuel Shattuck - legislator Massachusetts
appointed to study sanitary problems
no national or state PH programs were at the time
Drew up a health report that outlined the public healthneeds of state
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Shattuck's Recommendations Health education
Study, supervise and/or control TB, alcoholism, mental disease
Supervise and study immigrants Control smoke and food adulteration
Teach sanitary science in medical school
Include prevention in clinical practice
Get routine physical exams Keep records of family illnesses
Impact of this report was to start the Modern Era ofPublic Health in America
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Public Health in the Twentieth
CenturyAt the beginning of the century
Life expectancy was less than 50 years
Leading causes of death were communicable diseases
(influenza, pneumonia, tuberculosis , GI infections ,malaria & diphtheria)
Vitamin deficiency diseases were common includingrickets, pellagra and scurvy (symptoms of these diseases
were known but the cause was mystery)
Deaths associated with pregnancy and childbirth werealso high
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Public Health in the Twentieth
Century1.Health resources development period(1900-1960) :
much growth & development of health care facilities &providers took place during these 60years
- is further divided into The reform phase (1900-1920)
The 1920s
The great depression (1929-1935) and World War II (1939-45 )
The post war years
2.Period of social engineering (1960-1973)
3.Period of health promotion (1973 to present)
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Public Health in the Twentieth Century
The Reform Phase of Public Health (1900-1920) Growing concern about social problems in America due deepening
gap between upper lower classes led to reform movement
Broad movement involving social, moral & health issues
Upton Sinclair The Jungle drew attention to unsafe working
condition in meat packing factory 1906, the passage of the Pure Foods and Drugs Act
In 1910 first international congress on occupational disease washeld
New York passed Workers Compensation Act: Employers arerequired to make compensations to workers
First School of Public Health was established in 1918 at JohnsHopkins University
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Public Health in the Twentieth
Century The 1920s
Period of slow development in Public Health
Prohibition resulted in decline in alcoholics and alcoholrelated deaths
Life expectancy in 1930 risen to 59.7 years
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Public Health in the Twentieth
Century The Great Depression (1929-1935) and World War II
(1939-45 ) by 1933 private resources could no longer meet the needs of
the people who needed social & medical assistance Beginning in 1933, President Roosevelts New Deal created
agencies and programs for public works
Building of hospitals and laboratories, control of malaria andthe construction of municipal water and sewer systems
World War II decreased the availability of funds andresources for public health, but led to the development ofmany important medical discoveries that were made availableonce the war ended
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Public Health in the Twentieth Century The post war years
Antibiotic penicillin was made available
Insecticide DDT to kill insects that transmittedcommunicable diseases was made available
Communicable Disease Center was set up in Atlanta duringthe war, now known as the Center for Disease Control andPrevention (CDC).leading epidemiological center of
world
Two major events in the 1950s
Development of a vaccine to prevent polio
President Eisenhowers heart attack focused attention onthe nations number one killer, heart disease
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Public Health in the Twentieth Century
Period of Social Engineering (1960-1973) 1965 passage of the Medicare and Medicaid bills
Medicare provides for health care to the elderly and somedisable people
Medicaid provides health care for the poor Period of Health Promotion (1974-present)
Recognition that the greatest potential for saving lives isby education and life-style changes by individuals
In 1970s, CDC conducted a study that examinedpremature death : approx 48% of all premature deaths
were because of lifestyle or health behavior-choicespeople make
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Public Health in the Twenty-first
CenturyWorld health leaders recognized the need to plan for
21st century in 1977
WHO set a target for health for all by year 2000
Health resources should be distributed in such a waythat essential health care services are accessible toeveryone
Alma Ata conference adopted declaration on PrimaryHealth Care as a key to attain this goal
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Public Health in the Twenty-first
Century Goal is not achieved but it is not abandoned !
Renamed to Health of All(HFA)
HFE seeks to create the conditions where peoplehave, as a fundamental human right, the opportunityto reach and maintain the highest level of health
Although slow but achieved increase in life expectancy
globally
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Public Health in the Twenty First
Century Problems to be faced
Health care delivery cost
Environmental problems
Lifestyle diseases
Drug abuse
New communicable diseases or old diseases that have
become resistant to drug therapy
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ReferencesAn Introduction to Community Health:James
McKenzie, Robert Pinger, Jerome Kotecki
http://www.sciencemuseum.org.uk/broughttolife/themes/publichealth.aspx
http://www.islamic-study.org/public_health.htm
http://www.parliament.uk
http://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAAhttp://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAAhttp://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAAhttp://www.sciencemuseum.org.uk/broughttolife/themes/publichealth.aspxhttp://www.sciencemuseum.org.uk/broughttolife/themes/publichealth.aspxhttp://www.islamic-study.org/public_health.htmhttp://www.parliament.uk/http://www.parliament.uk/http://www.islamic-study.org/public_health.htmhttp://www.islamic-study.org/public_health.htmhttp://www.islamic-study.org/public_health.htmhttp://www.sciencemuseum.org.uk/broughttolife/themes/publichealth.aspxhttp://www.sciencemuseum.org.uk/broughttolife/themes/publichealth.aspxhttp://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAAhttp://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAAhttp://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAAhttp://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAA
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