HISTORICAL DEVELOPMENT OF MEDICAL – SURGICAL NURSING:

MEDICINE: It is relating to the science of medicine or to the treatment of patients by drugs etc , as
opposed to surgery.

Medicine is a science which deals with illness which can be cured by administration of medicines
alone. Nursing of a patient receiving medical treatment is called medical nursing.

 Acc to WHO:
Medical is the science and art dealing with the maintaince of health and the prevention, alleviation, or
cure of disease.
SURGICAL: It is relating to the process of performing a medical operation .of or relating to surgery.
 Surgery is a science which deals with disease which requires operation along with medical
treatment. Nursing of a patient receiving surgical treatment is called surgical nursing.
 Acc to WHO:
The branch of medicine that employs operations in the treatment of disease or injury. Surgery can
involve cutting, abrading, suturing or otherwise physically changing body tissues and organs.

Medical – surgical nursing: Medical – surgical nursing is a nursing specialty area concerned with the
care of adult patients in a broad range of settings. The history of medicine in India goes back through
the centuries to about 3000BC. The experience and concern in health development date back to Vedic
period between 3000BC – 1400BC. The Ayurveda and other system of medicine practiced during this
time suggest the development of comprehensive concept of health by the ancient sages of India.

INTRODUCTION: Medical – surgical nursing is the care of adults in health and illness .It is based on
knowledge derived from the arts and sciences and further enhanced by knowledge from nursing .The
focus of medical – surgical nursing is one adult’s patient response to actual or potential alternations in
health. Traditionally, medical – surgical nursing was an entry level position that most nurses viewed as
a stepping stone to specialty areas. The medical surgical nursing profession began to further distinguish
itself as a distinct entity in 1991 with the founding of the Academy of medical – surgical nurses. Today,
 surgical nursing continues its evolution as specialty and is the large group of practicising professionals,
according to the academy of medical – surgical nurses.

HISTORY DEVELOPMENT OF MEDICAL –SURGICAL NURSING: The history of medical

science, considered as a part of general history of civilization.

Medicine in the ancient world:

 Primitive peoples:

IN the 19th and early 20th centuries: Anthropologists studied primitive societies. Among them
treatment for injury and sickness was a mixture of common sense and magic .People knew of course
that falls causes broken bones and fire causes burns. Primitive people had simple treatments for these
things e.g. Australian aborigines covered broken arms in clay , which hardened in the hot sun
.However primitive people had no idea what caused illness. They assumed it was caused by evil spirits
or magic performed by an enemy . The cure was magic to drive out the evil spirit or break the enemies
spell.

 Ancient Egyptian medicine:

Much of Egyptian medicine still relied on magic. However at least they could keep written records of
which treatments worked and which did not .In this way, medicine could advance. The earliest known
medical book is the Ebers Papyrus, which was written about 1500BC .Egyptian doctors used a huge
range of drugs obtained from herbs and minerals .They were drunk with wine or beer or sometimes
mixed with dough to form a “pill”. Egyptian doctors also used ointments for wounds and they treated
hest complaints by getting the patient to inhale stream.

 Ancient Greek medicine: The roots of modern medicine are in ancient Greece .on the one hand
most Greeks believed in a god of healing called Asclepius. People who were ill made sacrifices or
offerings to the god .They then slept overnight in his temple. They believed that the god would visit
them in their sleep (i.e. in their dreams ) and when they woke up they would be healed .At the same
time Greek doctors developed a rational theory of disease and sought cures .However one did not
replace the other.
 .AS early as 500BC a man named Alcamaeon from croton in Italy said that a body was healthy if it had
the right balance of hot and cold , wet and dry .It is the balance was upset the body grew ill. However
the most famous Greek doctor is Hippocrates .Hippocrates stressed that doctors should carefully
observe the patient symptoms and take note of them .Hippocrates also rejected all magic and he
believed in herbal remedies.

 Roman medicine: The Romans conquered Greece and afterwards doctors in the Roman Empire
were often Greeks. Many of them were slaves. Doctor had low status in Rome .However the state paid
public doctors to treat the poor. The Romans also had hospitals called valetudinarian for their wounded
soldiers. Later in roman times Galen (130-200AD) become a famous doctors .At first he worked
treating wounded gladiators. Galen was also a writer and he wrote many books.
 MEDICINE IN THE MIDDLE AGES:
 In the Middle Ages medicine was dominated by the ideas of Galen and the theory of the four
humours. Medieval doctors was great believers in bloodletting .Ill people were cut and allowed to
bleed into a bowl .People believe that regular bleeding would keep you healthy .Medieval doctors also
prescribed laxatives for purging . Enemas were given with a greased tube attached to a pig’s bladder.
Doctors also prescribed baths in scented water. They also used salves and ointments and not just for
skin complaints. Doctors believed it was important when treating many illness to prevent heat or
moisture escaping from the effected part of the body and they believed that ointments would do that
.Medievel doctors also examined a patients urine. The color, smell and even taste of urine were
important. Astrology was also an important part of medieval medicine.
 MEDICINE IN 16TH CENTURY :
 Leonardo Da Vinci (1452-1519): Dissected some human bodies and made accurate drawings of
what he saw.
 Andreas Vesalius (1514-1564): He did many dissections and realized that many of Galen’s ideas
were wrong. IN 1543 he published a book called the fabric of the human body.
 1540 : An English translation called” The birth of mankind was published”.
 MEDICINE IN THE 17TH CENTURY: In the 17th century medicine continued to advance .In the
early 17th century an Italian called santorio invented the medical thermometer.
 Williams Harvey(1628): Published his discovery of how blood circulates around the body .Harvey
realized that the heart is a pump .Each time it contacts it pumps out blood .The blood circulates around
the body .Harvey then estimated how much blood was being pumped each time.

Unfortunately in the 17th century medicine was still handicapped by wrong ideas about the human body.
Most doctors still thought that there were four fluids or humours in the body, blood, phlegm, yellow
bile and black bile.

Robert Hooke (1665): was the first person to describe cells in the micrographia.

 Medicine in the 18th century:

John Hunter (1728-1793): He is sometimes called the father of modern surgery .He invented new
procedures such as tracheotomy. Furthermore during the 18th century a number of hospitals were
founded. The first hospital in America opened in Philadelphia in 1751.

In the late 18th century and early 19th century dispensaries and early 19th century dispensaries were
founded in many towns .They were charities were the poor could obtain free medicines .In the 18th
century many sailors suffered from scurvy (vitamin c deficiency).However a Scottish surgeon named
James Lind discovered that fresh fruit or lemon juice could cure or prevent scurvy

 MEDICINE IN THE 20TH CENTURY:

 Rene Laennec (1816): He invented the sthethoscope. At first he used a tube of paper. Later he used a
wooden version.
 John snow (1813-1858): He was showed that cholera was transmitted by water. However doctors
were not certain how.
 Later Louis Pasteur (1822-1895): proved that microscopic organisms caused disease. In the early
19th century many scientists believed in spontaneous generation i.e. that some living things
spontaneously grew from non- living matter.
 Robert Koch (1843- 1910): isolated the germ that causes anthrax. In 1882 he isolated the germ
that causes tuberculosis and in 1883 he isolated the germ that causes cholera in humans.
 Edwin klebs(1882) : The germ that causes diphtheria was discovered.
 Humphrey Davy (1778-1829): He realized that inhaling either relieved pain.
 Joseph lister (1828-1912); discovered antiseptic surgery which enabled surgeons to perform many
more complicated operations.
 Jean Henry Dunant (1864): He founded the international red cross.
 Alexander Flaming (1928): Penicillin was discovered.
 Dr. Johns Salk (1954) :He was invented a vaccine for poliomyelitis.
 1958. The first pacemaker was made.
 TRADITIONAL MEDICINE AND SURGERY IN INDIA: Indian medicine is ancient. Its
earliest concepts are set out in the sacred writings called the Vedas. According to a later writer, the
system of medicine called Ayurveda was received by a certain Dhanvantari from brahma, and
Dhanvantari was defined as the god of medicine. The period of Vedic medicine lasted until about
800BC. The Vedas are rich in magical practices for the treatment of diseases. The chief conditions
mentioned are fever, cough, consumption, diarrhoea, abscesses, seizures, tumors and skin diseases. The
herbs recommended for treatment are numerous.
 GOLDEN PERIOD OF INDIAN MEDICINE: The golden age of Indian medicine, from 800BC
until about AD100 may betermed the Brahmanistic period. It is marked especially by production of the
CHARAKA – SAMHITA and SUSHRUTA – SAMHITA, attributed respectively to the physician
Charaka and Sushruta, traditionally a surgeon. The Sushruta – Samhita probably originated in the last
centuries of the pre – Christian Era and became fixed in its present form in the 7 th century AD at the
latest. Both Charak and Sushruta state the existence of a large number of diseases.
A brief description of chronological events related to development of health and medicine in India is
given below:-
 3000 BC : In the Indus Valley Civilisation, one finds evidences of well developed environmental
sanitation programmes such as underground drains public baths, etc. ‘Arogy’ and ‘Health’ was given
high priority in daily life and this concept of health included physical, mental, social and spiritual well-
being.
 2000 BC: RIGVEDA marks the begining of the Indian system of medicine. Medicine was
considered part of Vedas. ‘Ayurveda’ a science of life and art of living said to be founded by sage
‘Atreya’. Good health implies an ideal balance between tridoshic factors such as wind, bile, phlegm
according to Ayurveda
 1000 BC: Atharvaveda mentions the twin aims of medical sciences as health and longevity and
curative treatment. Hygiene and dietetics are considered important in treatment.
 800 BC : Acodification of medical knowledge by AGNIVESA, said to be disciple of ATREYA,
called AGNIVESA. Samhita became the basis of later CHARAKA.
 600 BC: A treatise by KASAYAPA mainly dealing with pediatrics.
 500 BC: ‘CHIVARAVASTU’ a book written by unknown author is found. It mentions prince
Jivika, the court physician of Bimbasara, King of Magadha, as a marvelous physician and surgeon. He
is credited with such difficult operations as piercing the skill to operate on the brain, surgery of the eyes
etc.
 272 BC – 236 BC: King Asoka, a convert to Buddhism, built number of hospitals. More emphasis
was laid on the preventive aspects. Doctors, nurses and midwives were to be trustworthy and skillful.
This period saw famous medical schools at Taxila and Nalanda.
 237 BC – 201 BC: St. Buddha instituted a state medical system, appointed doctors for every 10
villages on the main roads of India. Pharmaceutical gardens were also maintained.
 200 BC – 100 BC : Patanjali explained the yoga system of philosophy of men and physical
discipline – the starting point of Yoga therapy later continued.
 100 BC: CHARAK SAMHITA, the first classical exposition of Indian system medicine deals with
an almost all the branches of medicine, anatomy, physiology, aetiology, prognosis, pathology,
treatment procedure and sequence of medictaion and an extension MATERIA MEDICA for more than
600 drugs. This treatise formed the basis of the ATREYA. School of medicine in India, in 100 AD.
 200 – 300 AD: SUSHRUTA SAMHITA appears to have been revised by Nararjuna, laid main
emphasis on surgery. This great treatise described more than 300 operations, 43 different surgical
processes and 121 different types of instruments.Sushruta defines ideal relations of doctor, patient,
nurses and medicine.
 500 – 600 AD: VAGBHATA wrote ASTANGA HARIDAYA (8 limbs and heart). The eight limbs
refer to the eight traditional branches of Ayurvedic knowledge, such as therapeutics, surgery, ENT,
mental and superstitious diseases, infantile diseases and treatment, toxicology, arresting physical and
mental decay and rejuvenation or regaining lost virility potency and procreative ability.
 600 – 800 AD: VRUDUKUNTA writes SIDDAYOGA, the earliest treatise on Rasa Chikitsa now
existing intact. The Rasa Chikitsa system considers mercury as the king of all medicines.
SIDDAYOGA explain the various preparations of mercury and other metals, alloys, metallic
compounds, salts and sulphur.
 800 – 1300 AD: A number of treatises were written in India during this period.
ARKAPRAKASHA, a book on tincture extraction. Sarangadhara Samhita, Chikitsa, Sangraha and
Yoga Ratnakara are the better known among them.
 1300 – 1600 AD: Bhavamsisra wrote Bhava – Pra – Kasha. This is the most renowned Indian
treatise during the period. It contains an exhaustive list of diseases and their symptoms and complete
list of drugs. It includes aetiology and treatment of syphilis, a disease brought to India by Portuguese
seamen.
 1600 AD: East India Company established British rule in India. Western medical and surgery
started to be practiced and became popular in India.
 NURSING IN INDIA:
BEGINING OF MODERN NURSING:
In the past, the progress of nursing in India has been hindered by many difficulties, such as the low
status of women, the system of purdah among Muslim women, the caste system among Hindus,
illiteracy, poverty, political unrest, language differences, and the fact that nursing has been looked upon
as servant’s work.Since independence day 1947, many changes have taken place and the attitude
towards nursing is changing. More women are being educated and many are taking up nursing as their
profession.
MILITARY NURSING:
Military nursing was the earliest type of nursing. In 1664, the East India Company helped to start a
hospital for soldiers at Fort St. George,Madras. Later, a civilian hospital was built and the medical staff
appointed by the East India Company, served in both hospitals. In 1797 a Lying-in-hospital was built
and in 1854 the Government sanctioned a training school for midwives.
In 1861, through the efforts were made to provide health services for the people of India. This Lid the
foundation for public health nursing. Miss.Adranvala has worked very hard to raise the status of the
nursing profession in India. She has given much of her time to the interests of the TNAI having held the
office of president for two terms and that of treasure until she was released at her own request.
MISSION HOSPITALS:

Mission hospitals were the first to begin the training of Indians as nurses, very gradually overcoming
the prejudices of parents against sending their girls for a training which was felt to be beneath the
dignity of decent educated girls. Religion prevented Hindu and Muslim girls from joining at all and so
only Christian girls could be trained at first.
 In the beginning there was no uniformity of courses or educational requirements. About 1907 –
1910 the North India United Board of Examiners for Mission hospitals was organized and set up rules
for admissions and standards of training and conducted a public examination
AUXILIARY NURSING:
The use of auxiliary nursing personnel to ease the shortage of professional nurses had been common in
some countries when it was first put into practice in India. A two year programme for the auxiliary
nurse – midwife was first established in 1951 at St. Mary’s hospital, Taran Taran in Punjab state. By
1962, there were 263 courses being offered in India. The auxiliary nurse midwife is prepared to practice
elementary nursing and full midwifery. She functions primarily in the community rather than the
hospital.
The practice of the auxiliary nurse – midwife has helped to improve the amount of care given to the
patient as well as the health teaching given to the public. In 1977 the ANM course was completely
revised by the Indian Nursing Council and expanded to include sociology health education and
communication skills and subjects necessary to equip the multipurpose health worke/ANM to serve
effectively as a primary health care worker in the community.
REGISTRATION OF NURSES:
As training for nurses, midwives, and health visitors progressed, the need for legislation to provide
basic minimum standards in education and training was felt. It was also felt that registration would give
greater professional status. For some years, nurses struggled to obtain proper examinations and
examiners and registration for nurses. In 1926 Madras State formed the first Registration Council.
While most states now have a recognized Registration Council. It is now possible for the students of all
schools in India to be registered in one of the State Registration Councils.
THE INDIAN NURSING COUNCIL:

The Indian Nursing Council Act was passed by an ordinance on December 31 ST 1947. The council was
constituted in 1949.

The purpose of the council is to co-ordinate activities of the various State Registration Councils, to set
up standards for nursing education and to make sure these standards are carried out. Before this time,
nurses registered in one state were not necessarily recognized for registration in another. The condition
to mutual recognition by the State Nurse Registration Council called reciprocity as possible only if
uniform standards of nursing education were maintained. Therefore, the INC was given authority to
prescribe curricula for nursing education in all of the states.

COMMUNITY HEALTH NURSING:

In India community health nursing had its beginning when the terrible conditions under which children
were born were recognized as a cause for the high civilian mortality rate.
It was realized that the untrained dais who attended women during delivery must be given training.
This was not an easy job as the dais were unwilling to be trained and the patients were very willing to
accept the old customary methods. The first attempts to train dais were carried out by missionaries as
early as 1886. In 1900, Lady Curzon brought about the establishment of the Victoria Memorial
Scholarship for the purpose of improving safe delivery practices. The need for training a better type of
midwife was felt .