Manual Medical History of Mankind : How Medicine Is Changing Life on the Planet

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Humans did not at first regard death and disease as natural phenomena. Common maladies, such as colds or constipation , were accepted as part of existence and dealt with by means of such herbal remedies as were available.


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Serious and disabling diseases, however, were placed in a very different category. These were of supernatural origin. They might be the result of a spell cast upon the victim by some enemy, visitation by a malevolent demon, or the work of an offended god who had either projected some object—a dart, a stone, a worm—into the body of the victim or had abstracted something, usually the soul of the patient.

The treatment then applied was to lure the errant soul back to its proper habitat within the body or to extract the evil intruder, be it dart or demon, by counterspells, incantations, potions, suction, or other means. One curious method of providing the disease with means of escape from the body was by making a hole, 2. Trepanned skulls of prehistoric date have been found in Britain, France, and other parts of Europe and in Peru.

The practice still exists among some tribal people in parts of Algeria, in Melanesia, and perhaps elsewhere, though it is fast becoming extinct. Magic and religion played a large part in the medicine of prehistoric or early human society. Administration of a vegetable drug or remedy by mouth was accompanied by incantations, dancing, grimaces, and all the tricks of the magician. The use of charms and talismans, still prevalent in modern times, is of ancient origin.

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Apart from the treatment of wounds and broken bones , the folklore of medicine is probably the most ancient aspect of the art of healing, for primitive physicians showed their wisdom by treating the whole person, soul as well as body. Treatments and medicines that produced no physical effects on the body could nevertheless make a patient feel better when both healer and patient believed in their efficacy. This so-called placebo effect is applicable even in modern clinical medicine. The establishment of the calendar and the invention of writing marked the dawn of recorded history.

It was in the last two centuries that literacy became the norm for the entire population.

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Today there are 5. In there were fewer than million people with the same skill. The historical estimates suggest that the entire world lived in poor conditions; there was relatively little variation between different regions, in all countries of the world more than every third child died before it was 5 years old. It would be wrong to believe that modern medicine was the only reason for improved health. Initially rising prosperity and the changing nature of social life mattered more than medicine.

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It was improvements in housing and sanitation that improved our chances in the age old war against infectious disease. Healthier diet — made possible through higher productivity in the agricultural sector and overseas trade — made us more resilient against disease. But surely science and medicine mattered as well. A more educated population achieved a series of scientific breakthroughs that made it possible to reduce mortality and disease further.

Particularly important was the discovery of the germ theory of disease in the second half of the 19th century.


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In retrospect it is hard to understand why a new theory can possibly be so important. But at a time when doctors did not wash their hands when switching from post-mortem to midwifery the theory finally convinced our ancestors that hygiene and public sanitation are crucial for health.

Public health mattered hugely: Everybody benefits from everybody else being vaccinated , and everybody benefits from everybody else obeying the rules of hygiene.

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With these changes global health improved in a way that was unimaginable to our ancestors. In child mortality was down to 4. You have to take this long perspective to see the progress that we have achieved. Political freedom and civil liberties are at the very heart of development — as they are both a means for development and an end of development.

Quantitative assessments can therefore be useful when they help us to measure freedom against the same yardstick across countries and over time. There is just no way around that. Again I want to give a time perspective to get an idea of how political freedom has changed over the last years. The chart shows the share of people living under different types of political regimes over the last 2 centuries.

Throughout the 19th century more than a third of the population lived in colonial regimes and almost everyone else lived in autocratically ruled countries. The first expansion of political freedom from the late 19th century onward was crushed by the rise of authoritarian regimes that in many countries took their place in the time leading up to the Second World War.

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In the second half of the 20th century the world has changed significantly: Colonial empires ended, and more and more countries turned democratic: The share of the world population living in democracies increased continuously — particularly important was the breakdown of the Soviet Union which allowed more countries to democratise. Now more than every second person in the world lives in a democracy. The huge majority of those living in an autocracy — 4 out of 5 — live in one autocratic country: China.

Human rights are similarly difficult to measure consistently over time and across time. The world population was around 1 billion in the year and increased 7-fold since then.

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But this increase of the world population should evoke more than doom and gloom. First of all, this increase shows a tremendous achievement. It shows that humans stopped dying at the rate at which our ancestors died for the many millennia before. In pre-modern times fertility was high — 5 or 6 children per woman were the norm. The increase of the world population followed when humanity started to win the fight against death.

Global life expectancy doubled just over the last hundred years. Population growth is a consequence of fertility and mortality not declining simultaneously. The fast population growth happened when fertility was still as high as it was in the unhealthy environment of the past, but mortality has already declined to the low levels of our time.

What we have seen in country after country over the last years is that once women realise that the chances of their children dying has declined substantially they adapt and chose to have fewer children. Population growth then comes to an end. This transition from high mortality and fertility to low mortality and fertility is called the demographic transition.