Medical Sociology · Evolution of Health and Healing · Topic: Historical Development of Medical Practices and Knowledge
Every society has an answer to a simple question: why do people fall ill? Over thousands of years that answer has changed many times, from angry gods to unbalanced body fluids, from dirty water to microbes. Each time the explanation changed, the healer changed too. That link between how a society explains illness and whom it trusts to heal is one of the first lessons of medical sociology (Bradby, 2009; Cockerham, 2025).
1. Supernatural medicine
In the earliest societies, illness was usually blamed on forces outside the body: gods, spirits, curses, witchcraft or the evil eye. People asked who caused an illness rather than what caused it. Healers were priests, shamans and shrine-keepers, and treatment meant prayer, sacrifice, charms and rituals. Some practices were physical as well, including herbs, massage, bone-setting and trepanning, in which a hole was drilled in the skull. Healed skulls show that some patients survived the procedure (Porter, 1997).
These ideas have not disappeared. In Pakistan, nazar, dam, taweez and visits to shrines sit alongside hospitals and clinics. A family's explanation of an illness often decides where the patient goes first.
2. Ancient civilisations: medicine begins to observe
Ancient Egypt, India and China began to record and study illness, although religion remained part of medicine. The Egyptian Edwin Smith papyrus (about 1600 BCE) works through injuries case by case: examination, diagnosis and treatment, with many cases of fractures and dislocations. In India, Ayurveda describes health as a balance of three doshas (vata, pitta and kapha), and the Sushruta Samhita describes surgical methods. Chinese medicine treats health as a balance of yin and yang and the flow of qi, using herbs, acupuncture, diet and exercise. The shared idea across all three was that health means balance (Porter, 1997).
3. Greek medicine: illness has natural causes
Hippocrates (about 460–370 BCE), often called the father of medicine, taught that illness has natural causes rather than divine ones. He asked doctors to observe patients closely and to consider diet, exercise and environment. The Hippocratic Oath is named after him. Hippocratic medicine rested on the theory of four humours: blood, phlegm, yellow bile and black bile. Health meant a balance between them; illness meant imbalance, treated with diet, rest, exercise, massage, bloodletting or purging.
Galen (about 129–216 CE), a physician in Rome, built this into a full system. Because human dissection was not allowed, he studied anatomy mainly on animals, and some of his descriptions were wrong. His books still guided medicine for around 1,500 years (Porter, 1997). The habit of calling foods garam or thanda in Pakistani homes comes from this humoral tradition.
4. The Islamic Golden Age and Unani medicine
Between roughly 800 and 1300 CE, scholars in the Muslim world translated Greek medical texts into Arabic, tested them in practice and added new knowledge. Al-Razi (about 865–925) kept careful clinical records and distinguished smallpox from measles. Ibn Sina (980–1037) completed the Canon of Medicine, which served as a standard textbook in the Islamic world and Europe for centuries. In the 13th century, Ibn al-Nafis described how blood passes through the lungs. Hospitals known as bimaristans had separate wards, pharmacies and medical teaching (Porter, 1997).
This tradition reached South Asia as Tibb-e-Unani; Unani means "Greek". In Pakistan, hakeems are registered by the National Council for Tibb, established under the Unani, Ayurvedic and Homoeopathic Practitioners Act of 1965 (National Council for Tibb, n.d.), and around 60,000 hakeems are registered (Hamdard Foundation Pakistan, n.d.). Patients often use a hakeem, a doctor and a faith healer at the same time. Sociologists call this medical pluralism.
5. Europe 1500–1800: studying the body directly
From the 16th century, European doctors began to test old authority against direct observation. Andreas Vesalius published De humani corporis fabrica in 1543, based on dissection of human bodies, and corrected many of Galen's errors. William Harvey showed in 1628 that the heart pumps blood around the body in a circuit. In the 1670s, Antonie van Leeuwenhoek saw microorganisms through his microscope, though their role in disease was not yet understood. In 1796 Edward Jenner used cowpox to protect against smallpox, the beginning of vaccination (Jenner, 1798; Porter, 1997). Smallpox was declared eradicated worldwide in 1980.
6. Crowded cities and the rise of public health
The Industrial Revolution packed workers into cities with dirty water, open drains, poor housing and long factory hours. Cholera, typhoid and tuberculosis spread quickly and hit the poor hardest. Many doctors still believed disease travelled through bad air, or miasma. In 1842 the reformer Edwin Chadwick linked disease in Britain to poverty and poor sanitation. In 1854 Dr John Snow mapped cholera deaths in London, traced them to a single water pump and had its handle removed, years before germs were proven to cause disease (Snow, 1855). In the 1850s Florence Nightingale cut deaths in army hospitals through cleanliness and organised nursing (Bradby, 2009; Cockerham, 2025).
The lesson was sociological: the causes of these epidemics lay in how people lived. In Pakistan, typhoid, hepatitis A and E, and cholera after floods still spread through unsafe water.
7. Did medicine make people healthier? The McKeown thesis
The British physician and historian Thomas McKeown studied death records for England and Wales. He found that deaths from tuberculosis and other infections had been falling for decades before effective drugs or vaccines existed. He argued that the main cause was rising living standards, especially better nutrition (McKeown, 1976). Later historians have argued that he underrated clean water and public health measures, so his details remain debated. His central claim, that social and economic conditions shape a population's health more than medical treatment does, became a foundation of medical sociology.
8. Germ theory and laboratory medicine
From the 1860s, Louis Pasteur showed that microorganisms cause fermentation and disease. Joseph Lister introduced antiseptic surgery in 1867, and Robert Koch identified the bacterium that causes tuberculosis in 1882. Wilhelm Röntgen discovered X-rays in 1895. Paul Ehrlich spoke of a "magic bullet": a drug that would target a single germ. Alexander Fleming discovered penicillin in 1928, and it came into wide use in the 1940s (Porter, 1997). "One germ, one cure" became the core of the biomedical model, and doctors' authority grew enormously (Cockerham, 2025).
9. Chronic disease and the whole person
As antibiotics and vaccines brought many infections under control, people lived longer, and chronic conditions such as heart disease, diabetes, stroke, arthritis and long-term back pain became the main health problems. These have many causes and no single cure, so the magic-bullet model fits them poorly. They need long-term care, rehabilitation and changes in daily life, and recovery depends on a patient's work, family, income and beliefs. George Engel proposed the biopsychosocial model in 1977 for exactly this reason (Engel, 1977). Physiotherapists, who treat these conditions every day, work at the centre of this shift.
10. Physiotherapy's own history
Massage and exercise were prescribed as treatment by Hippocrates, Galen and Ayurvedic healers. The modern profession began in Britain in 1894, when four nurses founded the Society of Trained Masseuses to protect medical massage from newspaper scandals and make it a trained, respected profession. Rehabilitation of soldiers wounded in the two world wars, and of polio patients, made physiotherapy essential. The society received a Royal Charter in 1920 and became the Chartered Society of Physiotherapy in 1944 (Chartered Society of Physiotherapy, n.d.). Organised physiotherapy is therefore older than both X-rays and penicillin.
Who did what
| Person | Period | Known for |
|---|---|---|
| Hippocrates | About 460–370 BCE | "Father of medicine"; natural causes; four humours; Hippocratic Oath |
| Galen | About 129–216 CE | Anatomy from animal dissection; humoral system |
| Sushruta | Ancient India | Sushruta Samhita; early surgery |
| Al-Razi | About 865–925 | Distinguished smallpox from measles |
| Ibn Sina | 980–1037 | Canon of Medicine |
| Ibn al-Nafis | 13th century | Blood passing through the lungs |
| Vesalius | 1543 | Human dissection; modern anatomy |
| William Harvey | 1628 | Circulation of blood |
| Van Leeuwenhoek | 1670s | First saw microbes |
| Edward Jenner | 1796 | Smallpox vaccination |
| Edwin Chadwick | 1842 | Sanitation report |
| John Snow | 1854 | Cholera traced to a water pump |
| Florence Nightingale | 1850s | Hospital cleanliness; modern nursing |
| Louis Pasteur | 1860s | Germ theory |
| Joseph Lister | 1867 | Antiseptic surgery |
| Robert Koch | 1882 | Tuberculosis bacterium |
| Wilhelm Röntgen | 1895 | X-rays |
| Paul Ehrlich | 1910 | "Magic bullet" |
| Alexander Fleming | 1928 | Penicillin |
| Thomas McKeown | 1976 | Living standards, not medicine, reduced deaths |
| George Engel | 1977 | Biopsychosocial model |
Summary
| Period | Cause of illness | Healer | Treatment |
|---|---|---|---|
| Ancient | Gods, spirits, evil eye | Priest, shaman | Prayer, charms, ritual |
| Greek / Unani | Imbalance of humours | Physician, hakeem | Diet, rest, massage, herbs |
| 1500–1800 | Faults in body structure | Anatomist, physician | Observation, early vaccination |
| 1800s | Dirt, poverty, crowding | Public health reformer | Clean water, sewers, housing |
| 1860s onwards | Germs | Doctor, laboratory | Antiseptics, antibiotics |
| Today | Body, mind and society together | Health team, including physiotherapists | Rehabilitation, long-term care |
Test yourself
- Who is known as the "father of medicine"? (a) Galen (b) Hippocrates (c) Ibn Sina (d) Pasteur
- "Unani" means: (a) Arabic (b) Persian (c) Greek (d) Indian
- Who first clearly distinguished smallpox from measles? (a) Ibn Sina (b) Al-Razi (c) Jenner (d) Koch
- Galen's anatomy contained errors mainly because he: (a) used X-rays (b) dissected animals (c) relied on prayer (d) used a microscope
- Vesalius (1543) is best known for: (a) germ theory (b) human anatomy (c) vaccination (d) X-rays
- In 1854 John Snow traced cholera to: (a) bad air (b) a water pump (c) a hospital (d) food
- McKeown credited the fall in deaths mainly to: (a) antibiotics (b) hospitals (c) better nutrition and living standards (d) vaccines
- Koch identified the bacterium that causes: (a) cholera (b) tuberculosis (c) smallpox (d) typhoid
- The "magic bullet" idea means: (a) one germ, one cure (b) many causes (c) treating the whole person (d) public health reform
- Organised physiotherapy began in 1894 when: (a) doctors opened gyms (b) four nurses founded a society (c) the army set up rehab units (d) WHO set standards
Answers: 1 b · 2 c · 3 b · 4 b · 5 b · 6 b · 7 c · 8 b · 9 a · 10 b
References
Bradby, H. (2009). Medical sociology: An introduction. SAGE.
Chartered Society of Physiotherapy. (n.d.). CSP history. https://www.csp.org.uk/about-csp/who-we-are/csp-history
Cockerham, W. C. (2025). Medical sociology (16th ed.). Routledge.
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136.
Hamdard Foundation Pakistan. (n.d.). Hamdard Foundation Pakistan [WHO EMRO document]. https://joomla.emro.who.int/images/stories/about-who/Hamdard_Foundation_Pakistan.pdf
Jenner, E. (1798). An inquiry into the causes and effects of the variolae vaccinae. Sampson Low.
McKeown, T. (1976). The modern rise of population. Edward Arnold.
National Council for Tibb. (n.d.). National Council for Tibb. https://nct.gov.pk/about/national-council-for-tibb
Porter, R. (1997). The greatest benefit to mankind: A medical history of humanity. HarperCollins.
Snow, J. (1855). On the mode of communication of cholera (2nd ed.). John Churchill.
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