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2. Historical evolution of healthcare assistance

2.1 From Hippocrates to the discovery of antibiotics

Hippocrates was born in Greece in 460 B.C. and died also in Greece in 377 B.C. He is considered the father of medicine. Treating disease and the sick has been a necessity formed with the very origin of man; as a spontaneous need of the patient to live in the community while not being alone against an illness. "Medicus" is not only the one who mediates between the patient and the disease, but also who stands between evil and death, often taking over the centuries a mystic or priestly role. The first medical schools were developed in the area of present-day Greece and Ancient Greece, including in Sicily and Calabria. In Crotone, Calabria, the school of Pythagoras (570 BC - 495 BC)⁹ was famous. At the center of the Hippocratic conception there was not the disease but rather a man with an extreme attention towards nutrition and the environment. This was the precursor of the knowledge of the first determinants of disease related to nutrition and healthy air. The writings of Hippocrates (or assumed so) were analyzed in the universities until the 1700. Such manuscripts were oriented towards prudence and caution before intervening with the moderate use of therapy also since in those days there were few remedies available, pharmacology was not yet known and herbal medicine was in its infancy, growing about a century later with Theophrastus (371 B.C. - 287 B.C.), a pupil of Aristotle (384 B.C. - 322 B.C.) to whom we owe an enormous boost of natural sciences.

Hippocrates gave medicine a holistic imprint centred on man and the environment, becoming in fact the precursor of the most advanced modern environmentalist theories, including the economic and ecological ones of our economist of reference, Jeremy Rifkin: our guide in describing the new paradigm of medicine that with this paper we disseminate: Zero Disease.

Hippocrates introduced the first concepts of medical ethics and it is to his school that the doctor's oath is attributed:

 â€œI swear by Apollo the healer, by Asclepius, by Hygieia, by Panacea, and by all the Gods and Goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath: I swear to to honour like I honour my parents he who taught me the art of medicine (concept of pupil-teacher); to share with him my sustainment and satisfy his needs, if he may need it;

 to consider his sons as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture;

 to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else (concept of caste);

 I will apply the diet regime for the advantage of the ill, according to my ability and judgement, I will spread them against anything harmful and unjust;

 I will not administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion;

 I will keep pure and holy both my life and my profession. I will not operate on who sufferers from stone, and will leave such practice to professionals;

 â€œInto whatever house I enter, it will be to help the sick, and I will abstain from all intentional corruption, especially from seducing women, men, free and slaves. And whatsoever I shall see or hear in the exercise of my profession as well as outside my profession that I can hear or see regarding the life of others that should not be divulged, I shall tacite, holding such things as secrets (concept of professional secret);

 I carry out this oath all the way and honour it, may I be able to enjoy the fruits of my life and of this art, forever honoured by all men; but if I transgress it and forswear myself, may the opposite befall me”.

Hygiene, from greek "salutare", is the branch of medicine that deals with health in a holistic way from its earliest conception that studies the wholesomeness of air, soil and water to its most modern conception that studies how to organize in public and private health care the health services as efficiently and effectively as possible. Hygiene has always dealt with how to prevent disease.

Democritus (460 B.C. - 370 B.C.) developed the theory of pores that came to condition the scarcity of hygiene that was found in the Middle Ages. For the school of Democritus, depending on whether the pores were open or closed, there would have been a condition respectively of relaxation or tension. According to this theory, it was necessary to try to maintain the pores naturally open with resulting attention on how to wash and on the water temperature. This concept was misinterpreted in the Middle Ages condemning water as a cause for the closure of the pores.

Fortunately, the erroneous theories of Democritus were uptaken only many centuries later (Middle Ages) while during the Greek and Roman era there was a remarkable development of hygiene. The water was the key element of Roman society that allowed the realization of impressive aqueducts passing through the streets of the empire and considerable construction of spas and saunas with an advanced water and sewage system.

The contrast to infectious diseases was conducted over the centuries especially thanks to the different hygiene techniques that, as we will see, will lead to the development of preventive medicine to the very recent predictive medicine and personalized medicine.

To fight diseases, medical facilities with a high concentration doctors and technology called hospitals, have developed over the past centuries. The modern hospital's origins can be traced back to the early twentieth century and initially it was the wealthy landowners who left a will in favor of places that dealt with poor and dying patients. These were charitable structures, almost always managed and organized by religious people.

Despite the catastrophic plague pandemics and raged leprosy and tuberculosis of the fourteenth and seventeenth centuries there was no awareness that the disease could be contagious to another living organism. The modes of transmission of infectious diseases were unknown and the most accepted theory was that odors carried the contagion, but no one knew how. In the Middle Ages there was no concept of hygiene and the sick were put on the beds with dirty sheets that was recycled without washing.

The hospital of the first industrial revolution can be traced back to the eighteenth century, a large and promiscuous operation between social and health care, where febrile patients were hospitalized with women in childbirth, psychiatric cases, surgical patients at risk of nosocomial gangrene but also the poor in need of shelter and food.

With the rise of environmental health knowledge to counter infectious diseases the pavilion hospital model began its development, built with low buildings separated from each other to avoid to a maximum contagion from one patient to another. Around 1850 began the construction of the first hospitals in pavilions that can still be seen today in the center of ancient metropolitan cities such as the Umberto I General Hospital and the San Camillo Hospital in Rome.

Gerolamo Fracastoro (1478 - 1553)¹⁰ doctor, mathematician and poet, taught logic in the University of Padua. He wrote the latin poem Syphilis sive de morbo gallico (1530), which tells of a young and handsome shepherd who, having offended Apollo, is punished with a terrible ulcerative colitis. Syphilis, a venereal disease at the time newly spreading, took its name from this poem. Fracastoro was among the first to believe that epidemic diseases were transmitted by a sort of seminal entity that carries the contagion (De contagione et contagiosis morbis, 1546).

Carlo Francesco Cogrossi (1682-1769) was the first who noticed that bovine plague had living organisms that transmitted the plague, but his argument fell on deaf ears.

Edward Jenner (1749-1823) was a british naturalist and doctor, know for introducing the vaccine against smallpox and considered the father of immunization.

The use of certain molds and plants for the cure of infections was already recognized in ancient cultures- greek, egyptian, chinese - their effectiveness was due to antibiotic substances produced by the vegetale species or by the mold. However, there was no possibility to distinguish the effectively active component nor isolate it. Vincenzo Tiberio, Molisane doctor in the University of Naples, already in 1895 described the antibacterial power of some molds¹¹ .

Modern research began with Alexander Flemming’s casual on penicillin in 1928. More than ten years later, Ernst Chain and Howard Walter Florey managed to obtain antibiotics in pure form. The three obtained for their merits the Nobel Prize for medicine in 1945.