Preventive Medicine

The Practitioner's Aid.

Whilst the state was thus calling in to being various public medical services, the practitioner in medicine and surgery was finding ways and means of preventing disease met with in his practice, both infectious and non-infectious. Abortion, miscarriage, still-birth are preventable conditions. Chil dren's disorders such as ophthalmia, rickets, dental decay and malnutrition are preventable, and the same may be said of many diseases of the skin, the eye, ear, nose and throat. The examina tion of recruits and of insurance patients shows that much physi cal impairment is due to the effects of rheumatism, dyspepsia, constipation, bronchitis, anaemia, debility, neurasthenia, heart disease, dental decay, mental disease or disorders of metabolism. Some of these conditions are due to factors such as infection (fevers, rheumatism, tuberculosis, venereal disease, etc.), or de generative processes, like arteriosclerosis and nephritis, or fatigue and unhygienic living ; others are more obscure, but the great bulk of them are in large degree preventable. Midwifery alone provides many opportunities for preventive medicine.

Surgical Aid.

Surgical conditions seem at first sight to be less directly preventable, and curative only. Yet (he task of the surgeon is to serve and assist nature by placing the human body and its organs at her service, by removing obstructions from her path, by supplementing and aiding her processes and by fortifying the body defences against infection or accident. All this is of the essence of preventive medicine. It is an alliance with nature against disruptive forces. Surgery finds its preventive expression in a great variety of ways. The fundamental principles of aseptic surgery are the elimination of sepsis and its practice is repair, the removal of hurtful tissues and the avoidance of disablement. Pre ventive surgery may be illustrated in a general way as follows : (a) Surgery in children's conditions—enlarged tonsils and adenoids, phimosis, hernia, ophthalmia.

(b) Surgery in deformities—rickets, tuberculosis, scoliosis, talipes, flat-foot, hammer-toe, fractures.

(c) General surgery—sepsis, tuberculosis, varicose veins, hernia, venereal disease, malignant disease, tumours, thoracic conditions, abdominal and genito-urinary surgery, gynaecology, dental caries.

(d) Industrial surgery—wounds, fractures, injuries, poisons, fumes, anthrax, tetanus, etc.

The first generation of the loth century (19oo-24) witnessed a continued development in sanitary environment, which indeed must always remain the foundation of preventive medicine, and in various new departures dependent upon the principles which had been established by the Public Health Act 1875, and by the growth of medical knowledge. The public health service expanded to include particular measures against tuberculosis and venereal disease, the provision of municipal midwives, and a remarkable extension of the supervision of maternity and child welfare. Indeed, the characteristic of this period was the progress made in personal hygiene as distinct from environmental hygiene. Its centre is the person rather than the premises. The School Medical Service was organized in 1907, systematic provision was made for the care of infancy in 1914, the. National Health Insurance Act was passed in 1911 and medical research has been organized on a large scale.

Concurrently with these great movements increased attention was given to industrial welfare and the health of the factory worker. Time alone can show the effect on the public health of the wide extensions and applications of the public health principles of 1875. It cannot be doubted that an improved midwifery service, the care of the newborn infant, the systematic health supervision of every school child, improved hygiene in the workshop and factory and a system of health insurance by which medical aid is promptly available for 14,000,000 insured persons must exert in the course of time a profound effect upon the national health.

That such an effect has already been produced is shown by the vital statistics. The following table gives the birth-rate, popula tion, number of deaths, average annual death-rate and infant mortality from 1871 to 192o:— decline in the infant mortality rate from 153 per i,000 born in 1891-190o to less than 8o for 192o-4 and less than 7o for 1927 is one of the most significant and sensitive indications of the improvement of the public health. Perhaps an even more valuable indication is the expectation of life at birth. In 1871-8o the expec tation of life at birth in London was for males 38 years, and for females 42. By 1920-2 these figures had risen to approximately 54 years for males and to 59 for females, a rise of 16 and 17 years respectively in two generations.

Since 190o there have been various collateral developments in medicine which cannot fail to exert powerful influence on the prevention of disease. The use of X-ray (q.v.), of radium (q.v.), and of the ultra-violet rays has been conducive not only to greater accuracy of diagnosis, but also to steady improvement in the treatment of tuberculosis (q.v.) and cancer (q.v.). Heliotherapy (q.v.) and open-air treatment are likewise finding many appli cations. The perfection of the Wassermann-Bordet test and the discovery by Ehrlich of Salvarsan (the 6o6th preparation tried for syphilis) have advanced the diagnosis and treatment of this disease, now carried out in England and Wales in 186 (1927) special clinics receiving state subsidy (see VENEREAL DISEASES). The Widal reaction for typhoid and various tests for tuberculosis have been followed by the Schick and Dick immunizing tests for diphtheria and scarlet fever, and these have opened up new oppor tunities for the control of these diseases (see INFECTIOUS FEVERS.) The dispensary and sanatorium treatment for tuberculosis has been greatly developed, and this has led to the arrest or retarda tion of the disease in many individuals. The disease has been steadily declining in Great Britain since about 1875. The new knowledge of filter-passing viruses has already created far-reaching possibilities, and that of the physiology of internal secretion has led to the introduction for therapeutic purposes of artificially pre pared extracts, such as insulin (for diabetes), thyroxin (for myxoedema) and pituitrin (for acromegaly). (See ENDOCRINOL OGY.) There has also been an enormous development in the use of antitoxins, vaccines and serums (see IMMUNITY ; SERUM THERAPY ; VACCINE THERAPY)—the harvest of the epoch-making work of Louis Pasteur.

These advances are finding their way into various forms and degrees of State enactment, the most recent example of which is the Local Government Act of 1929, which inter alia made available for the whole community upwards of ioo,000 hospital beds formerly allocated to the Poor Law.

Lastly, the creation of the League of Nations has facilitated considerable development in the international study of hygiene, and there has thus been opened a new sphere for the application of preventive medicine to international health problems and the control of the tropics for the white man. Plague, yellow fever, malaria and sleeping sickness have now, under favourable cir cumstances, come under man's dominion.

See J. G. Fitzgerald, P. Gillespie and H. M. Lancaster: An Intro duction to the Practice of Preventive Medicine (1923). (G. N.)