Omaha daily bee., 1919-11-09
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Preventive Medicine.

IT0vcutlSC uculC1uC.
From Tho London Times.)
The importance OF preventive
medicine in England has been urged
In the Times in season and out for
has now called for a memorandum
on the subject, and Sir George New
man, chief medical officer to the
ministry, has furnished it. under the
title of "An Outline Of the Practice
of Preventive Medicine" 1t is
probable that the future legislation
Of the ministry Of health must fol-
low the lines indicated by Sir George
Newman.
Sir George reviews the whole sub
ject in that broad spirit which
characterizes his work. He begins
with the unequivocal statement that
''the first duty of medicine Is not to
cure disease, but to prevent it," and
he goes on to define the objects of
preventive medicine as:
G) To develop and fortify the
physique of the individual and thus
to increase the capacity and powers
Of resistance OF the individual and
the community.
(2) To prevent or remove the
causes and conditions of disease or
of its propagation.
(S) To postpone the event Of
death and thus prolong the span of
mans life.
A great deal has already been ac-
complished, but though the death
rate of England and Wales has
fallen from 20.6 per 1000 living in
1868 to 1875 in 1917, and the infant
mortality rates from 1856 to 96 per
1000 births, we still lose in Eng
land every year upwards Of 235,000
lives by the death Of persons un-
der the age of so, and we still lose
upwards of $4,000 infants and many
still births. Moreover, the influenza
epidemic cost us 100000 deaths In
India and 100000 in England and
Wales.
The first line Of defense Is the
body, "a healthy, well-nourished and
resistant human body" The sec
ond, a knowledge Of the nature Of
disease, which is not capricious, but
Is subject to fixed laws, our ignor-
ance Of which in many directions
effectually ties our hands. At the
present moment we have indeed an
immense body of knowledge and ex-
perience old and new, and a vast
effort and desire to apply it, "but
there Is lack of correlation Of the
knowledge, and there is lack of un-
derstanding of the precise problems
to be solved and of the ways and
means by which they may be faced"
In the first place the new knowledge
Is insufficiently shared by the whole
medical profession; in the second,
the administration Of the public
health service, both central and
local, Is insufficiently co-ordinated
and unified, and lastly:
There is all over the country in
adequate treatment Of the sick and
incapacitated, in quantity and quail
ity. The beginnings Of disease are
still almost entirely ignored. The
treatment provided for the major
ity of the sick is insufficient and in
adequate; it does not represent the
best of medical knowledge Whole
groups of disease are neglected as
far as prevention is concerned, for
prevention has been too exclusively
concerned with certain infectious
diseases, and much disease is al
lowed to go by default untended
and untreated. The provision of
facilities for residential hospital
treatment of patients requiring it
with the exception Of the insane
and the infectious) falls far short
OF what Is necessary"
The evidence Of inadequacy is not
10 be gainsafd. For example, in
1918 there were probably 1000, 200
cases of measles in the country. in
the same year tuberculosis claimed
$4,000 fresh victims, and $500 new
ly born infants developed ophthal-
mia. OF the children at school in
England a large number are back
ward, upwards Of 10 per cent are
unclean. and 10 per cent are un-
dernourished. Not less than half
the school children stand in need of
dental treatment, and half a million
at least are urgently in need of 1t.
Upwards Of half million are so
defective in eyesfght as to be un-
able to take reasonable advantage
OF their lessons. Another quarter
OF a million suffer from ear and
throat diseases.
At the examination for national
service, as already announced in
the Times, 1t was found that the
number of recruits placed in the
lowest categories Of ill health or
unf1tness amounted approximately
to not less than 100000 men.
The following is the indictment
as set forth:
l. There is a steadily falling birth
rate, which in 1917 reached a fig
ure q7.S) gravely affecting the
source of the nation.
2. There is a death rate (13.5)
which shows steady decline at all
ages G841-45 compared with 1911
15), and there is an increased ex-
pectatton Of life from birth up
wards; nevertheless, nearly half the
deaths occur. under so years of age.
3. Although the infant mortality
rate (96 per 1000 births) is one of
the lowest recorded, there is still
unnecessary loss of life in infancy
and before birth (abortion, miscar-
riage, and still BIRTH.
4. There is a relatively light bur-
den of epidemic and infectious dis
ease. which, with certain exceptions,
Is steadily increasing in incidence
and mortality, an indication Of the
victory OF preventive mtdicine over
some infectious diseases.
B. tuberculosis, measles, acute
rheumatism, and influenza are, how
ever. still prevalent, and, with ven
ereal disease, lead to much disable
ment and mortality.
6. There has been in recent wears
remarkable and continuous inn
provement in sanitary environment,
though the problem Of insufficient
and unsuitable house accommoda-
ton remains.
In turning to the lines Of reform,
we find an enunciation Of principles
which have frequently been urged
in the Times. Thus early specialism
is condemned. The need for closer
integration between preventive and
curative medicine is emphasized. In
all cases the cause of disease, not in
the abstract alone, but in the par
ticular patient, must be sought. Dis
ease must also be considered in its
ancestry-e. G., tuberculosis follow
Ing measles.
In order that these ends NAV be