MAJOR ACHIEVEMENTS OF PREVENTIVE MEDECINE: SCARLET FEVER TUBERCULOSIS AND OTHERS
Scarlet fever
In 1900 scarlet fever was so virulent that three out of every 100 children who caught it died. By 1973 there were only three deaths in 11,000 cases in the UK. Certainly children are better able to withstand the effects of the organism today but scientists are also sure that the organism itself has changed in some way.
Tuberculosis
In 185513 per cent of all deaths were caused by ÒÂ, and once again the young suffered most. ÒÂ is a classical example of a disease falling in the mortality league long before specific cures were available. Less overcrowding, better food, better personal hygiene and sanatorium treatment-all helped to reduce the illness and death from ÒÂ long before the drugs to cure it were discovered. Since the early 1950s, with mass X-rays, drugs and BCG vaccinations, there has been a rapid fall in the number of cases and deaths. New cases today are confined almost entirely to very old men and certain immigrants. But even today when the disease is virtually eradicated it causes the loss of 2.3 million working days a year in the UK. Just think what things were like a century ago!
Poliomyelitis
About thirty years ago polio reached its peak incidence. In 1947, 7,984 cases were recorded and 10 per cent of these died. Between 1952 and 1954 nearly another 1,000 died of the disease and many more were left paralysed. Today there are about 12,000 people in the UK suffering from the after-effects of polio.
The first vaccine was introduced in 1957. The result is that in the years 1972-4 only twenty-two cases of polio were reported in the UK and none died. But because not everywhere in the world has a similar record on this disease it still makes sense to be vaccinated before going abroad to certain countries.
Smallpox
Once the scourge of whole populations, this disease is now officially extinct in the world.
Maternal mortality
We have seen how the outlook has improved for babies and young children but so too has that of mothers during pregnancy and childbirth. A century ago maternal mortality in childbirth was at epidemic proportions, and even as recently as 1935 between forty and forty-five women died for every 10,000 pregnancies. This totalled about 2,500 women every year.
The establishment of the Royal College of Obstetricians and Gynecologists, and the Midwives Act of 1936 helped raise professional standards, and the care of pregnant women and the confinement in hospitals under specialist care has reduced the maternal death figures to one in every 10,000 births. There are suggestions that even this can be improved upon.
The history of preventive medicine, then, is largely that of public health, but now the challenges are different. Certainly we have combated the infectious illnesses to the point where they no longer pose a fraction of the threat they once did, but today we face new threats from degenerative diseases such as cancers, stroke, and heart disease-the big single killer of Western man.
Can modern preventive medicine do tor these diseases what public health so successfully did for the infections? The problems today are fundamentally different. The last century’s illness epidemics were caused by poverty and shortage. This century’s are being caused by wealth and excess. No one much minds giving up poverty and shortage but persuading people to give up ‘the good life’ is much more difficult.
*8/72/5*
