PUBLIC HEAL' 



6386 



PUBLIC HEALTH 



public health possibilities of 

 general medical services working 

 more on hygienic and preventive 

 lines, are almost incalculable ; for 

 it is the general practitioner who, 

 with his first-hand knowledge of 

 the needs of the individual, is at 

 grips with the essential problems 

 of preventive medicine. 



Hygiene, or the art of preserving 

 health, has been taught and 

 practised since before the time of 

 Hippocrates, a great teacher of the 

 subject so far as empiricism could 

 advance it ; but it did not acquire 

 a scientific basis until the know- 

 ledge of the laws of life (physiology) 

 began to be studied, in the light of 

 which the causes of disease could 

 be discovered and prevented. 

 Sydenham's observations upon the 

 natural history of infectious disease 

 (1661-76) disclosed facts which 

 stimulated the study of epidemi- 

 ology long before the agents 

 directly responsible for infection 

 were known. 



The doctrine that infection spread 

 by minute parasitic organisms of 

 a specific nature was first philoso- 

 phically maintained by Fracastoro 

 in the 16th century, but Pasteur's 

 discoveries (1856-64) made possible 

 the bacteriological science of to-day 

 that has done so much for public 

 health. While the period 1760- 

 1800 saw the beginning of the 

 scientific foundation of public 

 health effort in Great Britain, and 

 the development of public concern 

 in this connexion, a real organiza- 

 tion of public services came much 

 later, and not until 1847 was the 

 first public health official, Dr. Dun- 

 can of Liverpool, appointed. 



Increased Public Knowledge 

 In the earlier days of organized 

 public health endeavour, the 

 central and local health authorities 

 concerned themselves with the 

 abatement of gross insanitary 

 conditions and with efforts to 

 prevent the spread of certain 

 specific diseases, which were regard- 

 ed as more particularly affecting 

 the health of the community. 

 With a broadening outlook an 

 increasing regard came to be paid 

 to the individual. This was first 

 manifested in the growing pro- 

 visions for the care and treatment 

 of the sick ; and the consideration 

 for environment, which had hither- 

 to been judged to be the main 

 issue, now takes second place to 

 that which relates directly to the 

 individual. The public health can 

 never be satisfactory while there is 

 ignorance and indifference to the 

 simple laws of healthy living, 

 whatever the environment may be, 

 and so increasing efforts were made 

 in order to educate the public in 

 these matters. 



The cult of the individual now 

 finds expression in countless useful 

 provisions for guarding his health, 

 amongst which the public care of 

 the expectant and nursing mother 

 and infant, the medical inspection 

 of school children, and national 

 health insurance, may be men- 

 tioned as of special importance. 

 The growing recognition of the 

 relationship between health and 

 industrial efficiency and poverty 

 has done much to bring about the 

 extension of public health endeav- 

 our and provisions ; and public 

 health work now requisitions a 

 personnel which administers to 

 the sick, protects from disabilities 

 and incapacities, and regulates 

 personal and industrial hygiene. 



Reduction of Infant Mortality 

 In more recent years an increas- 

 ing effort has been made to reduce 

 infant mortality, which had not 

 hitherto shared in the marked 

 reduction in the general death-rate. 

 It had long been evident that this 

 heavy loss of infant life annually 

 recurring was largely the result of 

 parental ignorance, and so a move- 

 ment was initiated to provide 

 advice and encouragement, and 

 assistance when this is required. It 

 was soon seen that the local 

 infantile mortality rates were 

 responding to these efforts ; and in 

 1907 the Notification of Births Act, 

 by requiring the notification of all 

 births to a medical officer of health 

 within 36 hours, made it possible 

 greatly to extend the value of this 

 work. Stimulated by these results 

 and by government grants in aid 

 of it, infant and ante-natal clinics, 

 child welfare centres, and many 

 related activities, grew rapidly ; 

 and the work of child welfare, 

 formerly confined to the first year 

 of life, was carried up to the 

 fifth, the age of compulsory school 

 attendance. 



A large number of public health 

 measures have been passed by 

 Parliament, and the increasing 

 powers and the growing provisions 

 for administering these powers 

 reflect the ever-widening domain 

 which it is sought to cover in the 

 interests of the public health. The 

 legislation relating to child-birth, 

 infancy, and childhood, the school 

 child, those industrially employed 

 in factories and workshops, housing, 

 national health insurance, and 

 communicable disease, is bearing 

 good results, and is pregnant with 

 greater possibilities for the future ; 

 and the measures put in operation 

 against tuberculosis (1912) and 

 venereal disease (1916) are an 

 expression of the determination to 

 make a direct attack upon these 

 diseases, two of the greatest enemies 

 of public health. 



Bacteriology has made great 

 advances in recent years, and with 

 the knowledge of the causal 

 agents of infection, the prevention 

 and cure of communicable disease 

 have gained considerably. Especi- 

 ally is this true in reference to the 

 bacteriological diagnosis of cases 

 of disease which cannot be diag- 

 nosed with certainty by clinical 

 methods, to the discovery of pre- 

 ventive inoculations to confer 

 temporary immunity from attack, 

 and of curative inoculations to re- 

 duce mortality. By the use of 

 ever-improving methods and pro- 

 visions for the early diagnosis and 

 the prompt notification of commu- 

 nicable disease, and by providing 

 for the isolation or quarantine of 

 sufferers, and for the necessary 

 disinfection, most forms of commu- 

 nicable disease are coming more 

 under control. Although there 

 remain some, such as measles, 

 whooping-cough, influenza, and 

 infectious pneumonia, which con- 

 tinue to resist the efforts to 

 prevent their spread, provisions for 

 reducing the mortality therefrom 

 are meeting with encouraging 

 success. The frequent occurrence 

 of obscure infection in carriers, and 

 mild, and therefore often un- 

 recognized, cases, with no sus- 

 picious symptoms, are now known 

 to be a source of infection of diph- 

 theria, cerebro-spinal fever, enteric 

 fever, dysentery, influenza, etc. 



Work of Public Authorities 

 In England the local govern- 

 ment board was the central con- 

 trolling department in most matters 

 of public health until 1919, when the 

 ministry of health was established, 

 more particularly to bring under 

 one central body the public health 

 powers which had previously been 

 exercised by several departments. 

 The public health administrative 

 authorities embrace county 

 councils, county borough councils, 

 borough councils, urban and rural 

 district councils ; and the public 

 health service of local authorities 

 includes a legal and clerical staff, 

 an engineering and surveying 

 staff, and a sanitary staff under 

 the direction of the M.O.H. 



A study of the vital statistics 

 of England and Wales for the past 

 50 years, and of the earlier life- 

 tables, furnishes evidence of the 

 improvement which has taken 

 place in the public health. More 

 than a quarter of a million lives are 

 now saved each year which would 

 have been lost 50 years ago, and 

 over 60 p.c. of the lives saved are in 

 respect of communicable disease ; 

 and the life-tables demonstrate 

 that the expectation of life of 

 males, which during 1834-54 was 

 39-91 years, has progressively 



