CONCEPTS OF PREVENTIVE MEDICINE
The principle of breaking the chain in the transmission of an infective illness became the king-pin of the measures taken to fight the next major health hazard to hit Europe-bubonic plague. By this time there were laws that made it an offence not to report plague to the health authorities. Many public health measures were adopted to control this killer disease but from the preventive medicine point of view perhaps the most important was the introduction of quarantine regulations. The pandemic of plague in the middle of the fourteenth century forced the public officials of Italy and southern France to create cordons sanitaires, observation stations, isolation facilities and disinfection procedures. By the seventeenth century these procedures were widely accepted throughout Europe.
All this effort effectively removed plague as a scourge and as England approached the eighteenth century it was a far healthier place to live than at any time since the Romans left 1,300 years before. At least the upper classes could look beyond the problems of immediate survival. It was from this group that the first real preventive medicine was to appear. In 1662 John Gaunt, a haberdasher, was the first to show that more boys were born than girls and that more births occurred in urban than rural areas. In 1676 William Petty wrote a book on Political Arithmetick which asserted that health and education were as much a part of a nation’s wealth and power as were its trade and manufacturing. This was something of a bombshell at a time when society simply didn’t think of health as a valued commodity. You were either healthy or sick. Petty, valuing the worth of a King’s subject at 20 a head, estimated that a 25 per cent reduction in natural death rate would add 4 million per year to the wealth of the nation. He estimated that it would take a century to achieve such a vast change in death rate but suggested that in the meantime the State should use the knowledge of illness rates to work out how many health-care professionals it needed.
Unfortunately, both of these far-sighted men were all but ignored-if only because they were centuries ahead of their contemporaries. Remember, this was a time during which people mainly accepted ill health as inevitable and during which the majority of society lived and worked with an overall condition of health that would appal most of us today. Chronic illness and early death were considered normal and diseases such as scurvy blighted the lives of millions yet did not kill them.
It was not until the eighteenth century that attitudes to health and disease began to change for the better-if only among the middle and upper classes. The concept that disease was simply divine retribution was being seriously questioned by the discovery that certain diseases at least had specific and provable causes. In 1757 James Lind proved that scurvy could be cured if sailors ate fresh fruit and vegetables, and environmental hazards such as lead poisoning were shown to be responsible for certain, hitherto mysterious, conditions. In 1798 Edward Jenner proved that smallpox could be prevented by vaccination and John Snow clearly proved the link between cholera and infected drinking-water supplies. Remember that all this was occurring long before bacteria were discovered.
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