Preventive medicine

“ The most important aid in the future to the influence of preventive medicine must be the education of the people so that the conditions of disease, the intrinsic and the extrinsic causes and the manner in which these act, shall all become a part of general knowledge, and the sympathy of the people with health legislation and their active assistance in carrying out measures of prevention may be obtained. ”

“ As teachers and writers on hygiene, as trainers for college athletes, as advisers for the welfare departments of large industrial plants, and in many other directions, physicians are finding fields for practising preventive medicine. Even the family physician is in some cases being asked by his patients to keep them well instead of curing them after they have fallen sick.
Furthermore, the preventive methods of modern medicine are being applied by the people themselves, as witness the great vogue to-day of sleeping out of doors; the popularity, not always deserved, of health foods and drinks ”

“ Preventive medicine is the application of medical science to the mass as well as to the individual. It attempts to arrest disease before its momentum has carried it beyond the means of help. It is the truly modern as contrasted with the medieval point of view. ”

“ Indeed, the golden age of preventive medicine has but recently had its dawn, and sanitarians at the present day often encounter great difficulty in convincing legislators and the public generally of the importance of the measures which have been proved to be adequate, when properly carried out, for the prevention of this and other infectious maladies. ”

“ In securing such a result there will be needed medical practitioners who are imbued with the ideals of preventive medicine in its widest sense. Let me, in this connection quote the following extract from a recent official report of my own:
There is needed a reconstruction of the training of each medical student, which will make preventive medicine in its widest sense an integral part of his training, and will insure that before he begins practice he has definite instruction in the application of the whole of his knowledge to preventive purposes. ”

“ Old and New Ideas Concerning Health Protection.—No science has made greater progress during the past hundred years than the science of preventive medicine. In early times all diseases were looked upon as due to the same cause, namely, the anger of the gods for some misdoing on the part of the individual or the community. ”

“ Again, a like spirit dictated the use of the physical or “natural” methods on a larger scale in the field of prevention. From the new regard given by physiologists and pathologists to the study of origins, and in the new hopes of thus dealing with disease at its springs, not in individuals only but in cities and nations, issued the great school Hygiene. of Preventive Medicine, initiated in England—E. A. Parkes (1819–1876) , J. Simon, Sir B. W. Richardson (1828–1896) , Sir H. W. Acland (1815–1900) , Sir G. Buchanan (1831–1895) , and forwarded in Germany by Max von Pettenkofer (1818–1901) . ”

“ The doctor has been regarded as a help when serious or acute incapacitating illness occurs, and he has but seldom had the opportunity of giving advice in the earlier and more controllable stages of illness. His training has been conducted on the assumption that his chief rôle should be on present lines, with the result that most medical practitioners enter into practice with a too scanty knowledge of hygiene and preventive medicine, and have to learn slowly in belated experience the influence of environment on the health of their patients. ”

“ Future medicine will be largely prophylactic, preventive, sanitary, hygienic, dietetic. What holds true of medicine in general holds true of that particular branch of it that deals with neurosis. The treatment will become largely prophylactic, preventive, educational, or pedagogic. ”

“ People in acute diseases may sometimes be their own physicians; but in the chronic, the cure must ever depend chiefly upon the patient’s own endeavours. The Doctor has also passed over the Prophylaxis, or preventive part of Medicine, very slightly, though it is certainly of the greatest importance in such a work. ”

“ Notwithstanding all that Medicine can achieve, to succour the body as it struggles against actual disease—notwithstanding those resources of drugs and handicraft, by which the physician or surgeon opposes death or mitigates pain in the detailed exercise of his art, all past experience, and every transaction of our daily practice, confirm the popular adage that prevention is better than cure. ”

“ By virtue of his profession and because of its onerous and responsible duties, no one stands more in need of robust health than the physician. Called from his bed at all hours of the night, brought in daily contact with disease, and that often of a contagious character, the largest demands are made upon his vital forces. He is expected, not only to dispense the necessary medicines, but also to carry comfort and cheer to the bedside of the sick. The very countenance of a healthy, cheerful physician acts like a medicine. ”

“ Although medicine is useful in some instances, yet, in a great proportion of the cases of disease, including fevers and inflammations of all kinds, attention to the laws of health will tend to relieve the system from disease; more certainly and speedily, and with less danger, than when medicines are administered. ”

“ Another difficulty is often found to arise, from the almost exclusive occupation of the physician’s mind by the diseased condition of the sufferer, the relief of which is, of course, our primary and incumbent duty. In order to give to each symptom, as well as to the whole assemblage of symptoms, a close and discriminating attention, and to adapt, with equal care, a corresponding treatment in medicine, diet and general management ”

“ So the doctor learns to combat disease with science, and at the same time to apply scientific laws of health that he may fortify the human body against the invasion of harmful germs. Thus, eventually, he makes medicine itself less necessary. ”

“ We have to dissect nature; which, for practice, is better than to abstract it.” “To clinical medicine the body becomes a pathological museum. In every part we recognise certain proclivities to morbid action; and the purpose of our study is to trace these tendencies to their source on the one hand, and to their effects on the other.” “The effects of disease may be for a third or fourth generation, but the laws of health are for a thousand.” “Happily, at this day, hygiene has gained strength enough to maintain an independent position in science. ”

“ Should she, out of respect to the resident physicians, decline to practise medicine, still she will have a noble function in the prevention of disease and physical deterioration, and in the assisting of physical development. ”

“ To this end must be added the one thing needful, personal fitness, sagacity in recognizing the peculiarities of individual cases, and in adapting the treatment of them, hygienic, dietetic, and medicinal, to the special requirements of each. In a word, the physician must never forget that he has a patient as well as a disease to treat. ”

“ The first of these agencies, perhaps, is the application of the general principles of medicine and surgery to the treatment of the sick individual. In other words, the patient’s general health becomes a problem for inquiry and appropriate consideration, irrespective of his mental state, on the general theory that physical health is at least the best condition precedent for undertaking a restoration to mental equilibrium. ”

“ The Methodists, it should be added, deserve special credit for having been the first to introduce and carry into effect the systematic treatment of chronic diseases; and, as a general proposition, it may be said that their treatment of all forms of disease was thoroughly practical, free from all tendency to resort to magical methods, and based largely on the employment of such hygienic measures as the use of baths of different kinds (hydrotherapy) , massage, moderate outdoor exercise, passive movements, sea voyages, fasting, regulation of the diet, etc. ”

“ It behooves every intelligent individual to see that this reproach is lifted from him. Knowledge is held to be a valuable possession in every department of life; but in no instance will it yield greater returns for the investment than in the field of hygiene—in learning how to keep well.
It must not be imagined that because the treatment previously described is such a wonderful curative and preventive of disease that nothing more is necessary that all other hygienic measures can be ignored. These bodies of ours were given us for a nobler purpose than to be the sport of our caprice or neglect. ”

“ It further ought to be remarked upon the apparently large number of cases of sickness, that as the people have medical advice and medicine gratis, that they come for it on the slightest illness, and the more so as not only the master of the works but also the physician encourages them as much as possible to do so, convinced that in most cases, by timely aid, more serious illnesses are prevented. ”

“ To discuss with anything like completeness the practical applications of what would be commonly considered as hygienic rules in the treatment of disease would be to write a treatise on nursing, and would also include a large part of the practice of medicine, for regimen is the more important half of practical therapeutics. ”

“ PARKES, GUY, SIMON, AND PUBLIC HEALTH. “Prevention is better than cure” is the homely proverb which marks out a large proportion of the work of sanitary science. The prevention of disease and of its spread, and the promotion of the general healthiness of the people—these are objects which modern progress has brought into view. When they are completely attained we shall all die of old age unless cut off by accidents or violence; and this is a goal which many sanitarians of the present day have vividly before their mind. ”

“ When informed that they do not need medicine and that outside treatment is unnecessary, they find it difficult to believe, for disease has always called for treatment of some kind in the hands of the medical profession. When further told that they have to help themselves by living so that they will not put any obstacles in the way of normal functioning of their bodies, they think that the physician who thinks and talks that way must be a crank, and many seek help where they are told that they can obtain health from pills, powders and potions or from various inoculations and injections. ”

“ In the chapter on the Uncertainty of Medicine, I treated quite at large of the vis medicatrix naturæ, or the tendency of the system to throw off disease, and thus cure itself. In the great majority of cases of sickness which fall under the care of the physician, this recuperative power is competent to effect a cure if they are left to themselves, and in most of them it will do so, even though a positively bad treatment may be pursued. ”

“ We know that such a work is necessary, that it is just as important as the educational practice of which I write. We know that without the physical side medicine would fail of its usefulness and that disease and death would reap far richer harvests: I only wish the two naturally related aspects of our dealing with patients might not be so completely separated that they lose sight of each other. As a matter of fact, both elements are necessary to our human welfare. If medicine devotes itself altogether to the cure and prevention of physical disease, it will miss half of its possibilities. ”

“ Great stress was laid by the physicians as well as by the priests of ancient India upon the observance of very elaborate rules respecting the care of the person while in health and, very naturally, when a patient became ill the physician in charge paid quite as much attention to the employment of hygienic and dietetic measures in effecting the desired cure as to the administering of drugs. ”

“ Twenty men employed constantly in putting up this medicine would not have been sufficient to have complied with all the demands which were made of me for it. Hundreds who were in health called or sent for it as well as the sick, in order to have it in readiness in case they should be surprised by the disease in the night, or at a distance from a physician. ”

“ The administration of medicine, however necessary it may be to alleviate pain, or to aid in the cure of disease, is but little calculated to ameliorate the air of a crowded hospital, or to promote that cleanliness which, in such circumstances, is, of all medicaments, the most indispensable. ”

“ The physical method of treating disease presents a tremendous and significant departure from the empiricism of medicine and the experimentation of dietetics, the restricted fields of electricity, suggestion, water cures, and massage. The patient as an individual is not treated; the disease as a disease is not treated ”

“ So much for the Art of Healing as practised by the physicians of America. What of our activities in the second aim of medicine, that is, the prevention of disease? While superficial examination is enough to lay bare the many hollow pretensions of the practice of medicine, it would appear a priori that the work of disease prevention might at least approach the category of the applied sciences. This would seem to be so, since the greater part of this field must of necessity concern itself with infectious disease. Now the etiologic agents of the majority of infectious diseases are known. ”

“ A new and in many respects a nobler conception of medicine has been developed. Formerly medical practice was almost exclusively a personal service to the sick individual, and measures looking toward the general relief of disease and its prevention received scanty consideration. The idea of a wider service to the city, to the state, to the nation, to humanity rather than the personal service to the individual, is becoming dominant in medicine. ”