MAJOR PREVENTIVE MEDECINE ACHIEVEMENTS

Posted on April 23rd, 2009, by admin

Cholera

Edward Chadwick, a barrister, pioneered the concern with water, drainage and sewage disposal, but it should not be thought that the battle was won without a fight. Years of opposition and debate were centred around the vast sums of money involved in the engineering needed. Such measures were also seen by some as infringing the liberty of the individual and when all is said and done the value of the whole exercise was unproven at the time. The result of these measures, though, was to eliminate cholera-a disease that killed tens of thousands every year in great epidemics.

Enteric fever

This was another major killer of the nineteenth century that was almost totally controlled by improved sanitation, although it wasn’t realized that this would be the case at the time. Things improved further as measures to ensure the safety of milk, shellfish, ice-cream and other foods were brought in. Enteric fever is relatively rare today in the UK (200-250 cases a year in England and Wales) and in three-quarters of the cases the infection is acquired abroad. Today’s regulations for food handlers and food preparation are safeguards against outbreaks of this killer disease.

Diphtheria

This, together with measles and whooping cough, was one of the frequently fatal diseases of childhood. It has been virtually wiped out and is so rare that most doctors wouldn’t recognize it if they saw it. Yet only 35 years ago it was a killer that terrified every parent. Between 1916 and 1925 there were well over 50,000 cases every year and more than 4,000 children died annually. After 1940 and the introduction of active immunization the death rate from diphtheria fell dramatically. This vaccine is now given to children routinely as part of their ‘triple vaccine’ (diphtheria, tetanus, whooping cough) with a booster on entry to school. Today there are almost no deaths from diphtheria in Britain.

Measles and whooping cough

More than 90 per cent of all cases of these diseases are in children below the age of 10. The main danger is that if they go on to pneumonia the child can die. Measles vaccine has been available since 1968 but it has not penetrated public awareness in Britain as it has in the US where the disease is now uncommon. As a result there are more than 250,000 cases of measles reported each year in the UK and doubtless many more go unreported.

Death rates from both these conditions were beginning to fall even before effective vaccines and anti-bio-tics (to prevent the complications) were available. Either the organisms were becoming less virulent or perhaps children were more resistant to infection because of better housing, nutrition and smaller family size.

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