It is the fashion in some quarters to
give excessive blame to what is called State
interference in medicine. But the day is long
past when the State could afford to remain
indifferent to the health of the people, and its
influence in the growth of preventive medicine must
be considered an essential and an increasing one.
There is a medicine of the schools and
laboratories and side by side with it, eagerly
awaiting and absorbing its conclusions, the system
of administrative practice conducted through Local
Authorities. More and more, recondite matters of
technique come under the review of laymen. What
the mind of his patient is to the physician in practice,
so the judgement of a Committee stands to his
colleague in the Health Service. Beliefs and
scientific data must insensibly be moulded by the
reaction which they cause and to which they pay an
At the root of all economic history in the
Nineteenth Century was the laissez faire idea. It
abolished the rigidity of former times and was the
responsive mechanism through which an enormous
expansion of power and wealth was made possible.
But new avenues of commerce brought problems and
abuses, and the social history of Queen Victoria's
reign is largely a description of how gradually, in
one way and another, individual freedom was limited.
Medicine shares in this tendency; the first
part of the history of Public Health reveals an
attempt to control individual cases of disease in the
interest of the community. Parliament yielded with
reluctance to the demands of health reformers and,
as is always the case in Britain, effective action
came more through public opinion than from Statutes.
It has been well said that next to philanthropy the
principal factor in early public health history has
But the dawn of true preventive medicine began
to break. In reality nothing is further from its
aims than mere police methods. Instead of waiting for
sickness and then applying semi-punitive powers (in
practice largely ineffective) it tries to make perfect
health the norm for each person in the country.
Tuberculosis was the first great disease to be
faced communally in this country. The campaign
against it has proved the widest and most successful
of all our social improvements. It has fertilised
many fields and to this must be ascribed a great deal
of the healthy reaction which has come over the habits
of society in the last two generations.
Chadwicks splendid failure and the final
repeal of the laws against Contagious Disease skew how
much the people of this country dislike coercion of
any kind, even for their own benefit. It should
be observed of all reformers, if they would but
read the history of the past, that no great abiding
change can take place in less than a generation
and to be truly effective, it must have a balance
At the beginning of the present century,
a `Mar disturbed national complacency by shewing
that the physique of the average man was very far
from perfection. The birth rate, too, was falling.
Labour was going to be a more important factor in
industry. It had become necessary to make the
most of each unit in the social machine. This
stimulated the interest in the processes of birth
The gradual attenuation and virtual repeal
of the compulsory vaccination clauses between 1898
and 1907 reveal plainly that official medicine
despite the abundance of proofs to its hand, had
made little attempt at propaganda.
But when preventive medicine reaches adult
life dangers set in from the opposite quarter.
Hasty legislation is framed by men ignorant of the
course of disease and of the history of medicine.
The National Health Insurance Act will always be a
monument to such unwise zeal.
We may presume that in future such departures
from the main current will become more rare. The
Machinery of health is now in existence and needs
only to be elaborated in order to meet every need.
Probably medicine will have more to fear from
irrationalism and what may be termed scientific
quackery. As therapeutic methods become more
complex, opportunities for organised obscurantism
will grow larger. Quasi religious and pseudo
psychological systems of medicine may become
powerful enough to embarrass legitimate practice just
as antivivisection has hindered research. The
danger which hung over medical education in the
seventies when theorists would have uprooted a
living ideal of medical education and substituted some
impersonal machine, is full of admonitions.
For these insecurities there is only one remedy.
The medical profession must insist upon the supreme
validity of its claim to practise the Healing Art..
It must embrace every new department of knowledge
which may illuminate the working of the human
The theme of this essay has been to describe
the morphology of our superb fabric of Preventive
Medicine. After one hundred gears of experiment
and evolution, it has at length won independence.
Its perils now, are those of maturity.
Science will continue to enlarge our
comprehension of the complexity of mants nature
and the function of State Medicine in the future
will be to secure that these achievements are
used not for any transient or sectional interest,
but towards the betterment of human society.