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accidental coal gas poisoning in the home is now very much his
concern.
What major changes have taken place in a hundred years?
Many of the environmental factors that caused disease and
high death-rates have been overcome, whilst regard to personal
health and hygiene to which attention began to be directed
towards the end of the century, has played a great part in this
also. As some problems are being solved others are appearing.
The tuberculosis death rate commenced to fall in the 1830's —
it has continued ever since. Cancer of the lungs, on the other
hand, is steadily increasing. Immunisation is now available
against many of the infectious diseases-diphtheria, whooping
cough, tuberculosis, typhus, tetanus, etc. and now poliomyelitis,
in addition to smallpox vaccination —the only one
available in Dr. Bristowe's time. But as he complained of the
low vaccination rate so do we. A hundred years ago the
infectious diseases and the effects of malnutrition were major
public health problems, they were associated with poor sanitation,
overcrowding, ignorance and apathy. To-day conditions
due to the stress of modern life are assuming more importance —
coronary disease, peptic ulcer and neurosis: cancer of the lung
is now very much on the increase, and tobacco and atmospheric
pollution are suggested as contributory causes. Vaccination
against smallpox and immunisation against diphtheria have
almost eliminated these deadly diseases, but concern is felt
at the small number of persons now protected. The swiftness
of modern travel from ah road increases the risk of importation
of such diseases as smallpox, and a number of outbreaks have
occurred in this country since the war. Whooping cough is
now responsible for far more deaths than diphtheria (although
only one occurred in Camberwell), food poisoning appears to be
increasing (there are no figures for comparison with 1856 since
the disease has only recently become notifiable), and poliomyelitis
has within the past few years become prevalent all
over the world; much is hoped for from the new vaccine which
is just becoming available in this country.
A new factor has come into being in social medicine —the
increased proportion of elderly people in the community. In the
middle of Queen Victoria's reign the expectation of life was only
40 years, now it is 68 for males and 73 for females. The proper
care and welfare of the aged is nowadays producing problems
which did not exist when Camberwell appointed its first Medical
Officer of Health. In 1856 appendicitis was not known as
such, and successful surgical intervention did not take place
until the end of the century. At that time, however, there
was no mention of the modern and increasingly "popular"
complaint—the intervertebral disc (the slipped disc). Another