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68
Unfortunately, to the middle-aged man the cigar, an even bigger
car and a surfeit of rich food and drink are the very outward and
visible signs of his success and herein lies the nub of the problem.
How does one change a pattern of behaviour, determined over many
years by an exacting but conforming business environment, which
by general acclaim is the right of the successful individual to
pursue?
Ideally what is needed for prevention is a restoration of the
ecological balance of society with a much more sensible adaptation
of man to his environment. Regrettably, it must be admitted that
this is a most unlikely development for factors which will contribute
to future cardiovascular disease are already present in the
faulty nutrition and habits of our young people. Suitable systematic
education, dietary control, elimination of cigarette smoking
and encouragement of regular exercise are laudable but probably
unattainable aspirations. Rather it would seem that drug control
of cholesterolaemia and high blood pressure, the search for a
"safe" cigarette and ways of identifying "high risk" cardiac groups
are the methods most likely to be adopted.
Clinical medicine and public health are drawing closer together,
a movement which, incidentally, will culminate in their amalgamation
in April, 1974. Where prevention fails, surgical heart
repair, replacement of occluded blood vessels and management of
cardiovascular emergencies will, as normal procedure, be subject
eventually to a community programme covering hospital treatment
and subsequent local authority after care.
As a nation we can ill afford the premature loss of first-class
middle-aged men who have so much to contribute to the life of the
community and who are becoming progressively more prone to this
20th century epidemic.
Mental Illness
Mental Handicap, a condition easier perhaps to define than
mental illness, is capable in many instances of some amelioration
if not cure. Ascertainment of reliable statistics is difficult but
nationally, of those persons known officially as suffering from
mental handicap, viz. 160,000, over 60,000 are in hospitals and
100,000 in local authority care. Of the hospital cases only about
8,000 are under 16 years whereas one half of those in the care
of local authorities are in this age group. Those persons known
to the various authorities as being mentally ill total 190,000, of
which 108,000 are in hospital and 82,000 in local authority care.
Together, persons known to authorities as suffering from mental
disabilities amount to some 350,000 or slightly more than 0.7%