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70
SECTION III
PREVALENCE OF, AND CONTROL OVER, INFECTIOUS
AND OTHER DISEASES
Truthfully it could be asserted that modern conditions are far
from ideal. Nevertheless, they are greatly in advance of those
prevailing during the middle 1800's when Chadwick established
a connection between material environment and health. What was
remarkable for that era was that, against substantial opposition,
he succeeded in getting this fact officially accepted. At that
time, for very practical reasons, Chadwick was constrained to
concentrate upon the material and physical aspects of the
problem and, perhaps because of this historical association epidemiology,
which by definition is concerned with occurrence and
distribution of all diseases, had acquired a narrower concept
linking it, fortuitously, with infectious disease. But if the conquest
of disease generally is to be achieved, then our cumulative knowledge,
not only of its epidemiology but also its aetiology, must be
expanded and expertly applied to its most important function,
namely, that of prevention.
Progress in preventive medicine is usually measurable or
discernible only over extended periods and is probably expressed
in language not readily understood by the public at large. However,
even in these terms, success there has been in abundance
and this has been traced in previous Reports not only by the
general decline in morbidity and mortality rates but also by the
increase in the expectation of life at birth which has almost
doubled during the last 150 years.
Although principles substantiated by Chadwick are still tenable,
health is seen today as the result of the interplay of physical,
mental and social circumstances. Hitherto, since being obliged to
appoint Medical Officers of Health before the close of the last
century, local health authorities have been concerned primarily
with preventive medicine encompassing as it does environmental
health in all its aspects as well as the care of the mother and
her child, school and mental health and, indeed, the welfare of
society in general. As a result of their sustained efforts over the
years they have seen the gradual shift of emphasis from acute
infections to the more progressive and degenerative diseases but,
fundamentally, there has always been a strong belief that only
in the unification of general practice, hospital services and public