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5
five giants on the road to reconstruction, one of the others being disease :
logically, therefore, one of the three assumptions in the report is a comprehensive
health and rehabilitation service for prevention and cure of
disease and restoration to capacity for work to be available to all members
of the community. Earlier in the year it had been announced that it
was proposed to establish at Oxford an Institute of Social Medicine, with
the object of investigating the influence of social, genetic, environmental,
and domestic factors on the incidence of human disease and disability ;
and to seek and promote measures other than those usually employed in
the practice of remedial medicine for the protection of the individual
and of the community against such forces as interfere with the full
development and maintenance of man's mental and physical capacity.
In this country specific diseases are declining. For this fall the activities
of those administering the health services might be held partly responsible.
There continues to remain, and, it may be that there is even a
growth in the non-specific invalidism or state of sub-normal health,
suggesting that there is something wrong in the social structure in which
we live—something independent of such factors as nutrition and housing,
and other external physical environment. Some diseases have declined
in incidence not as a result of measures directed at them specifically, but
because of improved sanitation in general. The attention paid to the
purification of our water supplies has undoubtedly contributed to the
fall in the incidence of typhoid fever, but purity of water is an ideal to
be achieved independently of the repercussions on the prevalence of
typhoid fever. Tuberculosis incidence was falling. Part of this fall
undoubtedly was due to the influence of the anti-tuberculosis measures,
but just as undoubtedly some fall would have occurred without these
activities. That this is so offers more hope for the future than if the
converse had been the position. Immunization against diphtheria
achieves no benefit except the protection against that disease ; vaccination
in childhood protects only against smallpox. It is possible, of course,
that in the case of the infective diseases some direct protective measures
of that nature will always need to be taken until the particular organism
has reached that stage in its development when it achieves its purpose of
adaptation to living in association with humans, in which case infection
would not be followed by a violent reaction, toxin production and disease
or death. In the aetiology of the infections though, important as may
be the question of the virulence of the invading organism, the state
of the immunity or resistance of the body to infection or to the influence
of the toxin is also of first importance. This immunity is not always
at the same level, and-it is often something more than the specific resistance
to any organism or group of organisms. Whether a child succumbs
to a dosage of infection depends on some factor other than the virulence
of the bacillus or the anti-toxic content of the blood. This non-specific
resistance to the development of communicable diseases, a factor perhaps
common to all and one that may not need to be specifically stimulated
for each of a number of infections, may be related to or associated with
that which resists the onset or possibly overcomes the development
of the non-communicable ailments. During this war millions are being
spent on pegging the cost of living, to ensure that financial difficulties