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now describe as primary prevention
The early 19th century thus witnessed
perhaps the most successful solution ever
divised by man to one of the most challenging
problems yet to be faced during his existence.
The eventual solution which included the
proper provision of sanitation, refuse disposal
and wholesome water supplies was at that
time a vital and essential form of progress
which in these days is apt to be taken for
granted.
Our present problems are occasioned by an
even more phenomenal technological revolution
and a rapidly increasing world population of
between two and three per cent a year. The
scale of pollution caused by both these factors
with the additional problems of stress and
future under-employment must be tackled by us
in a similar manner to that of our forebears by
primary prevention certainly before the end of
the twentieth century as otherwise the position
will become irreversible
Our duty to future generations is now
recognised at both national and local levels
and we must do everything within our powers
to ensure that there is an effective control of
pollution and of population increase so that the
quality of living is not only maintained but
improved
The importance cannot be over-emphasised
in this context of family planning and contraceptive
advice to married and unmarried women
of 16 years and over and on occasion under 16,
with the consent of the parents. These measures
of primary prevention can reduce unwanted
babies inadequate marriages, abortions and
illegitimate babies particularly in teenagers
In this country in 1969 some 22.000 babies were
born to teenagers and over 10 000 abortions
were carried out in the same age groupmarriages
below twenty years of age have also
proved very unstable. In Hounslow there were
289 illegitimate live births of which the 15-19
age group contributed 195 The illegitimate
infant mortality was 31 which is more than
double that for legitimate live births and
considerably higher than that for England and
Wales as a whole which was 25.
Primary prevention has a vital part to play in
the reduction of venereal disease which is now
reaching epidemic proportions particularly in
those under 20 years of age Adequate knowledge
and sheer common sense can ensure protection
and can be imparted by appropriate health
education. The search for an immunising agent
is continuing
The power of alcohol and drug addiction to
destroy is also amenable to the dictates of
primary prevention and many potential victims
could be prevented from succumbing to temptation
if steps were taken in time.
The primary prevention of food poisoning by
the proper application of the principles of food
hygiene by the prople under the vigilant eye of
the public health inspectorate is a topical
example.
As has been mentioned the primary prevention
of such infectious diseases as poliomyelitis,
diphtheria, tetanus, whooping cough, measles
and German measles by immunisation is still
of vital importance today in this country as is
immunisation against other diseases if one
should proceed abroad.
Fluoridation of the water supplies would
prevent a significant amount of dental disease
with its accompanying ill health and distress
Bronchitis which is a widespread and
distressing disease could in a very significant
proportion of cases be amenable to primary
prevention Reduction in numbers would follow
if particularly cigarette smoking and atmospheric
pollution were controlled. The following table
does show that the latter is responding to the
efforts of local health authorities by comparing
the average figures for pollution in winter in
central London in 1959 and 1969 and the latter
figure with Hounslow in 1969
Central London Smokeg/m3 SO/m3
1958/59 309 340
Central London
1968/69 67 221
Hounslow
1968/69 55 116
This and the following examples show how the
current extension of the principle of primary
prevention from infectious disease to many
other diseases is now becoming more practical
and may reduce the need for curative and after
care services
For instance the reduction in the number of
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