Læknablaðið - 01.06.1973, Side 37

LÆKNABLAÐIÐ
117
Sir George E. Godber
THE FUTURE OF PREVENTIVE MEDICINE
Læknablaðið birtir nú hinn síðari tveggja
fyrirlestra, sem Sir George E. Godber flutti, er
hann heimsótti Island 1971. Fyrirlestur bessi
var fluttur í Landspítalanum 26.8. 1971.
Ladies and Gentlemen.
Two years ago I had the honour to stand
cn a platform in Boston, Massachusetts,
with Dr. Sigurdur Sigurdsson when wr
both received centennial awards of the
Massachusetts Department of Health. My
pleasure on that occasion was the grealer
in that I was chosen with Dr. Sigurdsson.
You will understand therefore why I re
gard it as an even greater honour that he,
as Director of Public Health of Iceland,
asked me to visit you now. We have been
friends and colleagues, meeting many
times at the World Health Organisation
in the last dozen years, and in that body
no one stands higher in the general regard
than does Dr. Sigurdsson.
The health record of this country is re-
markable high, a circumstance that rnust
be a tribute to its health services, both
curative and preventive. But we are at a
time of rapid change in the capacity of
medical science both to cure and to pre-
vent disease and the changes which must
occur in preventive medicine in the rest
of this century are no less remarkable in
kind than those that we have seen in the
capacity of curative medicine since the
second world war. The needs vary widely
in different countries because the dangers
vary also. There are pathogens and vectors
cf disease which flourish in tropical coun-
tries and are no threat to your country
or to mine. There are environmental poi-
lutants which are of much more concern
to the heavily industrialised countries than
to yours. There are environmental factors
which operate here and do not materiaíly
affect Britain, and yet the nature and con-
tent of preventive medicine in our two
countries do not diverge so widely, íor
the populations as a whole, as to make
the content of our programmes materially
different.
One must first look at the evolution of
preventive medicine before considering
what its future development is likeiy to
be. There were preventive medical aspects
in the crganisation of very early societies.
They are to be found in biblical precepts
about elementary sanitation, in the savage
exclusion of sufferers from leprosy, in the
earliest application of quarantine measures
in Mediterranean maritime trading and in
such measures as a City Ordnance in Aber-
deen over 400 years ago aimed at remov-
ing those women who might be the trans-
mitters of venereal infection outside the
City. The earliest sanitary law in Britain
was concerned with the control of disposal
of human excreta and refuse, even though
the infective agents were not then known.
Essentially preventive medicine of the last
century was concerned with providing a
mcre sanitary environment in urban com-
munities, as a pragmatic means of reduc-
ing the likelihood that human infection
would spread within them.
There had been special smallpox hospit-
als in London at the beginning of the last
century and there remained separate hos-
pitals for communicable disease, establish-
ed with the primary object of isolating the
infected rather than treating the illness,
until after the second world war. We still
maintain a reserve of isolation accom-
modation for smallpox. Safe arrangements
for the disposal of human excreta and
universally available protected water sup-