Læknablaðið - 01.06.1973, Síða 50

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LÆKNABLAÐIÐ
almost uniformly fortified to a level of
400 i.u. per litre and has been for 20
years, but no one knows whether it has
done any good and no chemical test helps.
There is much activity in this area of
medicine but too little knowledge. The
method could be discredited by indis-
criminate use or for lack of challenge it
could go on, absorbing more and more
professional time of which there is too
little available. There are few areas of
medicine more urgently reauiring clari-
fication.
Tertiary prevention is essentially the
exercise of limiting disability by timely
and effective treatment and complete re-
habilitation. It is obvious that time lost
before treatment is given is a loss to the
patient and if he suffers a long period of
disability, it is a loss to societv also. But
the prompt completion of treatment and
rehabilitation is eaually important. If one
takes as an example acute myocardial in-
farction, prompt treatment can prevent in
some cases an immediately fatal outcome.
The method of subseauent care can deter-
mine whether the patient, if he survives,
becomes a chronic invalid or is restored
to a fairly high level of activity. The prac-
tice of prolonged immobilisation has been
giving way to early rising and active re-
habilitation. The same is true of cerebro-
vascular accidents. Very earlv rehabilita-
tion greatly reduces the risk and extent
of permanent incapacity. The point was
demonstrated much earlier in rehabilita-
tion after physical injury. In Britain dur-
ing the second world war methods of re-
habilitation of air crew after injury were
greatly improved as a means not only of
securing a greater recovery of function
but also of shortening the period of dis-
ability. The same had been demonstrated
in physically injured miners even earlier.
In psychiatric illness prompt and early
treatment, the use of appropriate drugs
and return to a normal or near normal
life situation at the earliest possible mo-
ment has led to a substantial reduction in
the number of beds for the mentally ill
used at any one time in Britain. In 1954
3.4 beds per 1,000 of the population were
used for the mentally ill, in 1971 that
number is unlikely to exceed 2.4 although
there are many more old people in the
population. The number of deaths in men-
tal hospitals was 10,000 a year; it is now
1,000. In mental subnormalitv, training
centres have been shown to bring about
great improvement in those with the less
degrees of handicap and even the most
severely handicapped have benefited and
become much easier to manage in the in-
stitutions in which they may still have to
stay.
I have been traversing verv auickly a
wide field of medicine, emphasising points
about preventive medicine that are not
matters for the specialist in preventive
medicine alone. That is surely the key
to the future development of prevent.ive
medicine. It is not so much a specialism
practised only by those specially trained
in it, as an aspect of most forms of medical
care which needs better organisation than
it has been given in the past. The future
of preventive medicine lies in the expert
in this specialty working with both the
hospital specialists and the general prac-
titioners in the community. Most of medi-
cal teaching is directed toward the treat-
ment of the sick, of the episode of illness
or injury. What prevention must do in
future is to prevent that illness or injury
from occurring if it is possible, and if it is
not, to bring the patient to treatment at
the earliest possible time and to shorten
the period of disability as far as that may
be. In these last two aspects it is bv secur-
ing the collaboration of clinical colleagues
that the expert in preventive medicine
must work. I do not believe that any
specialty in medicine can be independent
of the others. The subdivision of medicine
into specialties in fact has made those
specialties more interdependent than were
the d'-.ctors of an earlier generation. The
specialist in preventive medicine has his
greatest part to play in supporting and in-
forming his clinical colleaeues.
But preventive medicine will not be
fully develooed bv doctors alone. It re-
quires an informed public and that wiil
only be achieved by Health Education. We
have signally failed to convince the public
of the dangers of cigarette smoking or the