Nothing but my thirty-three.
Did time permit, the claims of preventive medicine might be illustrated in the facts as to the almost complete annihilation of typhus fever in this country and in Great Britain, under the influence of hospital segregation of each case, of supervision of contacts, and of increased national cleanliness; in the rapid reduction of enteric fever brought about by pure water and milk supplies, the avoidance of sewage-contaminated shell-fish, the control of carriers among food handlers, and the hospital immobilization of cases; and in the almost complete abolition of smallpox, secured by prompt recognition, notification and isolation of each case, the searching out and vaccination of all contacts, and their continued surveillance. The list of medical triumphs, especially in tropical diseases, might easily be extended. I do not fail to remember that respiratory infections have hitherto proved refractory to preventive measures; and that common catarrh, pneumonia, and still more influenza—as also cerebro-spinal fever and poliomyelitis—constitute territories on which the flag of public health has not yet been firmly placed. Tuberculosis must not be thought of in the same category. It is a controllable disease, so soon as physicians, public health authorities and the patients themselves will combine on an adequate scale to adopt measures already within reach. These measures will be less costly than the present position of partial inertia; health is always less costly than disease, and, as Dr. Herman Biggs has often reminded us, can be purchased within natural limits, to the extent which we really desire. This is preëminently true for tuberculosis.
Medical triumphs have not been restricted to preventive medicine. Time would fail me to speak of the introduction of general anaesthetics by Morton and Simpson, which has rendered possible the reaping of the full harvest of the work of Pasteur and Lister. Conversely modern surgery has itself abolished more pain than anaesthetics themselves.
The chief triumphs of modern curative medicine and surgery have been rendered practicable by the more accurate study of disease and the more skilled attention for the masses of the population obtainable in hospitals. The steady advance in the provision of skilled nursing has kept pace with medical advance.
Increasing Importance of Hospitals
From a return prepared by the Local Government Board in 1915 it appears that the number of hospital beds in England and Wales (not including lunatic asylums, tuberculosis institutions, or convalescent or nursing homes) was 4.9 per 1,000 of the population. In the United States, according to the Modern Hospital Year Book for 1919, the number of hospital beds amounts to 6 per 1,000 of the population, or 3.4 per 1,000, excluding beds for mental and nervous cases. It is not certain that the two sets of figures are comparable; but in both instances the distribution of hospital provision is very unequal, and large tracts of each country are left unprovided with available hospital accommodation.
Hospital services have grown in a manner which is characteristic of the Anglo-Saxon: first largely under voluntary management, and as examples of Christian charity; afterwards continued in the same way, but followed by official provision of hospitals on an even larger scale, the two systems working side by side. The extent to which the more satisfactory institutional treatment is replacing the domiciliary treatment of disease may be gathered from the striking facts that in England and Wales one in every nine of the deaths from all causes in 1881 occurred in public institutions, and in 1910, one in every five; while in London the proportion increased from one in five in 1881 to two in five in 1910.
The facts as to pulmonary tuberculosis are even more significant. In the year 1911 in England and Wales 34 per cent. of male and 22 per cent. of female and in London 59 per cent. of male and 48 per cent. of female deaths from pulmonary tuberculosis occurred in public institutions. As each of the patients, who thus had the solace of good nursing and treatment when they were needed most, spent on an average several months in hospitals, at the most infectious stage of their illness, an important annual reduction in the possibility of massive infection of relatives and others has also been secured.
Hospitals as a Partial Solution of Housing Difficulties
We may fairly claim that general and special hospitals have been important agents, not only in reducing the fatality of disease, and in restoring to efficiency more rapidly than in the past a large proportion of the total population; but also in reducing the incidence of tuberculosis, of syphilis, and of other diseases.