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From public health to preventive medicine FROM PUBLIC HEALTH TO PREVENTIVE MEDICINE
As we have seen, the vast majority of preventive medicine in the nineteenth century was done by way of public health measures, but preventive medicine is really a link between environmental health on the one hand and personal medical care on the other.
True preventive measures probably started with diseases of children. In 1892 Pierre Budin, a Parisian obstetrician, asked women to come back when their babies were 6 months old for a post-natal check-up. He was amazed at the number of children who had already died by this age and started to think about what could be done to prevent this awful toll. Preventive and health-maintenance services for children started in Britain in 1908 and the Boston Lying-in Hospital started an ante-natal programme in 1912.
Once the idea of prevention caught on it spread rapidly, and industrial and occupational medicine quickly became a valued part of the system too. But popular though they were, there was (and still is in the US) a reluctance on the part of preventive services to do anything creative, for fear of treading on the toes of the curative doctors. In the US, for example, community health centres sprang up before World War I but confined themselves to education and prevention and many were in slum areas. They were almost always separate from hospitals. In fact many such clinics had a motto:
No prescriptions given; no sickness treated.
Preventive medicine then became associated with the business of keeping people healthy while 'real' doctors got on with treating the sick. As the years went by it became apparent that public health and preventive medicine had chalked up some remarkable successes and reluctantly the medical profession accepted that prevention had a place. Much of this is still lip-service though, as can be seen from the curriculum of any teaching hospital on either side of the Atlantic. Preventive medicine and its concepts rank so low as to be almost invisible. Over the last twenty years or so doctors have realized that whilst they can do little for many of their patients, detecting disease early can produce truly dramatic results in conditions such as: glaucoma (a person's sight can be saved if the condition is caught early); obesity; depression (suicide deaths can be greatly reduced by treating the depression); hypertension (treatment reduces the incidence of strokes); and so on. The examples are numerous.
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GENERAL HEALTH
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