An Address delivered at the Opening of the Section of Public Medicine
BMJ (Clinical Research Edition)
DEVOLUTION AND EVOLUTION. As requested by the Association, I abstain from inflicting on you a formal address. Permit me to thank my friends in Dublin at whose suggestion the Council of the Association have nominated me President of this Section. I accept the compliment as paid to the position I hold as head of an important public service by which State Medicine, in the widest sense of that somewhat indefinite term, is carefully studied and practised. The science of public hei,lth is rapidly
... ,lth is rapidly assuming its proper position in the curriculum of medical education ; and although the General Council of Medical Education has not yet, so far as I know, laid down any standard of qualification for registration, the fact that diplomas in sanitary science, public health, State medicine, etc., must sooner or later be recognised as one of the necessary qualifications of medical men is sufficiently obvious. The present and the future of State Medicine have been so recently and so ably discussed by our esteemed Secretary in an address to the Academy of Medicine in Ireland, that I need say but little on that subject. I concur fully with Dr. Moore in thinking it very desirable not only that we should have uniformity of title in the registrable qualifications under this head, but that the curriculum of study and the scope of the examinations intended to test the standard of knowledge required should be carefully laid down. Of the subjects usually embraced in the term public medicine there are three-law, engineering, and medical jurisprudence, which are so mixed up with other branches of human knowledge that they may be left to specialists as highly important and interesting, blut as hardly within the requirements of the ordinary medical man. What we, as the constituted health guardians of the public, require, is a fair knowledge of those conditions which favour the full development of the human race, and keep it in health and vigour for the longest possible period, and an equally clear perception of those hostile influences which act injuriously on health, and thus tend to shorten life. The most important elements of such knowledge group themselves round the etiology of disease which lies at the very door of sanitary science. Without a clear comprehension of the factors that produce disease in the individual, attempts at prevention must be, what a great deal of our so-called preventive medicine is, merely guesswork. But the etiology of disease in man has always formed an important part of medical education, why then put it forward as a speciality? Our knowledge of deviations from the health-standard in man falls far short of what is really required. A careful investigation of all the conditions under which life is presented to us, including the whole range of so-called comparative physiology, is essential. When we approach the investigation of those deviations from health which eventually destroy life, our education as medical men is narrowed down to human pathology. Now the various orders of animated nature are so interdependent in regard to the causation and spread of disease, that it appears unwise to limit our pathological investigation to any one family or class. The diseases of men are not infrequently traceable to the lower animals, and through them, or even without them, to the vegetable kingdom. Our knowledge of pathology should therefore harmonise with that of physiology. Recent investigations into the origin and spread of scarlatina sufficiently illustrate this point. Careful study of comparative pathology as well as of comparative physiology is therefore a necessity for all who desire to master the very rudiments of public medicine. Again, the now familiar doctrine of evolution has thrown so much light on thLe hitherto ill-understood laws of development, that we are prone to forget the process of devolution or degradation which should have a greater attraction for students of public health than it has. It is by no means unusual in these latter days to hear the champions of sanitary science boast, and justly boast, of the perceptible prolongation of life which has been secured to the race through the beneficial effects of improved sanitary arrangements. This has bi en made suffaiiently clear by tihe numerous ?b1e popular addresses de-11389) livered by the members of public health organisations in the great centres of population throughout these kingdoms during the last ten years; to this must also be added the valuable oral and practical instruction given in the Parkes MIuseum, Margaret Street, London, an institution of great value, but one that is too little known, and is, in consequence, permitted to languish for want of that support from the public to which it is so justly entitled. But while admitting all the good thus done, there is evidence of perceptible deterioration or degradation of type in the lower orders of the people, and it is to this point that I desire to draw your special attention during the few mlnutes still remaining to me. I have here an analysis of the results of 32,324 examinations of men made by army surgeons from 1860 to 1864 inclusive, from which it appears that during these years, in which the number of men required for the army averaged 6,465, and permitted, therefore, a stricter investigation of physical fitness both by recruiters and surgeons, the rejections from all causes were only 371.67 per 1,000 ; while out of 132,563 men examined between 1882-1886 inclusive, the rejections were 415.58 per 1,000. A careful examination of these tables leads to the inference that the lower classes, from whom the recruits for the army are chiefly taken, are of an inferior physique now to what they were twenty-five years ago. 1860-64.