PREVENTIVE MEDICINE

efforts directed toward the prevention of disease, either in the community as a whole-an important part of what is broadly termed public health-or in the individual. Hippocrates, the Greek physician of the 5th century BC, classified causes of disease into those concerned with seasons, climates, and external conditions, and those more personal causes such as irregular food, exercise, and habits of the individual. Through the Middle Ages the principles of preventive medicine were ignored, in spite of the scourges of leprosy and plague. With the Renaissance came the new learning that revolutionized the whole content of medicine. Practitioners again observed the relation of the seasons, environmental conditions, and personal contact to the incidence of disease. Concurrent with the growth of medical knowledge there was an empirical movement of practical prevention. For example, in 1388 there was passed the first sanitary act in England, directed to the removal of nuisances; in 1443 came the first plague order recommending quarantine and cleansing; and in 1518 the first rough attempts at notification of epidemic disease and isolation of the patient were made. The study of mortality statistics was initiated in England in the 17th century. The basis of epidemiology was laid in the mid-17th century. In 1700 a treatise on occupational disorders was published in Italy. An English practitioner in the first half of the 18th century wrote on poisons, on plague and methods of its prevention, and on smallpox, measles, and scurvy. Vaccination was introduced in 1798. The early and middle years of the 19th century were notable for discoveries in the transmission of contagious diseases such as typhus, cholera, typhoid fever, and childbed (puerperal) fever. In the same period increasing attention was given to problems of hygiene and nutrition. The modern era in preventive medicine opened in the mid-19th century with Louis Pasteur's discovery of the role of living microbes as the cause of infections. Toward the close of the century the principle of insect-borne transmission of disease was established. Serological tests were developed, such as the Widal reaction for typhoid fever (1896) and the Wassermann test for syphilis (1906). An understanding of the principles of immunity led to the development of active immunization to specific diseases. Parallel advances in treatment opened other doors for prevention-in diphtheria by antitoxin and in syphilis by arsphenamine. In 1932 the sulfonamide drugs and later the antibiotics including penicillin, streptomycin, chlortetracycline, and chloramphenicol afforded new opportunities of prevention and cure of bacterial diseases. After 1900 there were many advances in preventive medicine other than those related to infectious diseases. The use of X rays and radioactive substances in the diagnosis and treatment of disease (e.g., tuberculosis and cancer) as well as in fundamental physiological research opened new possibilities. A greater understanding of endocrine functions, with the production of prepared hormone extracts such as insulin, led to preventive measures in certain metabolic diseases. The role of nutrition in health and disease and the isolation of many essential food factors illustrated the importance to health of adequate diet. Other 20th-century advances in preventive medicine included a wider recognition of psychological factors in relation to total health, new surgical techniques, new methods of anesthesia, and genetics research.