History of combating disease

The field of public health and preventive medicine is not the stuff of popular drama. However, the concept of preventing disease, rather than waiting to treat it, has probably been around ever since the time in the 14th century when port authorities in Sicily tried to prevent the introduction of bubonic plague into their country by quarantining ships, even to the point of burning cargoes.

However, intuitive ideas on preventing disease waited for a scientific basis until the 19th century, when Louis Pasteur demonstrated the bacterial nature of a number of diseases and began to formulate the principle of immunisation by challenging immune systems with dead or attenuated infectious agents.

About the same time, Dr John Snow in London took a decisive practical step in stopping a cholera epidemic by identifying and stopping access to a contaminated public water supply.

Thus, by the beginning of the 20th century, the concept that disease prevention was more cost-effective than investment in curative medicine gained ground to the point that official, and academic, initiatives in preventive and social medicine were logical and essential.

So it was by about 1890 that some attention was given to including instruction in the basics of preventive medicine in the medical curriculums used in the training of medical students in Britain, North America and doubtless elsewhere. It was therefore a logical development in the medical curriculum of the Otago Medical School that students be given some understanding of the principles of disease prevention - where hygienic factors were wanting - and vaccination appropriate within the knowledge of the time.

There was clearly a meeting ground between professionally active people in the public health field and doctors in training so that, to a large degree, doctors moving into active medical practice were themselves bringing the issues of prevention of disease into their day-to-day work as occasion demanded.

Ground-breaking programmes for the control, and hopefully elimination, of hydatid disease and goitre were among the notable initiatives of the leadership of the Dunedin department. Smallpox elimination was naturally a part of an international programme that was finally achieved through vaccination. By the middle of the 20th century, attention was beginning to shift to nutritional issues, to the need for healthy school programmes and, eventually, the elimination of tobacco smoking and curbing of alcohol consumption because of their injurious aspects.

The book deals with the changes in training methods and the awards of special qualifications where candidates would be able to take on leadership roles in the domain of social medicine and public health, both locally and nationally.

As a history of the University of Otago Department of Preventive and Social Medicine, the work is more than just a dry catalogue of achievements, as it lists the departmental leaders through the years and their often hard-fought battles, and usually successes, in making the department a jewel in the crown of the university and the Otago Medical School. The author has provided an account which will remain a valuable source for many years to come.

 
- Edwin Nye is a retired physician.