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Demography 363
between the individual and the deleterious factor. If such an encounter is
successfully avoided, the disease does not occur, and for a long time health
precautions were conlined to that. The sole aim of public health measures is to
protect the individual from dangers from the outside.13 Progress in vaccina-
tion pursues the same object: vaccination cannot prevent encounters with
deleterious factors, but its tendency is to reduce the effects of such encounters
to a minimum. The disease ceases to be dangerous.
32. If, despite everything, the deleterious factor penetrates into the individual
and the disease obtains a foothold, a return to normal calls for new methods of
intervention. These have been lacking for a long time: the patient was left to
recover his biological balance through his own personal efforts. The situation
has been radically altered by the discoveries of the last few years. We know
now how to cure, and we are getting better and better at it - so much so that we
run the risk of forgetting the importance of preventive measures.
33. Public health measures are generally cumbersome. They set in motion
administrative machinery that is often complicated and are only truly efficient
when applied to the whole population. There is a great temptation, when cures
can be effected easily, to abandon the difficult path of preventive medicine. It
seems that we are now witnessing this tendency. The death-rate is certainly
going down, but the disease-rate remains high.
34. There is thus a danger of creating a serious situation the consequences of
which we are only just beginning to perceive. The reason is that the individual
organism is a ‘memory’ and the person whom we say is ‘cured’ remembers
nevertheless the ravages of the disease in question. We do not yet know if this
‘memory’ will not have unfortunate effects on his future biological behaviour.
35. A similar situation has arisen through the success obtained in combating
the other category of diseases - those due to some deleterious factor the indi-
vidual carries within himself, with this difference, however, that in this case it
seems impossible for the time being at any rate to escape the consequenccs of
our intervention, whereas in the case of diseases due to external causes we can
still hope to be able to master those causes. There exist various methods of
dealing with diseases due to internal causes. In the presence of a functional
defect, there are several ways of trying to re-establish normal conditions. Some-
times a surgical operation is necessary to put the organism into proper working
order again, or at any rate to get it to function differently. At other times, the
faulty functioning of an organ is made good by supplying the organism with the
elements no longer produced by that organ, or again, by ordering a special diet.
But it is quite obvious that in solving a temporary difficulty the way is left open
for further problems later on.
36. This is clearly shown in the case of a hereditary diabetic treated with in-
sulin. An injection or the absorption of a number of pills a day enables the