First Do No Harm

Who Is the Father of Preventive Medicine?

You say preventative and I say preventive. What’s the difference? None. It’s like exploitive and exploitative; in this case, people prefer the latter, exploitative. In the case of preventive v. preventative, people prefer the former, shorter, preventive.

What is Preventive Medicine?

In naturopathy, the two most important facets to our health are: What goes in and what comes out.

Nutrition goes in; waste (and toxins) come out. Today we have to admit that there are enough toxins in our atmosphere (water, food, and air) today to choke that figurative horse. To be truly healthy, they must come out if we’ve taken them in but sadly, they don’t.

You will notice that this “naturopathic scheme” says nothing about exercise and we know from longevity experts (from Weston Price to Dan Buettner), that though diet is hugely significant to our longevity, the human animal must move its body.

Hippocrates is the recognized Father of Medicine, and he too wrote: “eating alone will not keep a man well; he must also take exercise.” [Sport and Exercise Science: Essays in the History of Sports Medicine, by Jack W. Berryman] Hippocrates believed that walking was the best of all exercises.

Galen, another Greek, but born nearly 500 years after Hippocrates in what was now the Roman Empire, was a physician of such renown that his theories influenced medicine for well over a thousand years after his death. Being both a philosopher and physician, he trod the middle ground between the rationalists (philosophical/theoretical medicine) and the empiricists (practitioners of physical medicine).

From the British medical journal, The Lancet, we get the following:

Central to Galen's theory was hygiene (named after the goddess of health Hygieia) and the uses and abuses of Galen's “six things non-natural”. Galen's theory was underpinned by six factors external to the body over which a person had some control: air and environment; food (diet) and drink; sleep and wake; motion (exercise) and rest; retention and evacuation; and passions of the mind (emotions). Galen proposed that these factors should be used in moderation since too much or too little would put the body in imbalance and lead to disease or illness.

You can see in Galen’s theory the modern day naturopathic focus (in and out), movement, hygiene, and rest. Now we are talking real health. And when you talk about real health and not the maintenance of health, then you are talking about preventive medicine.

Today

If you think about it, we Americans are not really the type of people who are into prevention. It is said that the best time to plant a tree is 20 years ago. The next best time to plant one is today.

The best time to start preventing the coming extinction period was in the sixties and seventies. We are told, by some scientists, that we’ve already passed the point of no return; that our extinction is now inevitable. We’re not really into prevention.

Ben Franklin told us an ounce of prevention is worth a pound of cure. Yet, really; where in medical school does one learn about nutrition, exercise, yoga, tai chi, or meditation? In medical school, students learn about disease and which drugs or how much radiation to use on them.

And I’m not all that crazy about the term “Father” of preventive medicine, because what if the Father was actually a woman? The Mother of Preventive Medicine?

Go Ahead and Google

If we Google “Father of Preventive Medicine” we’ll get a good number of answers. We even get this character who says that Moses was the Father of Preventive Medicine. The author’s name is DAWE DG. You’ll find a lot of articles in his name, but mainly on Christianity and theology.

Louis Pasteur’s name pops up quite a bit. His work in the field of immunization would qualify him as the possible FPM (Father of Preventive Medicine). His germ theory of medicine would also keep him in the running, but then, that would also put Ignaz Semmelweis right there with him, since Semmelweis tried to get physicians to wash their hands before the germ theory of medicine was even on the drawing board.

Robert Koch would also be in the running since he took Pasteur’s work still further by constructing his four postulates (criteria) for establishing a “causative” relationship between a microbe (germ) and a disease. Koch is known as the Founder of modern bacteriology. However, there is more to prevention than avoiding germs, don’t you think?

Prior to Koch, we have an English physician by the name of Richard Mead, who many consider the father of epidemiology [a branch of medicine dealing with the incidence, distribution, and possible control of diseases]. In 1720 he wrote a book entitled, A Short Discourse concerning Pestilential Contagion, and the Method to be used to prevent it. In this book he recommended quarantining of patients with communicable diseases. While working for the king, he took on the development of the Foundling Hospital, which instead of being a regular medical hospital, was a home for “abandoned children.” He had the architect design a court in which the children could exercise.

Mead was a colorful fellow and, according to rumors, was something of a womanizer. Lawrence Sterne, an early British novelist who wrote the first stream of consciousness novel, referred to the good doctor as Dr Kunstrokius.

A friend once gave me a book for Christmas that was from around the turn of the century (1900) and written by a physician who talked about a healthy diet and exercise. It was a remarkable book, seemingly, given our propensity to put off caring for our bodies until something goes wrong, in that it was an overall guide to health, even if some of its theories are a bit out of date today. I recently tried to find it to quote from it, but remembered that I’m a “book junkie” and that I'd given it away to someone.

It was at this time (1913) that, one person many refer to as the Father of Preventive Medicine, a Dr Milton Joseph Rosenau, published his book, Preventive Medicine and Hygiene. Rosenau was an epidemiologist who founded the School of Public Health at the University of North Carolina in 1936. The first school of Public Health, by the way, was started at Johns Hopkins in 1916 with a grant from the Rockefeller Foundation.

However, the folks at Harvard would probably take exception to this since it was Rosenau who, while teaching at Harvard Medical School, started up a program (in 1913) that grew into the Harvard School of Public Health. Their website posts this quotation by the good doctor: “We find monuments erected to heroes who have won wars, but we find none commemorating anyone’s preventing a war. The same is true with epidemics.”

Rosenau's greatest contribution to preventive medicine was his work in food safety. As a health official, he worked tirelessly to make sure that America's milk supply was safe.

Rosenau’s book is amazing. You can read it here: Preventive Medicine and Hygiene. It’s got some amazing theories, most of them having died years ago, but is quite thorough. The irony is that while trying to prevent “spreadable” diseases, the doctor himself died of a heart attack, which today we’re pretty sure is preventable.

His book speaks of exercise, but only in passing, and never mentions smoking but spends a lot of time on drinking and moral decline.

Nutrition ― The Food We Eat

Over the years, theories about nutrition have come and gone, changed, grown, shrunk, and have been tossed out. For one thing, nutrition has become an industry. Agra-business has taken over the family farm, and those fine people who brought us Agent Orange are now being given the keys to the car that will drive us over that cliff. Monsanto has enough lobbyists to convince every person in congress that what they are doing is good for the world and that, in the end, they are feeding a hungry nation (or nations).

Since money is involved here, you can expect the “science” of nutrition to be heavily influenced and contain a bushel basketful of conflicts of interest.

Butter was bad for us. Then good for us. Coffee was bad for us. Then good for us. Margarine was good for us. Then bad for us. Fat was bad for us. Then good for us. Then bad for us. The issue of fat was so confusing that people like Mary Eng had to become experts in the area of “lipids” (fats) to explain to us that there are a variety of fats; some good, some bad, and some really, really good, and some really, really bad.

Money talks, and the truth is blind, deaf, and dumb in this society. Where there is money to be made by talking, people will say anything.

We’ve talked about the Food Pyramid at this site, but our government was into food and health long, long before this little piece of art was commissioned.

The USDA (US Dept of Agriculture) was started up right after the beginning of the Civil War, in 1862, under President Lincoln. That year it published its first bulletin, which was all about varieties of grapes, their sugar content, and their suitability for wine. [Timeline of the USDA.]

It was in 1894 when the USDA published its first dietary recommendations. Enough information had been gathered for centuries for physicians to connect certain illnesses to diet. Scurvy, for example, was something that has been around with us since the beginning of time, written about in ancient literature, and finally conquered by Dr James Lind, but still not fully understood in the middle of the 1700s. Physicians simply knew that fresh limes seemed to alleviate it.

Then there were pellagra and beriberi, and food cures for those that came about through trial and error, but still not much understanding. It wouldn’t be until 1910, when a Polish born biochemist by the name of Casimir Funk moved to London and coined the term “vitamine” (meaning “vital amine”), and physicians began to truly get a glimpse into the role of nutrition in health.

The term was shortened to “vitamin,” and though not all of these substances discovered by biochemists would be amines, the term seemed proper in the classifications of those things vital to health that were found in the foods we eat. [The Nobel Prize and the Discovery of Vitamins]

So, as you can see, this first publication by the USDA (the author being Dr Wilbur Olin Atwater) came out before the discovery of vitamins. In 1904, Atwater published another little gem that recommended a “balanced” diet that measured calories, relied on moderation, and focused on nutritionally dense foods while advising against sugar, fat, and starch. ["Dietary Recommendations and How They Have Changed Over Time]

It was right after this publication that biochemistry truly began to blossom, and not only were vitamins discovered, but so too were the benefits of minerals being investigated. One of the first people I’ve ever found to be formally called a “nutritionist” was a woman by the name of Caroline Hunt. In 1916 she published the first food guide, called Food for Young Children, in which she divided food into five groups:

  1. milk/meat
  2. cereals
  3. vegetables/fruits
  4. fats/fatty foods
  5. sugars/sugary foods.

The very next year, the USDA released a booklet using Hunt’s work, but now designed for adults, called How to Select Food.

The five food groups lasted until the depression when the USDA, under guidance from FDR, published a nutritional guide based on four different cost levels. Eating healthy had become a luxury during the depression.

Still reeling from the Great Depression, but with employment now better than pre-depression levels, Roosevelt inspired a National Nutrition Conference in 1941, which resulted in the USDA creating the Recommended Dietary Allowances (RDA’s) for us all to follow. The RDAs were based on specific caloric intake and, as nutritionists today note, were the minimum requirement to avoid “anemia” in any one nutrient. In 1943 the USDA announced the “Basic Seven” guidelines that, besides confusing everyone, were aimed at helping people deal with food shortages caused by the war.

Here are the Basic Seven I found on Wikipedia:

  1. Green and yellow vegetables (some raw; some cooked, frozen or canned)
  2. Oranges, tomatoes, grapefruit (or raw cabbage or salad greens)
  3. Potatoes and other vegetables and fruits (raw, dried, cooked, frozen or canned)
  4. Milk and milk products (fluid, evaporateddried milk, or cheese)
  5. Meat, poultry, fish, or eggs (or dried beanspeasnuts, or peanut butter)
  6. Bread, flour, and cereals (natural whole grain, or enriched or restored)
  7. Butter and fortified margarine (with added Vitamin A)

If you’re old like me, then you grew up with the Basic Four, first published by the USDA in 1956 and kept right up till the early 1990s, when the most expensive commissioned piece of art work (the most expensive in the history of the world) was presented to the public: The Food Pyramid.

But….in between these dates occurred one of the most fascinating political battles in our history, which foreshadowed the battles that would be fought trying to establish the Food Pyramid.

United States Senate Select Committee on Nutrition and Human Needs

Often referred to as the McGovern committee, this was the first time in our history that our government (beyond the minor agencies tasked thusly) got involved in our nutritional needs. The committee started in 1968 and issued its findings in 1977:

  • Increase consumption of “complex carbohydrates” and "naturally occurring sugars;" and
  • Reduce consumption of refined and processed sugars, total fat, saturated fat, cholesterol, and sodium. [2015 Dietary Guidelines Advisory Committee]

As you can see from these recommendations, our government had bought into the utterly unscientific “lipid hypothesis” developed by Ancel Keys in his highly flawed Seven Countries Study.

First the American Heart Association bought into the lipid hypothesis in 1956 when television in America was just taking off. They flooded the airwaves with their recommendations, and by the time McGovern started up his committee, he and his colleagues had bought the hypothesis, lock, stock, and barrel of lard.

It was a simple idea: if you eat fat, you’ll get fat in your arteries, which causes heart disease. It was so simple that people who knew nothing about science could understand it. The trouble is: it was unscientific.

Little did anyone on the committee realize that after they published their recommendations, there would be a bit of a backlash from the food industry, and they’d have to “take them back” before a year had passed, issuing “less healthy” guidelines.

Let me give you a bit of insight into what went on here. First off, the term “complex carbohydrate” was first used in the publication of these guidelines. Great term, still used today. Secondly, the meat industry doesn’t like government servants (Senators) telling people to eat less meat; the dairy industry didn’t like the government telling the people to eat less butter and cheese; the sugar industry didn’t like . . . do you see where I’m going with this?

Even the “complex carbohydrate” industry didn’t like the recommendations, because humans consumed a lot less grains than the dairy and meat industries, and the grain industry makes more of its profits by feeing livestock than they do feeding humans.

Then all these industries formed an alliance with the American Medical Association. The AMA did NOT represent all of medicine. It’s more of a social organization with an agenda. This agenda is, more often than not, interested in keeping its members well off, financially.

And here is where the Twilight Zone episode begins:

In the congressional record for all to see is testimony by all these industries along with testimony by the AMA. As one author put it:

But the harshest attack came from the American Medical Association, which issued a statement that the new diet was “radical” and potentially harmful and that it would cause disruption in the US economy.

The AMA even went so far as to say that there is no proof that diet is related to disease. [I Wallace, D Wallenchinsky, A Wallace, Significa, (New York: EP Dutton, Inc 1983) 233 – 234]

As pointed out above, “Where there is money to be made by talking, people will say anything.” In front of congress, the AMA just gave a little speech that wrapped up thousands of years of nutritional history and tossed it into the garbage bin.

Is there any wonder than nutrition is not really taught in medical school?

So, let us slip ahead to the early 1990s and the release of the Food Pyramid.

We need not really tell you a thing about it because, in trying to publish this "art work," the USDA got the same, exact backlash from the food industry that we just read about above.

Grain growers wanted more meat (and a bigger picture), dairy wanted this, beef wanted that, chicken farmers wanted . . . .

In the end, our government spent over $450 million designing the Food Pyramid, and though many cry out disparagingly: Big Government!!! It was actually “big business” that wasted the taxpayers’ money.

And so much for that damned pyramid, because now we have MyPlate (and all the industries still aren’t happy).

The question of whether our government should even involve itself with our nutrition is a foregone conclusion. If left up to the industries, we’d be serving Nachos and Soda Pop in our school lunch rooms.

We need an “objective” partner to set nutritional guidelines, or the "butter is good butter is bad" argument never ends.

The only problem with our government getting involved is that it is not objective anymore and is influenced by industry more than by science, because (more than ever today) money is speech.

Had our government been influenced by science alone, the “lipid hypothesis” would have been tossed out years ago, and organic farmers would be getting as much in subsidies as agra-business.

But….that will have to wait till the revolution.

So Who Is The Father of Preventive Medicine?

George McGovern? Ancel Keys (for showing us the wrong way so we could find the right way)?

Having read a lot more than I’ve written here on the lives of those we’ve just discussed, I’m going to rule out those who focused mainly on contagious diseases. Next, I’m going to rule out Rosenau. Those familiar with him are jumping up and down now, cursing me. He’s the most likely candidate of all of them and has been called the Father of Preventive Medicine for over a hundred years.

But, except for his healthy/clean milk campaign, he was mainly a theorist and a teacher. He did NOT get down and dirty. He did not get into the trenches. As far as actually practicing preventive medicine goes, he didn’t do as much as Dr James Barry, who cleaned up soldiers’ quarters and made sure their food was nutritious and “untainted.”

I am going to have to go with Galen. He was both a theoretician and a practitioner. His guides to health were all encompassing, from exercise and sleep, to nutrition, to just getting out in the sun, while some of his work even spoke of keeping mentally fit. His theories and practice focused on the whole human being. 

He even went so far as to say that extreme exercise is, in the long run, detrimental.

Only today are we acknowledging that playing football might just be hazardous to our health.

In the mid fifties, my father returned from a medical conference in which they had blown up Mickey Mantle’s x-rays of his knees (for all to see). The orthopedist pointed out that, though in his mid twenties, Mantle had the knees of seventy year old man.

And this is baseball, mind you; a game that is spent mostly on a bench or just standing around.

Yes, I’m going to call Galen the Father of Preventive Medicine, mainly because of his wholistic approach to wellness.

Having made this judgment call, I would be utterly remiss in my duties as a journalist if I didn't pass onto you this next little tidbit.

The following was published in an old, very old, newsletter we put out years ago:

Let me tell you about my favorite doctor (who we will call Dr B)

Dr B went into private practice in 1900, but a year later applied for, and got, the job of medical inspector for the Department of Health in New York City. Dr B focused on the infant mortality rate and disease prevention. Dr B went from house to house with an entourage of nurses, teaching mothers about nutrition, cleanliness, and ventilation. Babies in those days wore cumbersome clothing and died from the oppressive heat and accidental suffocation; so Dr B designed baby clothing that was light and roomy and opened down the front. Dr B established standardized inspections of school children for contagious diseases; insisted that schools needed their own doctors and nurses on staff, set up a system for licensing midwives, invented a simple baby formula mothers could mix up at home, and, basically, set up a health care system that focused on maintaining health rather than on fixing diseases.

Dr B, because of the high rate of infant mortality in orphanages, was the first to theorize that babies who received no cuddling and attention simply died from loneliness. Dr B established the Foster Mother system and the death rates dropped.

When WWI broke out, it put a strain on the American economy and the poor got poorer. Dr B pointed out that it was safer to be in the trenches in France than to be born in New York, as the former (the soldiers) were dying at a rate of 4%, while the babies were dying at a rate of 12%. Because of Dr B's efforts, infant mortality rates in New York dropped lower than any other city in the US and Europe. Even the school lunch program was started up due to Dr B's efforts. By 1923, the year Dr B retired, it is estimated that the good doctor had saved over 82,000 lives.

But Dr B didn't stop there. In retirement Dr B helped establish child hygiene departments in every state in the union; served on 25 medical societies, wrote over 250 articles and five books; served as a consultant to the NY Dept of Health, oversaw the creation of what we now know as the Dept of Health and Human Services; and represented the US on the Health Committee of the League of Nations. Dr B even helped to apprehend Typhoid Mary (twice).

Who is this wonderful doctor? Why haven't you heard of this doctor before? Well, for one reason, our history usually discounts the merits and accomplishments of this type of person. "What type of person?" you ask.

Dr B was Dr Sara Josephine Baker, a womana brilliant woman with few, if any, contemporaries. She was a true healer. And it's about time you all knew of her and her accomplishments.

Dr Sara Josephine Baker is most certainly the Mother of Preventive Medicine, and just as deserving, if not more, than anyone listed previously. She jumped into the trenches, got down and dirty, and she saved lives. There is no one in the history of Preventive Medicine whose accomplishments can compare to hers.

Further Reading

Sara Josephine Baker on Wikipedia

Sara Josephine Baker Biography NIH

Sara Josephine Baker Biography Harvard

Dr. Carl Reich, considered to be "The Father of Preventive Medicine" for his pioneer work with vitamins and minerals in the early 1950s

Dr Milton Joseph Rosenau

Motion and rest: Galen on exercise and health

 


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