Now! Then! Clifford Allbutt, late of Leeds, tells a Bradford sanitary congress to reject the view that (preventive) medicine is antagonistic to the survival of the fittest

9 July 1903: Clifford Allbutt, late of Leeds, tells a Bradford sanitary congress to reject the view that (preventive) medicine is antagonistic to the survival of the fittest

Norman Walker and Harold Stiles, Ed. 1903. President Clifford Allbutt and the Darwinian Theory. The Scottish Medical and Surgical Journal, Vol. 13 (July-December). Edinburgh. Get it:

Excerpt

Elimination of the unfit by disease was too rough a method of compassing the survival of the fittest, even if the most vigorous of body were regarded as the salt of society. The profits were remote and precarious; the cost instant, enormous, and inevitable. They would do better to banish incidental disease, and to keep and develop the strong and the weak together for other conflicts. Disease did not kill; only too often it maimed and enfeebled; so that in a substantial, perhaps in a very large proportion of cases it subtracted the patients whom it might ultimately spare from the sum of the vigorous and added them to the sum of the relatively inefficient. Instead of withdrawing himself into the contemplation of disease as a means of suppressing the feeble and the maimed, the physician must endeavour to gain the countenance of the Darwinian by making it appear more and more approximately true that if the physician could but carry prevention far enough back – back to youth, back to childhood, back to infancy, back to the womb, nay, farther and farther back to the parent and grandparent, even to the third and fourth generation, whose physiological and other sins had visited their children – the margin for essential frailty of pedigree might merge into extinction. When Sir Frederick Maurice and other philanthropists warned them that the people were degenerating, should they submit to be told that medicine must bear some part of the blame? Should not the physician proclaim again to the deaf that it was not only infectious fevers and the poisons of tubercle, of rheumatism, of syphilis, of alcohol, which often blighted when they did not kill, but also the more insidious, and therefore more pervading and more perpetual degradation of bad air, bad houses, and other bad or defective conditions of life which perverted the lines of natural development and took the bloom off the fruitage of successive generations? To proclaim that by preventive medicine they could improve all bad stocks up to the present mean value, and fertilise the good ones to be fruitful infinitely above the mean, was more than he dared suggest, but he did declare that public health would do it better and more permanently than public disease could do it.

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To facilitate reading, the spelling and punctuation of elderly excerpts have generally been modernised, and distracting excision scars concealed. My selections, translations, and editions are copyright.

Abbreviations

Comment

Date in Rolleston, who has a similar find later:

On Thursday, October 16, [1919] he preached before an audience containing many medical men a sermon for St. Luke’s day in Leeds Parish Church from the text, “Were those upon whom the tower in Siloam fell, sinners above all men that dwelt in Jerusalem?” (St. Luke xiii. 2, 3, and 4), and insisted on the importance of preventive medicine, pointing out that epidemics of disease are not manifestations of an offended deity but the consequence of the nation’s want of wisdom (Rolleston 1929).

I haven’t seen Frederick Maurice’s famous “Where to Get Men,” published in the Contemporary Review in 1902, but here is his apparently similar “National Health” (Maurice 1913).

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Original

President Clifford Allbutt and the Darwinian Theory
At the Sanitary Congress recently held in Bradford, Professor Clifford Allbutt, President of the Section of Sanitary Science and Preventive Medicine, devoted his opening address to a defence of the medical profession against the charge that its work results in the survival of the unfit, and the consequent propagation of bad stock. Such a reproach, he said, had been made against the profession from the time of the Greeks. That in particular cases the medical craft perpetuated invalid lives, and gave occasion to the increase of unsound generations, was unquestionably true, as it was true that law might favour injustice, and religion engender hypocrisy; but disease had had a pretty free hand until our time, and yet in the biographies of famous men of the seventeenth and eighteenth centuries we perceive not only that the standard of old age was much lower than at the present day, but that mortality among young persons would seem to have been enormous.

Elimination of the unfit by disease was too rough a method of compassing the survival of the fittest, even if the most vigorous of body were regarded as the salt of society. The profits were remote and precarious; the cost instant, enormous, and inevitable. They would do better to banish incidental disease, and to keep and develop the strong and the weak together for other conflicts. Disease did not kill; only too often it maimed and enfeebled; so that in a substantial, perhaps in a very large proportion of cases it subtracted the patients whom it might ultimately spare from the sum of the vigorous and added them to the sum of the relatively inefficient. Instead of withdrawing himself into the contemplation of disease as a means of suppressing the feeble and the maimed, the physician must endeavour to gain the countenance of the Darwinian by making it appear more and more approximately true that if the physician could but carry prevention far enough back — back to youth, back to childhood, back to infancy, back to the womb, nay, farther and farther back to the parent and grandparent, even to the third and fourth generation, whose physiological and other sins had visited their children — the margin for essential frailty of pedigree might merge into extinction. When Sir Frederick Maurice and other philanthropists warned them that the people were degenerating, should they submit to be told that medicine must bear some part of the blame? Should not the physician proclaim again to the deaf that it was not only infectious fevers and the poisons of tubercle, of rheumatism, of syphilis, of alcohol, which often blighted when they did not kill, but also the more insidious, and therefore more pervading and more perpetual degradation of bad air, bad houses, and other bad or defective conditions of life which perverted the lines of natural development and took the bloom off the fruitage of successive generations? To proclaim that by preventive medicine they could improve all bad stocks up to the present mean value, and fertilise the good ones to be fruitful infinitely above the mean, was more than he dared suggest, but he did declare that public health would do it better and more permanently than public disease could do it.

549 words.