10. Medical schemes on the above general lines can only be completely satisfactory to the extent to which every physician taking part in them becomes imbued with an appreciation of the _almost unlimited preventive possibilities opened up by the opportunity to treat disease_, and by the realization likewise that an essential part of his family work should consist in detecting the _beginnings of disease_ and in detecting and securing the removal of domestic, dietetic, housing, industrial or other factors liable to cause disease. If these ideals can be even partially realised, we shall have approached the time when every practising physician will become a hygienist, and when any sickness insurance still demanded or required will be on a scale much lower than is necessary at the present time. In short, compulsory sickness insurance under present conditions is a measure of relief. It has almost as little prevention involved in it, as has insurance against the risk of fire. Relief must be given, by insurance or otherwise. How much preferable, however, it would be to precede it by a far-reaching scheme of effective preventive and curative work, or at the least to place it in a strictly subsidiary position to such a scheme in actual operation! FOOTNOTES: [11] An address given to the Quiz Medical Society, New York, Feb. 14, 1920. [12] _I. e._, any doctor in a given area who is willing to treat patients under the conditions of the Insurance Act. CHAPTER V SOME PROBLEMS OF PREVENTIVE MEDICINE OF THE IMMEDIATE FUTURE[13] The Great War has changed our outlook on social, including medical, problems; and has made all of us consider anxiously in the midst of the terrible wreckage from war, what useful lessons may be garnered for our future guidance. In speaking of losses, I am not referring to financial burdens, though these are fabulously high—the bare statement that the British national debt has increased from 645 to near 8,000 millions sterling, brings this home—and we shall, most of us, go relatively poor for the rest of our lives and our children likewise. Nothing but the most effective and scientific use of our energies on the part of workers of every class can save us from protracted poverty. I am thinking rather, however, of the losses of life and limb, of hearing and eyesight, and of reason, which have been experienced—one or other—in nearly every other family in the British Empire, and which show once more the wantonness of war: how cheaply life is held by it, how careless it is of the individual; and how disregardful it is of human promise and performance. The destruction of over 700,000 lives of sharers in our common Empire, killed in battle or dead from wounds, represents an imperial loss, a terrible destruction of the real capital of the Empire—its manhood—and of the flower of that manhood; and generations will come and go before the Empire recovers completely.