2.2  “Hygeia” and improved living conditions
Asklepios, the god of healing in ancient Greece, had two daughters, Hygeia and Panacea.  According to Dubos (1959), Hygeia was the guardian of health, she symbolised the belief the men could remain well if they approached their lives according to common sense. On the other hand, Panacea achieved fame not by teaching wisdom, but by interventions, mastering the knowledge of the curative virtues of plants and surgery.

 As medicine has developed through history, this division in approach has been preserved with dominance afforded to intervention rather than well-being.  The ‘myths’ of Hygeia and Panacea symbolise the never ending oscillation between  two different points of view (MacDonald, 1999).

Health is a natural phenomenon, the body is in a constant dynamic flux between health and disease. The body’s ability to adapt to chemical emotional and physical stress enable it to maintain a state of health.  Dubos (1959) argued that all the accomplishments of science and technology would not bring about the “health promoters” dream of universal well-being, because science and technology ignore the dynamic process of adaptation to a constantly changing environment that every living organism must face.

McKeown and Lowe (1974) illustrate the dramatic decline in the death rate from tuberculosis in New York from its high in 1812  of  700 deaths per 10,000 which was reduced to 48 deaths by the time antibiotics became routine treatment
 . Ninety per cent. of the total decline of the combined death rate from diphtheria, whooping cough, measles and scarlet fever had occurred before the introduction of antibiotics and widespread immunisation (no vaccine was ever developed for scarlet fever). The most important factors contributing to the decline were better housing and higher host resistance due to better nutrition (Szreter, 1995, cited by Dew, 1999).

Joseph Baselgett planned and developed the sewerage systems of Manchester and London in the late 19th century, virtually eliminating typhoid from the capital. MacDonald (1998) argues that Baselgett saved more lives and contributed more to general health and well-being than the whole “army of microbe hunters of the day.”

Ivan Illich (1976) argued in his controversial treatise that the medical establishment was a threat to health and began his attack upon the “mythic prestige” of the medical establishment by claiming that:
 “During the last century doctors have affected epidemics no more profoundly than did priests in earlier times. Epidemics came and went, imprecated by both touched by neither”.

Present day health promoters  argue that the introduction of immunisation resulted in a further and more rapid decline in disease incidence and deaths than would have occurred through public health measures alone (Bedford and Elliman 1998).The introduction of the Hib vaccine in the UK in 1992 reduced Hib meningitis by 80 per cent. in one year when there was no noticeable improvement in living conditions.

When reporting measles, the media and medical journals now describe it as a killer disease.  However, during the worst recorded measles epidemics in 1959, 41,000 cases were recorded in England and Wales in the first three weeks of the year and the editorial of the BMJ stated “Measles is the commonest disease in the world, nowadays normally a mild infection, complications are rare” (Clegg, 1959).

Before routine immunisation began in 1968, 90-95 per cent. of the population had had measles by the age of ten. For most well-nourished, healthy children living in developed countries measles is an unpleasant, but not life-threatening, illness. However Bedford and Elliman (1998) point out that measles can lead to severe complications in children who may have underlying illness  compromising their immune system or malnourished children  in the developing world. A major aim of immunisation is to protect these children.

Bedford and Elliman (2000), who present the NHS view on immunisation, state that it is only because people have no experience of dealing with the disease that they have become complacent regarding immunisation, particularly about the MMR vaccine.