HYGIENE

HYGIENE. Before the eighteenth century, physicians and priests were the principal students of health science in Europe and the New World. For centuries, the study of medicine had been divided into theory and practice. Theory included physiology, etiology, and semiotics, whereas practice included hygiene and therapeutics. Traditionally educated physicians understood and employed hygienic practices as well as therapeutic ones.

Priests, often viewing disease as punishment for sin, assumed major roles as health educators during the early Middle Ages, and they dispensed moral advice hand in hand with medical advice. Accordingly it was a clergyman, Thomas Thatcher, a pastor at Weymouth, Massachusetts, who prepared the first medical tract in the North American colonies during the third quarter of the seventeenth century.

In the eighteenth century, as superstition declined and social roles were secularized, teachers and government authorities assumed responsibilities as health educators. Simon-André Tissot, a Swiss physician, wrote his Advice to the People in General with Their Health (1761), declaring that owners of estates and schoolteachers should be instructed in matters of health and disease and should be expected to teach the uneducated. Sustaining this emphasis, Bernard Faust, a German physician, issued his Catechism of Health in 1794. Four years later, with the enthusiastic recommendation of Benjamin Rush in Philadelphia, an English edition of Faust's book was published in New York.

Faust had lived in a political system that championed effective health care. Officials in the absolutist states of western Europe believed that an enlightened government should protect the health of its people. Several of these governments established systems of medical police that regulated the personal lives of their citizens from the cradle to the grave with a plethora of laws and administrative agencies. Most nineteenth-century political leaders in the United States rejected the rigid paternalism of these systems. Nevertheless, with the lobbying of interested physicians, health legislation did appear in numerous states before the Civil War.

Thomas Cooper (1759–1839), trained as a lawyer and physician, saw a need for regulation of such nuisances as gambling, swearing, public drunkenness, filth and sewerage, vagrants and beggars, "careless and desperate drivers" of stagecoaches, and the firing of guns in the streets. Two outstanding New York City physicians, David Hosack and John Griscom, encouraged politicians to adopt legislation relating to epidemic diseases, constructing houses, locating cemeteries, and protecting sources of water. By 1832, most of the larger American cities had created boards of health that enacted various kinds of regulations, and twenty states had adopted licensure regulations for practitioners.

However, in caring for patients, American practitioners as a profession did not honor traditional attention to hygienic practices. Only a few individual physicians, beginning with Benjamin Rush, evinced a special interest in hygiene. These physicians acknowledged new British works on health and translated some key European treatises. Elisha Bartlett (1804–1855), John Bell (1796–1872), and Robley Dunglison (1798–1869) prepared original monographs on personal hygiene. An underlying theme, expressed succinctly by Bell, was the belief that "rules for the preservation of beauty" were the "same rules to be followed for the support of health," both physical and mental; these rules were also "in entire harmony" with those by which each individual was "required to maintain his ethical and religious relations with his fellow men." Like other physician-authors of the period, Bell discussed skin care, dress, exercise, diet, longevity, and certain aspects of public hygiene. Encouraged by such physicians, a democratization of health education occurred and some citizens, at Boston in 1837, founded the American Physiological Society in order to learn "that part of Human Physiology which teaches the influence of air, cleanliness, exercise, sleep, food, drink, medicine, etc., on human health and longevity." Although short-lived, this group reflected the growing concern among American citizens for an understanding of human physiology and appropriate hygienic practices.

By 1876, there was still no comprehensive American treatise on hygiene. The situation changed abruptly with the emergence of a preventive medicine based on the bacteriological discoveries begun by Louis Pasteur and continued by many others during the last quarter of the century. These discoveries offered a rational basis for many of the sanitary reforms that legislatures began to enact and provided justification for new kinds of specific hygienic practices, both personal and public. Although public health workers were primarily concerned with the control of contagious and epidemic diseases well into the first decades of the twentieth century, the National Committee for Mental Hygiene was organized in 1908. Eight years later (June 1916), the Johns Hopkins School of Hygiene and Public Health incorporated mental hygiene into its original prospectus. An emerging interest in occupational hygiene reinforced attention to mental hygiene.

Although a few doctors studied health problems associated with the work of miners, metalworkers, shoemakers, bakers, and numerous other craftsmen during the eighteenth and nineteenth centuries, it was not until the turn of the twentieth century that American physicians and other health professionals began to give significant attention to occupational hygiene and the prevention of diseases associated with particular occupations.

Between 1870 and 1930 bacteriological discoveries, statistical surveys of disease, health regulations of industrial workers, and other forms of health legislation led to a conceptualization of hygiene as a public concern rather than a strictly private matter. The first texts on hygiene and public health were written, and the Massachusetts Institute of Technology established the first school of public health in 1912. In medical schools, hygiene became part of the curriculum in public health or preventive medicine courses. Most authorities considered personal hygiene primarily a matter of infectious disease control.

A redefinition of health began to emerge in the mid-nineteenth century, reflected in the World Health Organization's view of health as a complete state of physical, mental, and social well-being. With the mushrooming demand for medical care among citizens who saw health care as a right rather than a privilege, the emergence of multiple new groups of professionals providing health care, and the surge of scientific knowledge about ways to prevent disease and maintain health, hygiene resumed its original position as an integral component of medical and liberal education.

HYGIENE

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