Hygiene And Public Health, 1700–1945
The concept of hygiene underwent immense changes during and after the eighteenth century. As the use of dissection and the microscope became increasingly common for the new medical sciences of anatomy, physiology, and pathology, Galenic theories were quickly discarded. Many physicians began to treat traditional hygiene as at best a branch of education rather than an area of medicine, at worst a form of folklore. However the status of hygienic study was defended by Paris professor of medicine Jean Noel Hallé (1754–1822), who argued that the subject of hygiene had two facets: the individual, in which the physician would consider such factors as age, sex, temperament, habits, profession, poverty, and travel; and the social, in which the physician would consider climate, location, occupations, customs, laws, and governments, as they affected health. This transference of many of the ideas incorporated in traditional hygiene to the level of the public and the population was reflective of a general growing interest in "state science," literally "statistiks." This referred to the collection of numerical data about the composition, strengths, and weakness of a population on the grounds that the economic and political strength of a nation were directly proportional to the health of its citizens. (Indeed, the concept population may be said to have been produced by these new measurement techniques.) As Hallé wrote, the hygienist must become counsel and spiritual guide to the legislator, intervening in those areas where an individual had little control.
The concept of "public hygiene" increased in importance as European societies experienced the devastating epidemics of cholera, typhoid, smallpox, and plague that struck as a result of war, colonization, and industrialization. Acting on the statistical relationship between mortality rates and living conditions, the primary government response was in terms of "sanitation," the removal of environmental pollution by garbage and nightsoil collection services, building ventilation devices in houses, and limiting industrial refuse. This environmental focus in public-health strategies reflected the popularity of the miasmatic theory of disease transmission, which conceived disease as the airy product of refuse, decay, and smell. It also shaped, and was shaped by, an increasing social preoccupation with cleanliness, possibly attributable to the transmission of the eighteenth-century French aristocracy's mannerly culture, a new kind of hygienic regimen that was distinguished from its predecessors by its cleansing rituals, from nose-blowing to bathing. Hygiene was partially distinguished from sanitation (though the two terms were interchangeable) by its focus on the social and moral health of society, the ultimate aim of sanitation. As Benjamin Ward Richardson (1828–1896) captured in his utopian tale Hygeia: A City of Health, it was felt that the mere fact of living in uncrowded conditions and enjoying regular bathing would result in the moral and spiritual uplift and pursuit of self-improvement among the great unwashed who were filling the fever-decimated hospitals, prisons, shipping vessels, and factories of the day.
Thus hygiene became a central technique of social government in the nineteenth and early twentieth centuries; indeed this could well be termed the Hygienic Era in honor of the proliferation of societies and subjects devoted to hygiene, each of which connected individuals to projects in governing society. In domestic hygiene, maternal hygiene, tropical hygiene, international hygiene, industrial hygiene, sex hygiene, moral hygiene, and many other arenas of hygiene, governments sought to regulate their citizens' movements, interactions, choices, habits, and thoughts. As public-health measures proliferated, from establishing house, city, or national-border based quarantines to building "lock hospitals" for prostitutes with venereal disease, "lines of hygiene" became literally lines of rule, and conversely, lines of rule were manifest through hygienic regulations. This was most obvious in the colonial world, where the containment, education, and/or exclusion of nonwhites (predominantly ethnic populations and immigrant laborers) were often managed medically by quarantines or isolation measures directed at their supposedly diseased bodies and unhygienic habits.
Population hygiene or health was now clearly predicated on notions of purity and pollution as Western cultures struggled to imaginatively maintain the boundaries of their bodies and identities against the incursions of various "others," from viruses to Chinese gold-seekers. Domestic hygiene aimed at excluding dirt, and equivalently moral hygiene aimed at excluding evil. Indeed, practices and instruments of hygiene, such as the minutely detailed bodily training given to those with tuberculosis or inactive typhoid bacteria about how to prevent their illness from spreading to others, produced identities. Hygienic practice marked who was white or nonwhite, citizen or alien, clean or contaminated, a good wife and mother or an impure one. By World War I, proper hygiene was regarded as a duty that all citizens owed their society. The widespread acceptance of the germ theory of disease in the 1890s encouraged this trend by focusing public-health measures away from the general environment and much more on personal practices, as the ordinary actions of apparently healthy people were now revealed to be the mechanisms that transmitted illness. With the sudden explosion of antibacterial soaps, powders for clothing, tissues, and face masks—beards were shaved and skirts lifted as Americans worried they harbored germs—came a renewed obsession with domestic and bodily cleanliness as the markers of healthiness and moral and civic responsibility.
In the late twentieth century, the concept of hygiene lost its prewar obsessions with purity and its heavy moral agenda. Hygiene in the twenty-first century refers virtually solely to personal cleanliness, and more particularly to personal habits that minimize exposure to germs. For the past century this has been its global definition also, as since the nineteenth century the practices of personal hygiene have been relentlessly proselytized in developing nations, not only by anxious colonizing Europeans, but also by indigenous cultures as they replaced traditional knowledges with Western medicine. (For example, the Japanese Private Association of Hygiene was founded in 1883, a decade after the new Medical Constitution of Japan, which formally declared that Western medicine would be the only legal practice in the nation, was passed.) Many physician-historians regard the spread of such personal hygiene practices as having been, and continuing to be, directly responsible for saving millions of lives, and point to the sharp downward slide in incidence of once-devastating epidemic diseases as evidence for this contention. They are not wrong—but ideas about hygiene have produced and continue to produce identities and politics that colonize other social worlds, as well as healthy bodies.
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