Hygiene

HYGIENE. - Hygiene (ὕγλεια = health) may be defined as the science and practice of health. Its fundamental purpose is the prolongation of human life, through the physical and psychic well-being of the individual and of the community of which he is a part; it seeks to attain this end through the conception, elaboration and subsequent application of its own methods, adequate to remove completely, or at least to neutralize, harmful environmental factors, or factors inherent in the various individual organic constitutions or in the structure of the social body.

From a broad point of view one may distinguish a scientific hygiene and a practical hygiene. The first investigates the grounds for the measures to be applied according to well-defined theoretical principles; it constitutes a great branch of medical knowledge, developed particularly and notably as a result of the fundamental microbiological discoveries and epidemiological observations of the last century. The second, on the other hand, draws from centuries-old empirical experience and from the data of modern experimentation and observation the norms for the technical implementation of the postulates enunciated by scientific hygiene; unlike the latter, it sinks its normative origins into the most ancient legislations, and in this regard it has within itself an educational, civil and moral purpose.

From the hygiene concerning the single individual (individual hygiene), which historically constituted the beginning of an empirical complex of observations that in remote times imposed themselves on the human mind as concepts useful for the preservation of the physical life of the individual himself, there developed a hygiene concerning the demographic community as a whole (public hygiene), and its evolution always occurred in direct proportion to the civilization of the respective people.

By the very nature of its tasks, hygiene must range over the domain of many disciplines, which supply it with the knowledge on which it elaborates and establishes its own methods of research and practical application. It draws its material from meteorology, climatology, geology, hydrology, from the various fields of physiology and pathology, as well as from the sociological disciplines. Air, water, soil, clothing, nutrition, urban and rural building, the fight against infectious diseases and against the so-called "social" diseases (tuberculosis, malaria, diabetes, rheumatism, etc.), welfare organizations for maternity, infancy, old age, the physically and mentally disabled, workers, etc., individual and species hygienic improvement, health legislation: these are the principal objects of hygiene. It is truly an encyclopedic task, which, owing to the needs of modern times, has been divided into specialized branches (food, industrial, hospital, military, naval, social-welfare, urban, rural, building hygiene, etc.), each evolving according to its respective theoretical and practical orientations, but in fruitful collaboration with one another and all tending toward the physical and psychic well-being of the individual and of the community.

The development of hygiene has always run parallel to intellectual education: to the education of the social community, in the sense that it should have an exact evaluation of the importance to be attributed to the physical and mental health of its members, and to the education of the single individual as a citizen in the State; the latter, in turn, becomes a legislative and therefore normative and imperative factor, codifying the basic concept that hygiene, in the broadest acceptation of the term, must be considered true preventive medicine both of the individual himself and of the demographic grouping.

The degree of social development of a civilization is measured by the complex of hygienic measures that it legislatively imposes, carries out and finally propagates among the population for an eminently educational and effective purpose.

Empirical notions and experiences of daily life constituted, at the dawn of history, in the era of the great migrations, the first rudiments of an individual hygiene, and when populations, abandoning nomadism, grouped themselves in stable settlements, there arose the necessity of providing normative measures that, limiting the freedom of the individual in the face of the needs of the community, might defend public health from the dangers deriving from agglomeration. The codification of those norms among the first civilizations (Chinese, Japanese, Assyro-Babylonian, Egyptian, Indian, Hebrew) was accomplished with a profound sense of nature, and from the empirical medicine of those epochs, with an essentially religious, priestly background, there derived the practices of baths, massages, gymnastics, diet, while hygienic thought was evolving (particularly among the Jewish people), which was to be charged with the necessity of providing not only for the single individual but also, and much more, for the physical and psychic health of the demographic aggregate: in a word, hygiene became the fundamental cornerstone of a political program.

During the travail of the historical centuries, the influence of social events has always manifested itself profoundly on the evolution of the hygienic idea, and this has marked in the course of time epochs of admirable ascent, alternating with epochs of depression, which in certain calamitous periods (famines, wars, pestilences) even reached the annihilation of every most elementary hygienic custom.

Thus one may portray as an incomparable master of hygiene the Greek world, the first to have made the physical education of youth a veritable State program, tending to attain, through individual education, in the community the most perfect eurhythmic harmony, physical and mental. Dietetics rose in Greece to the dignity of a hygienic science, and many of the Hippocratic concepts that foreshadow the modern contagionist doctrine informed there an entire legislation from which emanated a clear program of public health: cleaning of the streets, provisions for drinking water, control of foodstuffs, regulation of markets, mortuary police, baths, gymnasiums, private and public building, etc.; this stands as clear evidence that the development of hygiene runs parallel to the education of the intellect.

Just as much may be inferred from the Roman world with its technique, grandly simple, of aqueducts, sewers, baths, reclamation of marshy lands, with its building works in general, with its codified organization for the medical assistance of the population.

It is through the flowing of the centuries, from the Greco-Roman world one descends to the early Middle Ages, its obscure heir, but which bears within itself the seeds of the Renaissance and, even amid the decadence of hygienic practices, sees the first nosocomial foundations of the Byzantine East and the development of the monastic Orders that dedicate themselves to the assistance of the sick; while the Salernitan school handed down, in a most difficult period for scientific tradition, medical-hygienic thought in its purest form; while the epidemics, which raged throughout the then-known world and which had already given the Church occasion to concern itself with the health of populations (v. below), aroused, particularly in the 14th and 15th centuries, in the mercantile Republics, a rapid awakening and hygienic progress, taking concrete form in the elaboration of a prophylactic health legislation, which would later serve as a clear paradigm for similar subsequent legislations. There then appear the first treatises on individual hygiene (Taddeo Alderotti of Florence, Aldobrandino da Siena, Ugo Benzi), in which there is reborn, together with the concept of personal individuality, also the awareness of a defense of oneself as a member of the social body.

The subsequent prosperity of industries and commerce in the Italian Communes of the Renaissance, which saw their settled population increase rapidly, brought about the creation of institutions of social assistance and the promulgation of mandatory rules that can today be regarded as the germ of future protective labor legislation. Unforgettable names in the history of hygiene arise with the Renaissance, and their pleiad continues chronologically down to our own days: Fracastoro and Ingrassia in the 16th century: the former revives the principle of "contagium animatum sed vivum," the latter, tireless organizer against the Sicilian plague; in the 17th and 18th centuries, Vallisnieri, who likewise advocates the contagionist theory, Ramazzini, the true initiator of modern social medicine and who establishes the principles of the hygiene and clinical treatment of occupational diseases; Lancisi, in whose brilliant observations are found the fundamental precepts that two centuries later were to form the cornerstones of the antimalarial campaign; Monsignor Gastaldi, special health commissioner of the papal government, brilliant and prolific legislator of the anti-plague campaign of the 17th century in Rome; Antonio Cocchi and Domenico Cotugno, through whose initiative measures of protection against tuberculosis were promulgated in Tuscany; Giovanni Pietro Frank who, toward the close of the 18th century, sets forth in a classic treatise, gathering them into a coordinated system, the most important doctrines of political hygiene, regulates its measures, and affirms public health as their supreme basis.

But an even more rapid course of hygienic progress begins in England because of the cholera epidemic of 1830. That nation saw the sea routes rendered unsafe by contagion and therefore the most important factor of English economic life threatened. Hence a series of elaborate laws of protection for prophylactic purposes on ships and in ports of disembarkation. And likewise the migration of the rural population into the great English industrial and commercial cities makes plain to that nation the necessity of regulating the hygienic problems arising from the agglomeration of urban centers: hence a numerous series of "health acts" that constitute an important document of an incomparable evolution in the domain of public and private hygiene.

Meanwhile, even in Germany a systematic organization of the health administration was taking shape, and there, as also in France and in Italy, there is a rapid succession of studies and researches which, starting from the practical successes of Jenner in smallpox vaccination, from the discoveries of Agostino Bassi (on the muscardine of the silkworm), of Pasteur, of Lister and of so many other illustrious men, would lead to the present state of the fight against infectious diseases, while all the other branches of hygiene would also develop, seconded by modern technology, forming a "corpus" of knowledge and applications directed toward the social and economic well-being of nations.

Hygiene, following the progress of civilization of peoples, like every other manifestation of human activity, has increasingly instilled in man the conviction of the great usefulness that derives from it. Today this activity unfolds in correlation with the results of scientific investigation and tends in an ever more rational manner to procure and preserve for man and for communities the best conditions of life. It has taken its place among the biological and social sciences, and its importance is confirmed every day by the advantages that civilized peoples derive from it: prolongation of average human life, reduction in the incidence of mortality and morbidity, increased productive capacity, etc. Having the duty to guarantee to every individual of the community a complete health protection, so as to make up for the insufficiency of the means of individual self-defense, hygiene has become a function of the State.

Guido Tegoni

THE TASKS OF PUBLIC OR SOCIAL HYGIENE

The most rapid progress of hygiene, which began in England, gave rise to institutions of various kinds in all civilized nations, some through private initiative, others under the care of the States.

In Italy the Pontifical Commission of Assistance, the Italian Red Cross, the Opera Maternità ed Infanzia, and various insurance institutes are particularly efficient. Recently the World Health Organization (W.H.O.) has also arisen.

The fields of action of social hygiene are numerous:

1. Study of the state and movement of the population

Investigations must be instituted with statistical controls on a broad basis, and the deductions must be compared with those of other nations and with information drawn from the experience of past times. It has been seen, for example, that in many nations there exists a considerable excess of the female population over the male. This can be prejudicial to health and public morals because many men remain celibate, finding it easy to satisfy the sexual desire without assuming the obligations and burdens of married life; moreover prostitution increases, the number of illegitimate children grows, and finally there is an increase in venereal diseases, harmful to those who directly contract them and to their offspring. It has furthermore been seen that in many nations a progressive aging of the stock is taking place, owing to the decline in births and the lengthening of the average lifespan.

It is up to social hygiene to indicate the means of remedying, as far as possible, the consequences of these two phenomena.

2. Working conditions

An excess of working hours, activity carried out in unhealthy environments without the necessary provisions, inadequate pay, the employment of female labor to the detriment of male labor, can be the cause, according to the case, of harm to health (an increase in tuberculosis), of the break-up of families (the woman does not attend to the proper running of the family), of a decline in the birth rate, of unemployment, of nervousness, of excitement and even of social disturbances.

3. Nutrition

It is studied by social hygiene in relation to the caloric, vitamin and mineral requirements of populations and of the worker.

Unhealthy and insufficient nutrition may be founded on factors of an economic nature, on local customs, or on the particular kind of life that makes it difficult to adhere to the rules of healthy eating; its consequences are, according to the case, tuberculosis, osteomalacia, rickets, deficient fetal development, deficient somato-psychic development of the child, asthenia, many metabolic diseases, etc.

4. Housing

The problem of housing is of great importance because man, in order to preserve his own health and for the stimulus to work, needs space, the green of plants, sun, and quiet. The insufficiency of housing is a cause, among other things, of promiscuity, harmful to the physical and moral health of populations.

5. Clothing

Social hygiene points out the harms of certain styles of dress (corset, tight belts, unsuitable shoes) and studies the types of clothing most suited to the different categories of workers. Because of the ties it has with moral hygiene, it furthermore promotes the formation of an ethical conscience that makes one shrink from the use of clothes that improperly excite sensuality: everyone has the right to prefer the clothing that pleases him, but in exposing himself in public he must feel the obligation to respect the moral conscience of others.

6. Recreational activities

Sport in all its manifestations (swimming, rowing, ball games, races, excursions, tennis, etc.) falls within the tasks of social hygiene because it educates in cleanliness, order and discipline and improves health by conferring freshness and energy on the organism.

It is furthermore up to social hygiene to procure healthy joys, by valuing religion, the pacifier of souls, and by fostering the joy of work. Psychotechnics comes to the aid of social hygiene by indicating the activities for which one who aspires to a job is best suited; it is well known that the adequacy of one's aptitudes to the work task is one of the most important factors in the joy of work.

7. Eugenics

It must be studied in the light of the progress of the biological and social sciences, without fanaticism and in full respect for the human personality.

The harmful influences on offspring of certain infectious diseases and of certain chronic intoxications are well known; it is furthermore known that the advanced age of the mother can be a cause of weakness in the children; that conception in a state of drunkenness can have a harmful influence on the product of conception; that marriage between carriers of defects of the same kind risks transmitting similar defects to the children; that marriages between persons belonging to different regions are better (whereas, on the other hand, marriage contracted between persons of a different race gives rise to inferior products); that having an only child is not eugenically advisable, etc.

Basing itself on these general principles, social hygiene turns to the protection of maternity, of newborns, of children and then of adolescence and youth, promoting the institutions suited to safeguarding the physical and moral health of families and of each of their members.

It then carries out its action in favor of workers, whom it defends from excessively prolonged working hours, from the unhealthiness of working environments, from the action of toxic substances in unhealthy industries, from excessive noise, etc.

It furthermore studies the action of the social environment on the onset and spread of certain particularly ticularly formidable diseases, such as plague, cholera, leprosy, typhus, smallpox, tuberculosis, venereal diseases and certain particularly harmful intoxications such as alcoholism, morphinism, cocainism; it then examines the problem of prostitution, which still awaits its solution, since both regulation and abolition have proved equally ineffective.

Another task of social hygiene is to provide for the prophylaxis of mental illnesses, in whose genesis congenital disposition and many causes of a toxic or environmental nature are important.

Social hygiene finally provides for the implementation of efficient health legislation for the protection of the citizen's health (insurance against illness and in particular against tuberculosis), for the protection of the worker (insurance against accidents at work, provisions for the prevention of accidents, for the healthiness of working environments and for compliance with the rules concerning working hours), for the defense against occupational diseases, for protection against invalidity and old age, etc., and to that end it organizes study centers, clinics, hospitals, convalescent homes, maternal refectories, nurseries, kindergartens, open-air schools, foundling hospitals, houses of redemption for the wayward, etc.

In its complex work, social hygiene must keep in mind the immutable norms of the moral laws and must be animated by that spirit of true charity which recognizes the rights of others and teaches respect for those of others.

Eleuterio Boganelli