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Knowledge Systems for Sustainable Development

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    • Sanitary prevention, a question of training
      • Education for hygiene has played a crucial role in the extension of life expectancy in the beginning of the 19th Century. Velvl W. GREENE

Education for hygiene has played a crucial role in the extension of life expectancy in the beginning of the 19th Century. Velvl W. GREENE

In the second half of the 19th Century, because of the sanitation revolution, mortality diminished radically in Europe and the United States. Also, this revolution made it possible to fight effectively some serious diseases, such as malaria and tuberculosis.

Some people portray the 19th Century in idyllic terms: neither pollution nor climatic change were problems to worry about! Nevertheless, this was not a golden age.

In the middle of the Victorian era, the average life expectancy in Liverpool, for example, was only 15. Cholera was pandemic in Europe in 1831-33, 1848-49, 1853-54, 65-67, and even later. The disease killed vast numbers: in London, 53 000 people died from it in one single year.

The history of humanity is a long tale of plague, mega mortality, and social upheaval. All of a sudden, around 1860 in the middle of the century, something happened...

Two very important events occurred in the 19th Century: malaria, that had been rampant in Chicago, which was built on marshland, vanished; then smallpox, also very deadly, appeared, and then it also disappeared. In 1838, records show that tuberculosis began to decline in the United States, but nobody really knew exactly why. Scarlet fever also declined.

The United States do not have any national records of mortality prior to 1900, but local records show that the death rate started to decline during the middle of the 19th Century and continued to improve year after year, a veritable "health revolution".

This phenomenon, which cannot be attributed to a single factor, continues today, particularly as regards infant mortality. It could be called the "great sanitary awakening".

In the 18th Century, a few individuals began to worry about living conditions in prisons and among the poor. This was later picked up again by those militating for hygiene. The equation was a simple one: people were contaminated by the excrement of others which led to cholera, typhoid fevers, and infant diarrhoea.

In fact, the revolution simply consisted in cleaning what was dirty. The sanitation revolution began in France. Pierre Charles Alexandre Louis, at the end of the 1800s, developed a computation system to translate medical parlance into quantitative and statistical terms. Some of his students disseminated the information, in particular the one who discovered the origin of typhoid fever.

In London, Hamburg, Albany (State of New York), and Pittsburgh, water sanitation made it possible to fight epidemics. This was the starting point of campaigns in favour of hygiene in general.

Regarding infant diarrhoeas, sanitation became important in the 1890s. Starting at this time, the Sears catalogue began to offer for sale toilets, bathtubs, and various qualities of soaps. We can now establish a relationship between infant mortality and the consumption of soap. These remarks are not meant to denigrate the progress of medicine in the 19th Century, but rather to point out that the battle against epidemic diseases was won more by sanitation than by medication.

Sanitation is still very important today, and it is a pity that medical students see this as an unimportant part of their training.