Public Health: Scientific Complexity

This week’s readings focused on the cause of diseases and a change in Public Health.  In “The New Public Health,” Hill describes a shift in the approach to prevent disease.  He says that Public Health includes fostering health and preventing disease and is divided into Hygiene and Sanitation, which are interdependent.  Hygiene deals with the individual, whereas Sanitation refers to the environment.  Hill presents misconceptions about diseases and how they are spread.  General good health may protect individuals from disease, but specific cleanliness can provide protection against each individual disease.  Hill points out that disease does not only inflict the poor, who are weak and lack good hygiene because if this were true, then all of these weaklings would have been killed off throughout the years and we would have a society of strong, healthy people, free from disease.  But this is not the case.  Anyone can be inflicted with a disease if it is present in the environment, as seen in “Typhoid Fever.”  Well-off guests, who had no prior health problems, attended a ball in town where about 1/3 of them came down with Typhoid fever.  The cause was contaminated water from a well close to a receptacle that received excretions from a person with the fever a few days prior.  These people had high health and would not have come down with the fever if they were not exposed to it through the water they were drinking.  Hill says that the New Public Health is concerned with the individual rather than the environment.  In the case of the people at the ball, New Public Health officials would have isolated the man that had the fever a few days earlier and found where he was excreting and taken care of the problem, which was the source of the other people’s illness.  Hill says, “Practical modern public health recognizes that the bulk of most of the infectious diseases are derived directly, or almost directly, from infected persons, not from infected things, except recently infected water, milk, food and flies,” which supports the theory that the people at the ball became sick from the infected water.  Hill also says that “the routes by which the discharges of the sick person pass to the well person are exactly those by which the same discharges pass from the well person to the well person in ordinary life.”  For example, in “Typhoid Fever” another incident occurred in a town that had a stream running through from the top of the hill to the bottom which contained normal waste.  A father from one of the cottages at the bottom of the hill became sick with Typhoid fever after doing business out of town and had diarrhea that was dumped into the common privy through which the stream flowed.  People in the cottages toward the bottom of the hill soon became sick with the fever as well, but the people living at the top of the hill were fine and healthy.  The waste flowing in the stream from the infected man had obviously contaminated the water that flowed down to the rest of the cottages.  Normal waste hadn’t made the inhabitants sick, but the moment someone dumped infected waste into the stream, people became ill.  It is interesting to read Hill’s points of view and see the difference in focusing on the individual rather than the environment.  Sometimes we may be too concerned with finding the original source of the disease in the water or earth, rather than finding the infected person whose bodily excretions are contaminating others.

“The Great Stink of Paris” showed the neglect that officials sometimes have during a Public Health issue.  In the summer of 1880 an overwhelming stench in Paris could be smelled for miles.  People complained of the disgust and discomfort they felt and some even vomited.  People wanted to know the cause and factors involved, but authorities were more concerned with other issues rather than the well being of the population.  Officials took vacations to get away, while people living there had to deal with the smell.  Newspapers put out stories about how the government was not solving the problem or taking responsibility.  When authorities began to take action, they were dismissive, defensive, and blamed one another.  There were confliction opinions, but they agreed that the foul odors were a threat to public health.  The health council formed committees  to examine the problem and report back.  Louis Pasteur was placed on one of the committees that concluded different things contributed to the Great Stink – soil, sewers, ventilation pipes, cesspits, waste dumps, and treatment plants.  The wind transported the odor throughout the city.  Some, but not all the odors were hazardous, but this was a problem that needed to be addressed.

I thought the experiment that Pasteur carried out with the sheep was revolutionary.  Healthy sheep were dying on a farm where twelve years earlier sheep that died from anthrax were buried.  Pasteur brought healthy sheep to the site, where no grass to eat was growing.  The sheep died from sniffing the ground, which proved that anthrax could live for at least twelve years and be present in the air.  Miasmatism gained some validation from this experiment.

This week’s readings all showed how complex science is and how many different theories and approaches there are to identifying, treating, and preventing diseases.