Until the 18th century ; 1346–1353) intensified urban responses to disaster on the basis of earlier practices. Miniature from "The Chronicles of Gilles Li Muisis" (1272–1352). Bibliothèque royale de Belgique, MS 13076–77, f. 24v.|alt= From the beginnings of
human civilization, communities promoted
health and fought
disease at the population level. Definitions of health as well as methods to pursue it differed according to the medical, religious and natural-
philosophical ideas groups held, the resources they had, and the changing circumstances in which they lived. Yet few early societies displayed the hygienic stagnation or even apathy often attributed to them. The latter reputation is mainly based on the absence of present-day
bioindicators, especially
immunological and
statistical tools developed in light of the
germ theory of disease transmission. Public health was born neither in
Europe nor as a response to the
Industrial Revolution. Preventive health interventions are attested almost anywhere historical communities have left their mark. In
Southeast Asia, for instance,
Ayurvedic medicine and subsequently
Buddhism fostered occupational, dietary and sexual regimens that promised balanced bodies, lives and communities, a notion strongly present in
Traditional Chinese Medicine as well. Among the
Mayans,
Aztecs and other early civilizations in the
Americas, population centers pursued hygienic programs, including by holding
medicinal herbal markets. And among
Aboriginal Australians, techniques for preserving and protecting water and food sources, micro-zoning to reduce pollution and fire risks, and screens to protect people against
flies were common, even in temporary camps. victims Western European,
Byzantine and
Islamicate civilizations, which generally adopted a
Hippocratic,
Galenic or
humoral medical system, fostered preventive programs as well. These were developed on the basis of evaluating the quality of local
climates, including
topography, wind conditions and exposure to the sun, and the properties and availability of water and food, for both
humans and nonhuman
animals. Diverse authors of
medical,
architectural,
engineering and
military manuals explained how to apply such theories to groups of different origins and under different circumstances. This was crucial, since under Galenism bodily constitutions were thought to be heavily shaped by their material
environments, so their balance required specific regimens as they traveled during different
seasons and between climate zones. In
complex,
pre-industrialized societies, interventions designed to reduce health risks could be the initiative of different stakeholders. For instance, in
Greek and
Roman antiquity, army generals learned to provide for soldiers' wellbeing, including off the
battlefield, where most combatants died prior to the twentieth century. In
Christian monasteries across the
Eastern Mediterranean and western Europe since at least the fifth century
CE,
monks and
nuns pursued strict but balanced regimens, including nutritious
diets, developed explicitly to extend their lives. And
royal, princely and
papal courts, which were often mobile as well, likewise adapted their behavior to suit environmental conditions in the sites they occupied. They could also choose sites they considered salubrious for their members and sometimes had them modified. In
cities, residents and rulers developed measures to benefit the general
population, which faced a broad array of recognized
health risks. These provide some of the most sustained evidence for preventive measures in earlier civilizations. In numerous sites the upkeep of
infrastructures, including roads, canals and marketplaces, as well as
zoning policies, were introduced explicitly to preserve residents' health. Officials such as the
muhtasib in the Middle East and the
Road master in Italy, fought the combined threats of
pollution through
sin,
ocular intromission and
miasma. Craft
guilds were important agents of waste disposal and promoted
harm reduction through honesty and
labor safety among their members. Medical practitioners, including public physicians, collaborated with urban governments in predicting and preparing for calamities and identifying and isolating people perceived as
lepers, a disease with strong moral connotations.
Neighborhoods were also active in safeguarding local people's health, by monitoring at-risk sites near them and taking appropriate social and legal action against artisanal polluters and neglectful owners of animals. Religious institutions, individuals and charitable organizations in both
Islam and Christianity likewise promoted moral and physical wellbeing by endowing urban amenities such as wells, fountains, schools and bridges, also in the service of
pilgrims. In western Europe and Byzantium, religious
processions commonly took place, which purported to act as both preventive and curative measures for the entire community. Urban residents and other groups also developed preventive measures in response to calamities such as
war,
famine,
floods and
widespread disease. During and after the
Black Death (1346–53), for instance, inhabitants of the
Eastern Mediterranean and
Western Europe reacted to massive population decline in part on the basis of existing medical theories and protocols, for instance concerning meat consumption and burial, and in part by developing new ones. The latter included the establishment of
quarantine facilities and health boards, some of which eventually became regular urban (and later national) offices. Subsequent measures for protecting cities and their regions included issuing health
passports for travelers, deploying guards to create
sanitary cordons for protecting local inhabitants, and gathering morbidity and mortality statistics. Such measures relied in turn on better transportation and communication networks, through which news on human and animal disease was efficiently spread.
After the 18th century With the onset of the
Industrial Revolution, living standards amongst the working population began to worsen, with cramped and unsanitary urban conditions. In the first four decades of the 19th century alone,
London's population doubled and even greater growth rates were recorded in the new industrial towns, such as
Leeds and
Manchester. This rapid
urbanization exacerbated the spread of disease in the large
conurbations that built up around the
workhouses and
factories. These settlements were cramped and primitive with no organized
sanitation. Disease was inevitable and its incubation in these areas was encouraged by the poor lifestyle of the inhabitants. Unavailable housing led to the rapid growth of
slums and the
per capita death rate began to rise alarmingly, almost doubling in
Birmingham and
Liverpool.
Thomas Malthus warned of the dangers of overpopulation in 1798. His ideas, as well as those of
Jeremy Bentham, became very influential in government circles in the early years of the 19th century. The 18th century saw rapid growth in voluntary hospitals in
England. The practice of
vaccination began in the 1800s, following the pioneering work of
Edward Jenner in treating
smallpox.
James Lind's discovery of the causes of
scurvy amongst sailors and its mitigation via the introduction of
fruit on lengthy voyages was published in 1754 and led to the adoption of this idea by the
Royal Navy. Efforts were also made to promulgate health matters to the broader public; in 1752 the British physician Sir
John Pringle published
Observations on the Diseases of the Army in Camp and Garrison, in which he advocated for the importance of adequate ventilation in the
military barracks and the provision of
latrines for the soldiers.
Public health legislation in England was a pivotal influence on the early public health campaign. The first attempts at sanitary reform and the establishment of public health institutions were made in the 1840s.
Thomas Southwood Smith, physician at the
London Fever Hospital, began to write papers on the importance of public health, and was one of the first physicians brought in to give evidence before the
Poor Law Commission in the 1830s, along with
Neil Arnott and
James Phillips Kay. Smith advised the government on the importance of
quarantine and sanitary improvement for limiting the spread of infectious diseases such as
cholera and
yellow fever. The Poor Law Commission reported in 1838 that "the expenditures necessary to the adoption and maintenance of measures of prevention would ultimately amount to less than the cost of the disease now constantly engendered". It recommended the implementation of large scale government
engineering projects to alleviate the conditions that allowed for the propagation of disease. Its formation followed the 1843 establishment of the Health of Towns Commission, chaired by Sir
Edwin Chadwick, which produced a series of reports on poor and insanitary conditions in British cities. and was followed up with a supplementary report a year later. During this time,
James Newlands (appointed following the passing of the 1846 Liverpool Sanatory Act championed by the Borough of Liverpool Health of Towns Committee) designed the world's first integrated sewerage system, in Liverpool (1848–1869), with
Joseph Bazalgette later creating
London's sewerage system (1858–1875). The Vaccination Act 1853 introduced compulsory
smallpox vaccination in England and Wales. By 1871 legislation required a comprehensive system of registration run by appointed vaccination officers. Further interventions were made by a series of subsequent
Public Health Acts, notably the
1875 Act. Reforms included the building of
sewers, the regular
collection of garbage followed by
incineration or disposal in a
landfill, the
provision of clean water and the draining of standing water to prevent the breeding of mosquitoes. The
Infectious Disease (Notification) Act 1889 (
52 & 53 Vict. c. 72) mandated the reporting of infectious diseases to the local sanitary authority, which could then pursue measures such as the removal of the patient to hospital and the disinfection of homes and properties.
Public health legislation in other countries in
New Haven, Connecticut, United States In the United States, the first public health organization based on a state health department and local boards of health was founded in
New York City in 1866. During
The Weimar Republic, Germany faced many public health catastrophes. The
Nazi Party had a goal of modernizing health care with
Volksgesundheit, German for ''people's public health''; this modernization was based on the growing field of
eugenics and measures prioritizing group health over any care for the health of individuals. The end of World War 2 led to the
Nuremberg Code, a set of research ethics concerning human experimentation.
Epidemiology John Snow mapped
clusters of cholera cases in London. The science of
epidemiology was founded by
John Snow's identification of a polluted public water well as the source of an 1854
cholera outbreak in London. Snow believed in the
germ theory of disease as opposed to the prevailing
miasma theory. By talking to local residents (with the help of
Reverend Henry Whitehead), he identified the source of the outbreak as the public water pump on Broad Street (now
Broadwick Street). Although Snow's chemical and microscope examination of a water sample from the
Broad Street pump did not conclusively prove its danger, his studies of the pattern of the disease were convincing enough to persuade the local council to close the well pump by removing its handle. Snow later used a
dot map to illustrate the cluster of cholera cases around the pump. He also used statistics to illustrate the connection between the quality of the water source and cholera cases. He showed that the
Southwark and Vauxhall Waterworks Company was taking water from sewage-polluted sections of the
Thames and delivering the water to homes, leading to an increased incidence of cholera. Snow's study was a major event in the history of public health and geography. It is regarded as the founding event of the science of
epidemiology.
Control of infectious diseases injecting a plague vaccine in Karachi, 1898 With the pioneering work in
bacteriology of French chemist
Louis Pasteur and German scientist
Robert Koch, methods for isolating the
bacteria responsible for a given disease and vaccines for remedy were developed at the turn of the 20th century. British physician
Ronald Ross identified the
mosquito as the carrier of
malaria and laid the foundations for combating the disease.
Joseph Lister revolutionized
surgery by the introduction of
antiseptic surgery to eliminate
infection. French epidemiologist
Paul-Louis Simond proved that
plague was carried by
fleas on the back of
rats, and Cuban scientist
Carlos J. Finlay and U.S. Americans
Walter Reed and
James Carroll demonstrated that mosquitoes carry the virus responsible for
yellow fever. Brazilian scientist
Carlos Chagas identified a
tropical disease and its vector. == Society and culture ==