Sanitarian

“ As the knowledge of hygiene and of the doctrine of cleanliness and purity in regard not only to dwellings and towns, but also in relation to food of all descriptions, including water, became known and appreciated, hospitals were found to be of even greater importance, if that is possible, to the healthy in crowded communities, than to the sick. It took many centuries before sound hygiene really began to occupy the position of importance which it is now known to possess, not only in regard to the treatment and cure of disease, but to its prevention and eradication. ”

“ It has placed the practice of medicine upon a scientific basis, and inaugurated the era of preventive medicine. The day of curative measures, with which we are most familiar, is passing. In most of the cities and large communities of the world, Public Hygiene has become a very important department of government. Observe our own city of Philadelphia; we have there the largest water purification plant in existence. Its effect, in that city is to reduce the number of typhoid fever cases 80 per cent. of the former total, and perhaps 100 per cent. ”

“ In watching diseases, both in private houses and in public hospitals, the thing which strikes the experienced observer most forcibly is this, that the symptoms or the sufferings generally considered to be inevitable and incident to the disease are very often not symptoms of the disease at all, but of something quite different — of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet, of each or of all of these. And this quite as much in private as in hospital nursing. ”

“ The true physician brings to his aid Physiology, Hygiene, and Medicine, and combines the science of the former with the art of the latter, that restoration may be made permanent, and the health preserved by the aid of hygiene. But when any one makes Hygiene exclusively the physician, or deals wholly in hygienic regulations with little respect for physiology, or lavishly advertises with hygienic prefixes, we may at once consider it a display, not of genuine scientific knowledge, but only of the ignorance of a quack. ”

“ Consider first the average American household, where the family physician cannot call every day. Not a day finds this household without the need of information in medicine or hygiene or sanitation. More efforts of the profession are thwarted by ignorance than by epidemic. Not to supplant the doctor, but to supplement him, carefully prepared information should be at hand on the hygiene of health—sanitation, diet, exercise, clothing, baths, etc.; on the hygiene of disease—nursing and sick-room conduct, control of the nervous and insane, emergency resources, domestic remedies ”

“ Where persons are ill they should always be attended by a trained nurse if possible, but if this is out of the question a few suggestions as to the sick room and its hygiene should certainly not be omitted from any book dealing with rural sanitation. ”

“ The university medical school has here a great function to perform, for it is the legitimate source of knowledge pertaining to hygiene and sanitation. There are few problems which have not been suggested by contact with disease. Sanitary science is broad and rests upon many foundations, and the means of disseminating its teachings are many, but its origin is in pathology. Without the stimulus of the continual presence of disease its problems may become trivial and its practise ineffective. ”

“ It is the duty of the nurse to ascertain the habits of the patient as respects the period for eating and sleep, when in health, that she may prepare the food and arrange the sick-room in accordance with the practice of the patient. 436 If the person who is sick is ignorant of the necessity of the removal of the waste products from the system the nurse should invite attention to these functions at such periods as are in accordance with the previous habits of the patient. ”

“ The visitor was thus prepared to pass into the section in which the common infectious diseases of man were shown, how they originate and how they are best prevented, at the same time exhibiting busts of the most noted men of science who have contributed most to our knowledge in this department of sanitation.
A most noteworthy feature also was the development, care and best mode of nutrition for nurslings; it was here shown that the care for the child must begin before birth and must extend to the mother. ”

“ Hygiene, or the science of health, has a widely extended field of labor in laying a scientific foundation for our sanitary regimen. Even if in many cases it only shows that all is not as it has heretofore been supposed to be, that has its great practical value. ”

“ The period of which I have to speak has certainly witnessed great improvements in the theory of hygiene. The old heroic treatment of diseases has nearly disappeared. The nauseous draughts, the blood-letting and blisters, have given place to moderate medication, the choice of climate and the regulation of diet. Women have been admitted as copartners with men in the guardianship of the public health. Athletic sports help the student to fresh blood and efficient muscle, without which the brain sickens and perishes. ”

“ In sanitation, diet, and exercise are the great fields of medical enterprise and advance. I need not say that the physician who, in the case of those under his charge, or who may possibly require his aid, contents himself with waiting for developed disease, is like the soldier in a besieged city who opens the gates and then attempts to repel the invader who has effected a lodgment. ”

“ Every sick Man, as soon as he arrives at an Hospital, should be washed with warm Water, or if there is a warm Bath, or bathing Tub, to be put into it; and afterwards be supplied with a clean Shirt [156] well-aired before he be put to Bed; and his own dirty Linen should be immediately carried to the Wash-House: And every Morning each Nurse ought to carry a Bucket full of warm Water, and a Piece of Soap and a Towel, round to each of her Patients, and make them wash their Hands and Face, and their Feet, when dirty. ”

“ Supremacy of Hygiene.—Taking the results of sectional discussions as a whole, it was very generally shown that, by our increasing knowledge of hygienic law, its wide diffusion amongst the people, and its intelligent application to daily life, we can counteract the evil influence of heredity, get rid of epidemics, improve the stamina of the race, advance in longevity and in the natural enjoyment of our earthly span of life. Thus it is by the advance of sanitation that the Art of Healing can alone become a science of Medicine. ”

“ It is truthfully said that both medicine and surgery have been perfected to such a high degree that the length of human life greatly has been increased; that sanitary science is so well understood,3 and its principles so generally practiced, that disease germs born in filth no longer exist in such abundance as in the days when, because of the ignorance or indifference of the majority of the population, food, air, and water carried these breeders of disease to their unhappy victims. ”

“ Much more attention is given to preventive medicine in the twentieth century than in the seventeenth, but the value of cleanliness, fresh air, and quarantine was known. Hygienic measures taken, or recommendations made, by public authorities make clear the fact that the cause of disease was not commonly thought to be supernatural by the educated and responsible. ”

“ Have first your infirmary or hospital.
The T.B. man needs special treatment, nursing care and dietetic care. One of the chief things to give to a T.B. infirmary is good dietetic care;—place the food before your patient in an appetizing manner; too much will disgust him.
Then have your ambulant section and sub-divide it into the section in which there is clinical activity of the disease, and into the section in which the clinical condition of the disease is quiescent. ”

“ Patients who in their own homes enjoy sanitary and hygienic care; who may have a room of ample size for their exclusive use, which is thoroughly aired, day and night; who are provided with the "right kind of nourishment," [Pg 419] and who will obey implicitly the rules which the physician, who is conversant with this particular method of treatment, will lay down, may be assured that a prompt response will ensue. The intelligent reader will understand that this statement does not apply to patients in the last stages of the disease. ”

“ The cradles are unwieldy things, and so completely fill the sick apartment, that room is not left for a patient to move a step from his bed, and cleanliness is thereby prevented. On the other hand, hammocks could be sent on deck in the morning, which would enable the Surgeon to employ ventilation, and ensure cleanliness 91whenever he pleased, on the efficacy of which I need not expatiate. Certain it is, that no sick person can ever be considered a fit subject for proving the powers of medicine, if the strictest attention be not given to air, diet, and cleanliness. ”

“ The modest worker in sanitation, however, who explains the means of the development of these diseases, and the conditions and laws by means of which they may be prevented, is looked upon without interest and frequently with disfavor. But in spite of these conditions, the laws of hygiene are gradually becoming more farspread, and their influence is felt more with each advancing year.
The nose, throat, and ear are so intimately connected with the other parts of the body that their health depends to a large extent upon the condition of the system in general. ”

“ In the first place, all effective care given to a consumptive has to include nursing as well as teaching. Now, one can “educate” in a woollen dress, but one certainly cannot give bed-baths in anything but a cotton dress, which can be plunged into a tub and washed. And whether she enters the home to give a bed-bath, or whether she goes in merely to distribute prophylactic supplies, the 30fact remains that a nurse spends some eight hours a day in contact with an infectious disease. Good technique demands that she be dressed in washable material. ”

“ Medically the aim and function of hygiene is to increase the internal resistance of the individual and thus prevent dis-ease and prolong life. The aim and function of sanitation or sanitary science is to improve the environmental conditions and thus prevent dis-ease and prolong life of the individual. ”

“ An effort has been made to include only that part of hygiene pertaining to our science. Since sanitation pertains especially to the environment, the approach to its study is the same regardless of the viewpoint from which it is considered. ”

“ Again, a like spirit dictated the use of the physical or “natural” methods on a larger scale in the field of prevention. From the new regard given by physiologists and pathologists to the study of origins, and in the new hopes of thus dealing with disease at its springs, not in individuals only but in cities and nations, issued the great school Hygiene. of Preventive Medicine, initiated in England—E. A. Parkes (1819–1876) , J. Simon, Sir B. W. Richardson (1828–1896) , Sir H. W. Acland (1815–1900) , Sir G. Buchanan (1831–1895) , and forwarded in Germany by Max von Pettenkofer (1818–1901) . ”

“ The practical deduction is, that if we would maintain the health of a parish and prevent cholera, diarrhœa, typhus, or any other epidemic, p. 20we must improve our sanitary condition. Pure water lies at the foundation of all sanitary improvements. Let it be well known that impure water is to be dreaded, and the fear of an epidemic may prove a healthy stimulus to increased activity and cleanliness in connection with a subject of such vital importance. Whether cholera visits us or not, we shall be all the better for having paid proper attention to our sanitary arrangements. ”

“ In the most highly civilized countries the advance of scientific surgery and discoveries in medicine are hailed with the greatest applause. In such countries the subjects of sanitation and hygiene are given the closest attention, not only by students and scientists, but by every thoughtful individual. It is being recognized that there is no great and impressive mystery about our physical natures by virtue of which we escape responsibility for guarding our own health in every reasonable way. ”

“ It is chiefly useful in preventing acute or infectious diseases, such as typhoid fever, scarlet fever, measles, whooping-cough, small-pox, yellow fever, and diphtheria, and in preventing accidents and occupational diseases. Individual hygiene is chiefly useful in preventing the chronic or degenerative diseases, that is, diseases of nutrition and of circulation, such as heart and kidney affections, nervous prostration, insanity. ”

“ If the hands be washed with a strong antiseptic solution after waiting upon the patient, and the cheerful habit sometimes indulged in of putting fruit or other delicacies into the sick-room for a day or so, in the hope that they may tempt the appetite of the patient, and then taking them out and letting the children eat them as a treat, be abolished, and the nurse be not allowed to officiate in the kitchen, risk from this source will be done away with. ”

“ Another point might then also have become clear: the whole tendency of medicine is towards a recognition of the predominance of Hygiene. The modern aim is to prevent disease. The whole national system of medicine is being slowly though steadily built up in recognition of the great fact that the interests of Health come before the interests of Disease. ”