Summary
Public health and sanitation
Chapter 1. Hygienic thinking and practice. In this section two types of technology will be discussed which were developed in order to improve public health: medical statistics and sanitary technology. The first was part of a new way of thinking about disease as a social phenomenon. The second was a group of techniques of a more material nature, involving waterpipes, sewerage systems and so on.
Chapter 2. Medical statistics. During the 1850s a group of young Dutch doctors, inspired by English and German colleagues, introduced a new way of measuring the health of the population. By counting the number of deaths, specified by cause of death, and comparing this figure with the total population of a town or region, they could show that some areas of the kingdom were much less healthy than others. High mortality rates could only be be explained by bad sanitary conditions, for which local governments were held responsible. In this way, the ‘hygienists’, as they were called, introduced an entirely new understanding of the relationship between health, the environment and government.
The success of the hygienists in influencing the public debate and stimulating reform is explained by (1) the fact that they offered a new and apparently more ‘scientific’ answer to the baffling problem of epidemic disease;
(2) by the prominence of the hygienists in the newly founded professional organization which operated as a national organization for collecting of statistical data;
(3) by the constitutional reform of 1848, which made local governments responsible for public health; and (4) by the extension of central and municipal agencies for collecting population statistics.
Chapter 3. Sanitation. At the beginning of the nineteenth century the quality of water became a central focus of concern, especially when doctors demonstrated the connection between epidemic disease and water pollution. In the cities, drinking water came from canals in which human and industrial waste was also dumped, or from wells which were similarly polluted. One solution would have been to create a separate system for providing clean water, but this was deemed too expensive, both by the government and by private investors. Therefore, all effort was concentrated upon improving the quality of surface water. Between 1865 and 1880 two methods of collecting human waste were introduced: the technically simple one of distributing and collecting barrels and a very sophisticated system (invented by the engineer Liernur) of pipes which collected the waste from toilets into a central reservoir by means of air pressure. Although both methods worked reasonably well, after 1880 they were abandoned in favour of the system that has become dominant ever since: the water closet, connected to a sewerage network which carries the waste material to a river or the sea. This chapter describes this shift and attempts to explain it.
Chapter 4. Professionalization and state formation. In the final chapter in this section, the emergence of modern systems of public hygiene is placed in the context of two aspects of the modernization process: the extension of government intervention and the professionalization of public health (especially the role of civil engineers and doctors).