Preventing

<< Previous Module

We live in the age of precaution: People exercise, watch what they eat, pay health insurance premiums with foresight or protect themselves against diseases with vaccinations. States are also interested in the health of the population and guide health behaviour with laws and education campaigns. The fact that various actors naturally try to promote health and prevent illness through measures in the present is the result of a long history that goes back to the 18th century and is based on changes in health concepts and the idea of a future that can be planned.

The State and Health

In the 18th century, European states developed a new interest in health and disease, as the size of the population was considered an important factor in maintaining political and economic power. The concept of "medical policing" lays the foundation for public health care. With the help of doctors, the rulers of the Enlightenment now systematically began intervening in the health behaviour of their subjects: They built health authorities and regulate the medical professions.

Plague and Charlatans

The Bernese government had taken precautions against epidemics since the Middle Ages and positioned "plague guards". In the 18th century, political interest in the health of the population increased. Thus, in 1765, Albrecht von Haller, as a member of the Sanitary Council, noted in a report that medical care was inadequate and called for an improvement in training. In fact, the Bernese authorities began taking stronger action against "charlatans" at the end of the 18th century. However, it was not until the 19th century that the newly founded canton pushed ahead with the professionalisation of medical studies in order to guarantee the care of the population.

The Talented Michel Schüppach

close

The Talented Michel Schüppach

Wound doctor Michel Schüppach did not complete his academic education, but learned his trade in an apprenticeship. In 1727, he took over a surgical practice in Langnau. From 1768, he ran a successful spa business and earned a legendary reputation. Sick people from all over Europe appreciated his diagnosis by means of urinalysis, and prominent guests such as Johann Wolfgang von Goethe also made pilgrimages to Langnau. Haller and other doctors were less pleased. For them, Schüppach's methods were the epitome of uneducated crankery and a reason for the poor health care in rural areas. Accordingly, they portrayed him as a deadly quack.

The First Vaccination

Smallpox was one of the most common causes of death for centuries. At the end of the 18th century, the English country doctor Edward Jenner presented the vaccination (from the Latin vacca: cow). This harmless vaccination with cowpox virus protected people, but is not based on research but on empirical knowledge. It spread quickly – even in Bern, the surgeon Rudolf Abraham von Schiferli advocated free vaccination as early as 1800. The smallpox vaccination marked a turning point in state health policy: For the first time, the general population could be protected against an epidemic in advance. At the same time, massive resistance began forming against state intervention.

The individual provision

Since the 18th century and the Enlightenment, health has been regarded as the most valuable commodity. For doctors, a person’s state of health is no longer exclusively God-given, but can be actively shaped through a moderate lifestyle and the regulation of internal and external stimuli. The emphasis on personal responsibility corresponded to the self-image of the aspiring middle classes. To stay healthy – according to medical advice – citizens should pay attention to diet, breathe good air, drink fresh water and maintain a balance between work and rest. Naturopathy, which was formed in the 19th century in distinction to scientific medicine, also emphasised the importance of air, light, water and movement.

Dietetics

The medical recommendations for a moderate lifestyle are based on the ancient understanding of health – dietetics. Central to this practice was the doctrine of "sex res non naturales". It emphasises the importance of air, light, climate, clothes, personal hygiene or nutrition for good health. Numerous guidebooks, magazine articles and lectures provided recipes for everyday care of the body and maintenance of health.

Säftegleichgewichte

close

Säftegleichgewichte

The doctors of the 18th and 19th centuries not only considered external factors to be decisive for health, but also the processes inside the body. This "doctrine of the humours" is also based on antiquity. According to this work: An imbalance between blood, yellow and black bile and phlegm causes disease. Popular remedies to maintain or restore a healthy balance are cupping, bloodletting, sweat cures or laxatives.

Air, Light & Water

In the 19th century, doctors distinguished themselves as experts on health issues and emphasised the health-promoting effects of water, light and air. Thus, Swiss spas also began experiencing a "Golden Age". In the canton of Bern alone, there were 73 baths in 1863. With mineral or mud baths, drinking cures or light air and sun baths, especially the wealthy clientele were able to recover and cure themselves. The thermal baths in Weissenburg and the Gurnigelbad with its sulphurous and ferruginous springs are particularly well-known. In the 17th century, the Gurnigelbad was still a spa for the rural population, but in the second half of the 19th century, it developed into a well-known spa hotel, accommodating guests from all over the world.

Public hygiene

Since the 1830s, cholera epidemics occurred regularly throughout Europe. The numerous victims of the pandemics clearly show that individual health care must be supplemented. The concept of "public hygiene" was established, which transferred the traditional formulas for good hygienic to the entire population. Governments were beginning to promote healthy places to live, clean water, proper nutrition and adequate recreation. The reforms were not yet based on a knowledge of bacteriology, but they improved living conditions, especially in cities.

(Waste)water

In the 19th century, Bern was spared from cholera, but not from typhus. The city council formulated rules of conduct to prevent diseases and sets up a permanent sanitary commission for disease control. Public notices pointed out sources of danger such as "disease-infested water" or "unclean treads". In particular, the Bernese representatives of the hygiene movement Adolf Vogt and Adolf Ziegler were committed to keeping water, air and soil clean. Around 1870, a high-pressure pipeline network for drinking water supply and an alluvial sewer system replaced the medieval water systems.

A hygienic hospital

close

A hygienic hospital

The hygiene conditions in the Inselspital were considered precarious in the 19th century. As late as 1873, there was no flushing system and the toilets had to be emptied with a "bucket system", causing odour nuisance in the wards and raising fears of the transmission of infectious diseases. Besides the lack of space, it was these unhygienic conditions that rendered the erection of a new building unavoidable. When planning the new hospital site on the Kreuzmatte, sewerage and water pipes were then to be included in the plans from the very beginning.

Literary "Vaccination Propaganda"

In the 19th century, the Bernese government took stronger action against "quacks" and intensified the fight against smallpox. To this end, the Sanitary Commission ordered Jeremias Gotthelf to write an educational pamphlet. Supported by his childhood friend, the professor of internal medicine and head of the commission – Emanuel Eduard Fueter – Gotthelf wrote the two-volume novel "Wie Anne Bäbi Jowäger haushaltet und wie ihm mit dem Doktern geht", which was far more than flat-out propaganda. Gotthelf did indeed settle things with those who held superstitious beliefs and other miracle healers, but also took a critical look at the limits of the natural sciences.

The Bern Chair of Hygiene

The re-evaluation of health care was also reflected in its institutionalisation. The German chemist and pharmacist Max von Pettenkofer is considered the founder of hygiene as a medical discipline in its own right, committed to researching and improving the environment. In Switzerland, the University of Bern established the first Chair of Hygiene in 1876. The professorship was taken up by the German-born Adolf Vogt, who as a doctor had previously been involved in improving housing conditions and sanitation. He contributed to the popularisation of the hygienic idea with his research and especially with his numerous publications.

"Fight" against bacilli

From 1880, the old hygiene order received competition from the rising bacteriology. Bacteriologists demonstrated the connection between numerous diseases and microorganisms visible under the microscope. A fundamental change in the understanding of disease began to emerge: It was no longer a multitude of factors that determined whether someone is healthy or ill, but a single microorganism. This meant that traditional hygienic measures and self-care were becoming less important and doctors, as experts, were increasingly taking responsibility for health.

Hospital History / Spanish Flu

Safe Spitting

Tuberculosis was a widespread and feared disease in the 19th century. As the evidence began to mount that it was an infectious disease, major education campaigns were launched to prevent infections. Above all, the authorities and doctors are trying to get people to stop spitting on the floor. Especially practical: a pocket spittoon developed in 1889. It could be closed tightly and the blue glass hid the unappetising contents, which was why it soon bore the nickname "Blauer Heinrich" of "Blue Henry".

Bernese vaccinations

Bacteriology was beginning to identify ever more pathogenic microorganisms. This offered new and ground-breaking starting points for disease prevention: Bacteriologists and immunologists had been developing vaccinations against various diseases since the end of the 19th century. In 1898, the Swiss Serum and Vaccination Institute Berna was founded in Bern from the merger of two companies. Initially, it produced mainly smallpox vaccines, but soon this included vaccines against diphtheria, cholera and later also polio, hepatitis or influenza.

The mobile laboratory

In 1894, the Swiss bacteriologist Alexandre Yersin identified the plague pathogen and thus helped to clarify the transmission route. When minor plague outbreaks occurred in Europe in 1899, the Swiss Federal Council decided to take precautions and commissioned the development of a mobile testing laboratory. Ernst Tavel, head of the Institute for Research into Infectious Diseases at the University of Bern, itself still in its infancy, designed a mobile plague examination box in collaboration with the Maurice Schaerer medical supply shop, which could be used to clarify suspected cases.

Health care in the early 20th century

In the course of the 19th century, hygiene became a ubiquitous topic and health care a civic duty. Medicine and politics, as well as numerous private institutions and associations, were committed to maintaining the health of individuals and, above all, of the entire "people". The state exerted influence with structural and legal measures, international conferences dealt with school or food hygiene, alcoholism or venereal diseases, and countless papers and large exhibitions and campaigns encouraged people to lead healthy lives.

Hygiene exhibitions

Since the end of the 19th century, large hygiene exhibitions have presented knowledge and population policy ideas in an easily understandable way. The hygienic "people's education" was intended to help prevent illness, maximise work performance and save on sickness costs. In 1911, Switzerland was invited to participate in the International Hygiene Exhibition in Dresden with a chalet-style pavilion where it presented its hygienic achievements – including models of the Inselspital. 20 years later, the first Swiss Hygiene and Sports Exhibition (Hyspa) was held in Bern, bringing numerous aspects of healthcare to a wide audience.

Iodine against goitre

Travellers through the Alpine region have described seeing people of a short stature, with hearing impairment, deformities and mental disabilities since the Middle Ages. In the 19th century, medical studies proved the enormous prevalence and the first doctors linked goitre and cretinism to iodine deficiency, but also to climatic and hygienic factors. Only after 1910, when the concept of deficiency disease became established and the connection between iodine and the thyroid gland was clarified, was the way clear for a particularly successful preventive measure: By 1930, all cantons enforced state-mandated iodised salt prophylaxis, which immediately reduced the phenomena of goitre and cretinism.

Sanatorium for those afflicted by cretinism

The doctor Johann Jakob Guggenbühl (1816-1863) was the first to provide education and medical care for those afflicted by so-called cretinism. With the help of patrons, he opened a sanatorium for up to 50 children on the Abendberg above Interlaken in 1841. The favourable climate, teaching, physical exercise and diet are expected to lead to improvement, if not a cure. Famous personalities from home and abroad visited the flagship institution and Guggenbühl became a busy celebrity himself. But he neglected the institution and even feigned healing success. An investigation in 1858 found blatant instances of neglect which led to the closure of Abendberg. Nevertheless, Guggenbühl remained an important figure: He initiated the founding of numerous centres for the mentally ill based on the Abendberg model.

Kocher and the Goitre

close

Kocher and the Goitre

In 1909, Bernese surgeon Theodor Kocher received the Nobel Prize for his research on thyroid surgery and physiology. He was a pioneer in the surgical treatment of goitre – but not in iodine salt prophylaxis. In the 1880s, he noted that when the thyroid gland was completely removed by surgery, patients developed symptoms similar to cretinism. Like many of his colleagues, he assumed that the thyroid gland was damaged by microbes in the drinking water, which is why iodine deficiency and prevention via iodised table salt were initially out of the question for him.

"Widespread disease" tuberculosis

In 1903, the "Swiss Central Commission against Tuberculosis" (today: "Lung League") began its work in Bern. This foundation indicated a new phase in dealing with tuberculosis. The focus was no longer only on healing or alleviation; rather, education and targeted measures were to protect against infection. In 1928, the Swiss authorities finally enacted the Tuberculosis Act, which set to coordinate the various measures and obliged the cantons to provide prevention and education.

The health insurance funds

For a long time, sick people had to pay for the costs of illness themselves. The increase in wage labour in the context of industrialisation then made a new form of provision necessary: Private associations, professional organisations and trade unions set up relief funds in the 19th century, which initially covered the loss of wages and then also the costs of treatment. After lengthy discussions, Swiss voters adopted the Health and Accident Insurance Act in 1912, which, however, continued to refrain from implementing a compulsory system. As a result, the number of people with health insurance slowly but steadily began increasing. Despite several attempts, however, a nationwide compulsory system did not come into force until 1996.

Slim & healthy

Eating and drinking properly and consuming stimulants in moderation have been considered the key to a healthy life since the 18th century. In the 20th century, discussions about nutrition took on two new tones: On the one hand, in the course of the affluent society in Europe, obesity was increasingly becoming a medical problem in the general awareness of the medical community and the wider public. On the other hand, poor nutrition was suspected of being a risk factor for various diseases. The important cue here was medicine, but the expertise for nutrition today did not rest exclusively with science: Low-carb, food combining, intermittent fasting – diet specialists, fitness influencers or nutrition coaches all like to suggest a confusing variety of diets.

Nutrition counselling at the Inselspital

Bread, "mues" – a traditional dish – and the daily ration of wine – since its foundation, providing sufficient food for female patients in the Inselspital has been a recurring theme. From 1920 onwards, "diet nurses" have prepared individual menu plans and provided advice at the bedside. In the second half of the 20th century, the "scientification" of nutrition has progressed: Thus, in 1966, the endocrinologist Arthur Teuscher founded a diabetes counselling centre and developed specific dietary schemes, in 1969 the Inselspital created an internal school for dietary cooks and, in 1972, a training course for dieticians followed.

The enemy – Alcohol

The excessive consumption of alcohol, especially schnapps, became increasingly problematic at the end of the 19th century. Authorities, but above all private organisations such as non-profit societies, socio-hygienic associations or the Christian-motivated "Blue Cross" regarded alcohol as a danger to "public health" or social morals. They propagated moderation or complete abstinence. As consumption habits changed, the abstinence movement began losing importance, but to this day alcohol consumption is considered a possible risk factor for various diseases.

Calorie counting

In the late 19th century, physiologists quantified food for the first time and introduced the "calorie" as a unit of measurement. Simultaneously, medicine identified obesity as a problem for the first time, so that initial guidebooks began recommending calorie counting for weight control. In the second half of the 20th century, the ideal of the slim body became established. In the age of fitness, nutrition plays a central role alongside exercise. Government campaigns, but also private actors, began providing recommendations and tips on how to maintain or achieve the ideal weight.

Health risks

In the second half of the 20th century, prevention concepts underwent a decisive expansion. The focus was now on health risks. With the establishment of the risk factor model dating back to the 1950s, the orientation towards preventive measures underwent a shift: The focus was no longer exclusively on combating individual diseases. Rather, risky types of behaviour were now to be refrained from. Large-scale health campaigns by the state or private organisations then also aimed to raise awareness among the population about alcohol consumption, smoking, a lack of exercise or the dangers of obesity.

Diseases afflicting civilisation

Since the 1950s, chronic and, in particular, cardiovascular diseases have come into the focus of science and the public. They cannot be traced back to one pathogen, but to different risk factors such as smoking, high blood pressure and increased cholesterol levels. They are considered a typical side effect of the modern and stressful lifestyle. The risk calculation serves as a basis for individual prevention as well as for targeted government measures to maintain health.

Cancer

Around 1900, statistical surveys, accumulations and development patterns of cancer make it a much more visible and discussed topic. With the aim of informing the population about the "cancer problem", the "Swiss Association for Cancer Control" (today: "Krebsliga") was created in Bern in 1910. Whereas doctors initially interpreted cancer as a disease of civilisation or old age, in the second half of the 20th century a differentiated view prevailed that identified different risk factors. The Association for Cancer Control used new media in its educational work and publishes educational films. The message was clear: Early detection is necessary for successful therapy.

Preventive medicine

The growing interest in preventive measures in the second half of the 20th century is also reflected in the establishment of an independent medical field: Preventive medicine aimed to improve or maintain the health of the population. In 1971, the University of Bern created the Institute for Social and Preventive Medicine, which conducted research on addictive behaviour, health training or obesity.

The Age of Fitness

In the late 1960s, a fitness boom began. Health campaigns, guides and recommendations all spoke in favour of a fit and slim ideal body. Every individual should voluntarily invest in his or her health. It was not so much laws and regulations, but subtle cues that point individuals in the right direction, i.e. the direction that is considered healthy. Individual prevention began experiencing a renaissance and people started going to the gym, watching their diet and using new technologies to measure their body and movements. This self-optimisation proved a good fit with a working world and a society that placed high demands on its citizens.

Forest gymnastics

Swiss people have been running and doing gymnastics in the forest since the 1970s. In 1968, a first "Vita-Parcours" opened in Zurich – named after the sponsor. The free sports facilities, which went to be introduced in other countries, are an expression of a larger development that reassesses physical fitness. In the 1980s, forest trails faced competition from gyms and other trendy sports, but have recently regained popularity during the covid pandemic.

Swiss Aerobics

The fitness wave also proved to be a media phenomenon. Magazines, inexpensive paperbacks and especially TV programmes offered numerous health and fitness tips. In Switzerland, the former gymnast Jack Günthard encouraged the Swiss to do strength and endurance exercises in the 1970s in the radio programme "Frühturnen mit Jack" and the TV programme "Fit mit Jack", making them all work up a sweat.

Self-measurement

Various technological developments would go on to support individuals to become more beautiful and fit. There were already mechanical pedometers in the 19th century that counted steps. But it is only through the reassessment of physical fitness and increasingly individual health care that electronic devices began gaining in importance. Today, numerous apps and tracking devices help to record, evaluate – and above all compare – the duration and intensity of a sporting activity. The state no longer needs to exhort us to healthy behaviour – we control ourselves.

Return of the "plagues"?

Thanks to improved hygiene, vaccinations and antibiotics, at least in the global North, infectious diseases faded into the background in the course of the 20th century. But the AIDS epidemic of the 1980s at the latest made it clear that infectious diseases cannot simply be eradicated, even with great effort. In view of increasing antiobiotic resistance or, most recently, the Covid-19 pandemic, the question even arises as to whether the world is facing a new age of "epidemics".

AIDS

Anfang der 1980er-Jahre berichten Medien über eine neue, sexuell übertragbare Krankheit. Gesundheitsämter, Politikerinnen, Ärzte und auch die Öffentlichkeit ringen um einen angemessenen Umgang mit der Epidemie. Eine wichtige Massnahme: 1985 wird die «Aids-Hilfe Schweiz» gegründet. Sie führt grosse und viel beachtete Informationskampagnen durch, um die Lebensqualität Erkrankter zu verbessern und Neuinfektionen vorzubeugen.

Covid-19

Im Dezember 2019 treten im chinesischen Wuhan erste Fälle einer Lungenentzündung auf. Wenige Monate später wütet eine weltweite Pandemie. Politische Entscheidungsträger und -trägerinnen lassen sich von Epidemiologen und Virologinnen beraten. Viele Staaten greifen zur Eindämmung der Erkrankung auf alte Rezepte zurück: Einreisesperren, Ausgangsbeschränkungen, Quarantäne oder Maskenpflicht – Massnahmen, die seit der Vormoderne zur Seuchenbekämpfung eingesetzt werden. Die Rückkehr zur Normalität verspricht die Entwicklung eines neuartigen Impfstoffs in Rekordzeit.

Impf- und Maskenskepsis

Ein grosser Teil der Bevölkerung unterstützt die Massnahmen zur Eindämmung der Pandemie. Einige Menschen lehnen es jedoch ab, Masken zu tragen und sich impfen zu lassen. Auch die wissenschaftliche Expertise stösst in dieser Gruppe auf Widerstand.

Auswahlbibliografie

  • Abplanalp, Andrej (07.08.2019): Der Vorturner der Nation, Blog zur Schweizer Geschichte - Schweizerisches Nationalmuseum, URL: https://blog.nationalmuseum.ch/2019/08/jack-guenthard/ (abgerufen am 26.05.2021).

  • Germann, Pascal (2017): Wie kam das Jod ins Salz? Eine Präventionsgeschichte, 1820-1920, in: Schweizer Zeitschrift für Ernährungsmedizin 5, S. 14-17.

  • Hannig, Nicolai & Thiessen, Malte (Hg.) (2017): Vorsorgen in der Moderne: Akteure, Räume und Praktiken, Berlin & Boston.

  • Hauptbibliothek Zürich (06.04.2021): «Ist der Impfzwang berechtigt?» Gegner der Pockenimpfung, Blog der Hauptbibliothek, URL: https://www.uzh.ch/blog/hbz/2021/04/06/ist-der-impfzwang-berechtigt-gegner-der-pockenimpfung/ (abgerufen am 11.05.2021).

  • Ingold, Niklaus (2018): Fitness als Glück: Gesundheit, Unbehagen und Sex im Film JE KA MI, in: Stephanie Kleiner & Robert Suter (Hg): Stress und Unbehagen: Glücks- und Erfolgspathologien in der zweiten Hälfte des 20. Jahrhunderts, Berlin, S. 98-125.

  • Lengwiler, Martin & Madarasz, Jeannette (Hg.) (2010): Präventionsgeschichte als Kulturgeschichte der Gesundheitspolitik, Bielefeld.

  • Lengwiler, Martin & Beck, Stefan (2008): Historizität, Materialität und Hybridität von Wissenspraxen, in: Geschichte und Gesellschaft 34(4), S. 489–523.

  • Martschukat, Jürgen (2019): Das Zeitalter der Fitness. Wie der Körper zum Zeichen für Erfolg und Leistung wurde, Frankfurt am Main.

  • Pfister, Christian (1995): Im Strom der Modernisierung Bevölkerung, Wirtschaft und Umwelt im Kanton Bern, 1700-1914, Bern (Geschichte des Kantons Bern seit 1798, Bd. 4).

  • Ruckstuhl, Brigitte & Ryter, Elisabeth (2017): Von der Seuchenpolizei zu Public Health öffentliche Gesundheit in der Schweiz seit 1750, Zürich.

  • Rusterholz, Peter (2012): Gotthelfs «Wie Anne Bäbi Jowäger haushaltet und wie es ihm mit dem Doktern geht»: Historischer Anlaß und aktuelle Bedeutung, in: Walter Pape (Hg.): Erzählkunst und Volkserziehung, Tübingen, S. 43–54.

  • Sarasin, Philipp (2011): Die Geschichte der Gesundheitsvorsorge: das Verhältnis von Selbstsorge und staatlicher Intervention im 19. und 20. Jahrhundert, in: Cardiovascular Medicine 14 (2), S. 41–45.

  • Stalder, Ruth (Jahr): Von der «Cloakenfrage» zur Schwemmkanalisation in der Stadt Bern 1850-1900, in: Berner Zeitschrift für Geschichte und Heimatkunde 64(4), S. 161-197.

  • geschichtedersozialensicherheit.ch