Milestones for a history of public health in France of the nineteenth century to today
Medicine and Health
Recognize the centrality of health Medicine reports a tautology, but emphasizes a point that it is not useless to insist, namely the historic contradiction between medicine 'curative' who is interested in patient's body and medicine preventive 'focused on the health status of a community. Curative medicine after the clinic in the early nineteenth century was interested in the disease, its practice based on the famous dentist and one dialogue his patient. The art of the clinician, based on a supposed empiricism compensate its therapeutic impotence, laid the principles of a liberal humanist inspiration medicine, but hostile to all forms of collectivism. But at the turn of the twentieth century, preventive medicine after the Hygienist and pasteurizer drew its resources in quantitative and scientific approach expected to address the problems of disease at the population level. Its effectiveness was based on the development of vaccination, for example in the BCG tuberculosis control on the installation of dispensaries and a medical employee, finally adopting public health measures intended to achieve equality all as regards health. Today, driven by the progress of knowledge in the life sciences, a progressive unification of the practices of care and prevention seems to operate, a development referred to by the pr. Francois Sikorsky:
"J until recently, medical education was cut canonical way, according to the major themes of the practice, ie in relation to the ills suffer different organs: neurology, neurology, the hematology, cardiology, etc. The fact that human medicine remained separate veterinary medicine or bacteriology, microbiology and virology have claimed to cover different territories, all this contributed to a crumbling unfavorable to medical progress. The introduction of molecular biology has completely changed the landscape and reunited. I mean that the interest is now door to the understanding of biological mechanisms outweighs pathology ... / I added and in terms of research, health and biology have now replaced medicine in the strict sense. In many sectors, research is more concerned with conditions of good health that treat diseases. It focuses on preventive and predictive medicine, it also raises many ethical problems, since the individual practice of traditional medicine or the Hippocratic is supplanted by a collective approach to health problems or environmental. It is moreover well as medical research is likely to be brought even closer humanities and social sciences "(F. Sikorsky, September 12, 2001)
At the origin of disease prevention, hygiene
Originally public health concerns, there is a 'Public Health Advisory Committee of France' installed in 1848 the Ministry of Trade, in charge of health issues (healthy cities and housing, drinking water supply, monitoring of foodstuffs, industrial hygiene, legal protection of workers, etc.), and prophylactic measures to prevent the spread of epidemics and animal diseases (isolation, disinfection, maritime sanitary prophylaxis, etc.). Over the years 1889-1902, u n institutional turning point occurs when the main health services are transferred to the Ministry of Commerce of the Interior, natural guardian of local government, ie entrusted to councils and municipalities already loaded Administration hospitals and hospices. Therefore, social hygiene supposed moralizing individual behaviors (alcoholism, sexuality, etc.) is supported by the prefecture administration and private law associations or leagues with which they are related.
Simultaneously, the Pasteur prophylaxis based on vaccination and serum therapy, which are often presented as the epitome of health prevention, opens new perspectives in the struggle against social diseases (tuberculosis, venereal diseases, etc.) as emphasized the historian P. Guillermo:
"The discovery of the role played by microbes or viruses by Louis Pasteur, Robert Koch and their emulators provides a scientific justification of hygienic practices advocated for decades, but had to empirical foundations. From messy, sometimes often contradictory and already, binding hygienist tends to become systematic and action hygienists leads to a new definition of local authorities' responsibilities for sanitation under the law of 15 February 1902 "(P. Guillermo , 'The doctor's role in society for two centuries 1800-1945' Association for the Study of the history of Social Security, Paris, 1996, p. 10).
The sanitary revolution 'has key players that drive physicians parliamentary debates where we see opposing the advocates of modern Hygienist defenders of liberal medicine. Thus, the dean of the medical school, Paul Boulevard, one of two government commissioners alongside Henri Mo nod, director of public health, is opposed to dr. Ideal Reveille which, "... while bowing to the Pastor of Glory (!), Challenges the bacterial origin of typhoid" (!). In fact, the rise of Hygienist whose effectiveness is affirmed through vaccination and aseptic, does not erase the rule of a medical art 'marked by the scientific ignorance of the majority of practitioners , for their therapeutic impotence. Nevertheless, social hygiene and health education will long remain confined to subordinate positions in front of a medical corps attached to the defense of its prerogatives, for example denying the name of medical confidentiality the reporting obligation contagious diseases. L. and P. Lumberman Mudguard dealt a severe judgment on this situation:
"There is little evidence apart from its neighbors the French hygienist movement in the second half of the nineteenth century. The differences erupt in contrast to the rooting stage of public medicine in the unit of local and national authorities. ... / But far to show that he showed Jacobin ism on the school grounds, (the Third Republic) has been unable to disseminate the expertise needed for the application of its laws. And where it was found, these experts when the Faculty dam was the emergence of a true profession hygienist? Nothing more than that abortive professionalization dismisses the health of its French and German counterparts English. The 1902 law denounces the impotence of the central government. A parliament to leash the executive, seems itself leashed by plutocracy significant and doctors ... "(L. & P. Mudguard Lumberman, 'Hygiene in Republic. The Public Health in France or utopia upset, 1870-1918 ', Paris, Fayard, 1996, p. 470).
Nevertheless, on the eve of the Great War, the emancipation of social hygiene, understood as a synthesis of assistance and preventive medicine, is the support of charities or mutuality movement in full swing, what does not fail to congratulate Senator hygienist Leon Bourgeois:
"Everything has been said long ago on the state of public health in our country. We are far from being in this regard to the rank which should put us among the nations the intellectual, financial strength and all ideas moral and social of our country ... / Fortunately, the seriousness of the cause we plead beginning to be understood, outside the government, by private initiative groups who for thirty years have developed so powerfully in our country ... / The spirit of association renews the national thought and it is marvelous to see how in any order companies, cooperatives, mutual trade, which tends to be organized collective life, knowledge of the solidarity that must unite all elements of the nation in the common defense of health and life, is now recognized in acts "(L. Bourgeois," France to stay strong must protect the health of its citizens' in Science and Life, January 1914).
First draft of a public health policy
The Great War has generated the implementation for the first time a centralized health policy while mobilizing gave the state authority over the medical profession. Unlike the pre-war, now it is less to provide health care of the population, this "capital of all capital," according to L. Bourgeois, of the need to recover the benefit of armies and War factories the largest number of wounded and sick. This requirement makes the watchful State for health protection of military and civilian populations against epidemics (appearance and systematization of the first health monitoring and warning devices; generalization of vaccinations against smallpox and typhoid fever, psychotherapies); but also to the fight against social evils likely to begin the working capacity of the population (tuberculosis, venereal disease, alcoholism, cancer).
Nevertheless, at the end of the conflict this policy led by Under Secretary of State for Health, Justin Godard, was abandoned by the public authorities careless to assume financial burden in an economy bled by war. Certainly, a Ministry of Health told the Senator Jules-Louis Breton is made in 1920, but without external services and in the absence of government arbitration, he never could unite the various scattered sanitation services other departments. The social hygiene will therefore hold its own game with the help of French and foreign works (Red Cross, Rockefeller Foundation, etc.), supported at intervals by the state and local authorities. It even became the confluence of private and public actions preventive and educational purpose (health education; public propaganda; social support; training of specialized personnel: visitors, nurses, multiplication leagues and associations ...). With support from the Rockefeller Foundation, Senator Justin Godard, returned to the head of a large Ministry of Social Affairs in 1924, creates a National Social Health Office (ONHS), with a budget of which three quarters are initially matched by the American foundation. The ONHS is responsible for drawing up health statistics, to take care of health education and coordinate government action and private works. With communication tools and modern propaganda, the organization launched the first major information and prevention campaigns, focused mainly on tuberculosis control.
The Social insurance and private medicine
In the interwar period, the debates on health prevention above the laws of 1928 and 1930 on social insurance polarize tensions between an essentially liberal curative medicine and medicine has employed in large companies, mutual clinics , etc. During the parliamentary debates, Senator Paul Strauss, the founder of cancer control centers, do not hesitate to say that "... the disease may be lessened by the permanent use of preventive medicine and social hygiene "; what the dr. Felix Gadabout, a deputy representative of the Doggone medical unions, objected: "... [that] medicine [is] essentially a liberal activity, doctors [fear] from a drift towards a dual medicine, medicine and cash Customer medicine. [They] are [also] allergic under collective 'or' social 'contiguous to those of' medicine 'or' healthy '. " This cleavage increasingly evident between the two forms of medicine raises the adoption of a genuine charter of liberal medicine on a few fundamental principles: free choice of doctor by the patient, respect of confidentiality, the right to fees for any ill treated, as well as home to the hospital, the fee for the physician by the patient, full freedom and therapeutic prescription. In silent, laborer reunited by medical unions (Austerer enshrined in the law of December 1927), the Charter reinforces anchoring a medical anxious to defend its corporate interests, concerned to counter any state interference hint in the field of care.
For their part, the laws of 1928 and 1930 introduce a concept 'insurance-' preventive health care around the opening of health funds topped up by employees and their employers.
"Social risk prevention should aim to reduce the social consequences of the damage and, to the extent possible, to prevent its implementation. It should enable the company to save money by eliminating the most common risk of interruption Work: There is no doubt that rationally organized, prevention must 'pay': it 'pays' the sickness and disability institutions, that is to say, it helps them save money benefits in cash and kind; it 'pays' too, from the individual point of view, by the reduction of human suffering it determines; it 'pays' finally the national point of view, that is to say, she translates for the country by increasing the health capital of a considerable part of the population "(Circul. of 28 July 1931 on the organization of the MTPS of disease prevention).
These new provisions are implemented by a pioneer in public health medicine, Jacques Paris Dean of the Faculty of Nancy. In relation to the social works of the Lorraine steel industry, Paris develops occupational medicine, installs clinics and creates a hygiene institute Further et Moselle mainly dedicated to tuberculosis control.
By Nickeya
Medicine and Health
Recognize the centrality of health Medicine reports a tautology, but emphasizes a point that it is not useless to insist, namely the historic contradiction between medicine 'curative' who is interested in patient's body and medicine preventive 'focused on the health status of a community. Curative medicine after the clinic in the early nineteenth century was interested in the disease, its practice based on the famous dentist and one dialogue his patient. The art of the clinician, based on a supposed empiricism compensate its therapeutic impotence, laid the principles of a liberal humanist inspiration medicine, but hostile to all forms of collectivism. But at the turn of the twentieth century, preventive medicine after the Hygienist and pasteurizer drew its resources in quantitative and scientific approach expected to address the problems of disease at the population level. Its effectiveness was based on the development of vaccination, for example in the BCG tuberculosis control on the installation of dispensaries and a medical employee, finally adopting public health measures intended to achieve equality all as regards health. Today, driven by the progress of knowledge in the life sciences, a progressive unification of the practices of care and prevention seems to operate, a development referred to by the pr. Francois Sikorsky:
"J until recently, medical education was cut canonical way, according to the major themes of the practice, ie in relation to the ills suffer different organs: neurology, neurology, the hematology, cardiology, etc. The fact that human medicine remained separate veterinary medicine or bacteriology, microbiology and virology have claimed to cover different territories, all this contributed to a crumbling unfavorable to medical progress. The introduction of molecular biology has completely changed the landscape and reunited. I mean that the interest is now door to the understanding of biological mechanisms outweighs pathology ... / I added and in terms of research, health and biology have now replaced medicine in the strict sense. In many sectors, research is more concerned with conditions of good health that treat diseases. It focuses on preventive and predictive medicine, it also raises many ethical problems, since the individual practice of traditional medicine or the Hippocratic is supplanted by a collective approach to health problems or environmental. It is moreover well as medical research is likely to be brought even closer humanities and social sciences "(F. Sikorsky, September 12, 2001)
At the origin of disease prevention, hygiene
Originally public health concerns, there is a 'Public Health Advisory Committee of France' installed in 1848 the Ministry of Trade, in charge of health issues (healthy cities and housing, drinking water supply, monitoring of foodstuffs, industrial hygiene, legal protection of workers, etc.), and prophylactic measures to prevent the spread of epidemics and animal diseases (isolation, disinfection, maritime sanitary prophylaxis, etc.). Over the years 1889-1902, u n institutional turning point occurs when the main health services are transferred to the Ministry of Commerce of the Interior, natural guardian of local government, ie entrusted to councils and municipalities already loaded Administration hospitals and hospices. Therefore, social hygiene supposed moralizing individual behaviors (alcoholism, sexuality, etc.) is supported by the prefecture administration and private law associations or leagues with which they are related.
Simultaneously, the Pasteur prophylaxis based on vaccination and serum therapy, which are often presented as the epitome of health prevention, opens new perspectives in the struggle against social diseases (tuberculosis, venereal diseases, etc.) as emphasized the historian P. Guillermo:
"The discovery of the role played by microbes or viruses by Louis Pasteur, Robert Koch and their emulators provides a scientific justification of hygienic practices advocated for decades, but had to empirical foundations. From messy, sometimes often contradictory and already, binding hygienist tends to become systematic and action hygienists leads to a new definition of local authorities' responsibilities for sanitation under the law of 15 February 1902 "(P. Guillermo , 'The doctor's role in society for two centuries 1800-1945' Association for the Study of the history of Social Security, Paris, 1996, p. 10).
The sanitary revolution 'has key players that drive physicians parliamentary debates where we see opposing the advocates of modern Hygienist defenders of liberal medicine. Thus, the dean of the medical school, Paul Boulevard, one of two government commissioners alongside Henri Mo nod, director of public health, is opposed to dr. Ideal Reveille which, "... while bowing to the Pastor of Glory (!), Challenges the bacterial origin of typhoid" (!). In fact, the rise of Hygienist whose effectiveness is affirmed through vaccination and aseptic, does not erase the rule of a medical art 'marked by the scientific ignorance of the majority of practitioners , for their therapeutic impotence. Nevertheless, social hygiene and health education will long remain confined to subordinate positions in front of a medical corps attached to the defense of its prerogatives, for example denying the name of medical confidentiality the reporting obligation contagious diseases. L. and P. Lumberman Mudguard dealt a severe judgment on this situation:
"There is little evidence apart from its neighbors the French hygienist movement in the second half of the nineteenth century. The differences erupt in contrast to the rooting stage of public medicine in the unit of local and national authorities. ... / But far to show that he showed Jacobin ism on the school grounds, (the Third Republic) has been unable to disseminate the expertise needed for the application of its laws. And where it was found, these experts when the Faculty dam was the emergence of a true profession hygienist? Nothing more than that abortive professionalization dismisses the health of its French and German counterparts English. The 1902 law denounces the impotence of the central government. A parliament to leash the executive, seems itself leashed by plutocracy significant and doctors ... "(L. & P. Mudguard Lumberman, 'Hygiene in Republic. The Public Health in France or utopia upset, 1870-1918 ', Paris, Fayard, 1996, p. 470).
Nevertheless, on the eve of the Great War, the emancipation of social hygiene, understood as a synthesis of assistance and preventive medicine, is the support of charities or mutuality movement in full swing, what does not fail to congratulate Senator hygienist Leon Bourgeois:
"Everything has been said long ago on the state of public health in our country. We are far from being in this regard to the rank which should put us among the nations the intellectual, financial strength and all ideas moral and social of our country ... / Fortunately, the seriousness of the cause we plead beginning to be understood, outside the government, by private initiative groups who for thirty years have developed so powerfully in our country ... / The spirit of association renews the national thought and it is marvelous to see how in any order companies, cooperatives, mutual trade, which tends to be organized collective life, knowledge of the solidarity that must unite all elements of the nation in the common defense of health and life, is now recognized in acts "(L. Bourgeois," France to stay strong must protect the health of its citizens' in Science and Life, January 1914).
First draft of a public health policy
The Great War has generated the implementation for the first time a centralized health policy while mobilizing gave the state authority over the medical profession. Unlike the pre-war, now it is less to provide health care of the population, this "capital of all capital," according to L. Bourgeois, of the need to recover the benefit of armies and War factories the largest number of wounded and sick. This requirement makes the watchful State for health protection of military and civilian populations against epidemics (appearance and systematization of the first health monitoring and warning devices; generalization of vaccinations against smallpox and typhoid fever, psychotherapies); but also to the fight against social evils likely to begin the working capacity of the population (tuberculosis, venereal disease, alcoholism, cancer).
Nevertheless, at the end of the conflict this policy led by Under Secretary of State for Health, Justin Godard, was abandoned by the public authorities careless to assume financial burden in an economy bled by war. Certainly, a Ministry of Health told the Senator Jules-Louis Breton is made in 1920, but without external services and in the absence of government arbitration, he never could unite the various scattered sanitation services other departments. The social hygiene will therefore hold its own game with the help of French and foreign works (Red Cross, Rockefeller Foundation, etc.), supported at intervals by the state and local authorities. It even became the confluence of private and public actions preventive and educational purpose (health education; public propaganda; social support; training of specialized personnel: visitors, nurses, multiplication leagues and associations ...). With support from the Rockefeller Foundation, Senator Justin Godard, returned to the head of a large Ministry of Social Affairs in 1924, creates a National Social Health Office (ONHS), with a budget of which three quarters are initially matched by the American foundation. The ONHS is responsible for drawing up health statistics, to take care of health education and coordinate government action and private works. With communication tools and modern propaganda, the organization launched the first major information and prevention campaigns, focused mainly on tuberculosis control.
The Social insurance and private medicine
In the interwar period, the debates on health prevention above the laws of 1928 and 1930 on social insurance polarize tensions between an essentially liberal curative medicine and medicine has employed in large companies, mutual clinics , etc. During the parliamentary debates, Senator Paul Strauss, the founder of cancer control centers, do not hesitate to say that "... the disease may be lessened by the permanent use of preventive medicine and social hygiene "; what the dr. Felix Gadabout, a deputy representative of the Doggone medical unions, objected: "... [that] medicine [is] essentially a liberal activity, doctors [fear] from a drift towards a dual medicine, medicine and cash Customer medicine. [They] are [also] allergic under collective 'or' social 'contiguous to those of' medicine 'or' healthy '. " This cleavage increasingly evident between the two forms of medicine raises the adoption of a genuine charter of liberal medicine on a few fundamental principles: free choice of doctor by the patient, respect of confidentiality, the right to fees for any ill treated, as well as home to the hospital, the fee for the physician by the patient, full freedom and therapeutic prescription. In silent, laborer reunited by medical unions (Austerer enshrined in the law of December 1927), the Charter reinforces anchoring a medical anxious to defend its corporate interests, concerned to counter any state interference hint in the field of care.
For their part, the laws of 1928 and 1930 introduce a concept 'insurance-' preventive health care around the opening of health funds topped up by employees and their employers.
"Social risk prevention should aim to reduce the social consequences of the damage and, to the extent possible, to prevent its implementation. It should enable the company to save money by eliminating the most common risk of interruption Work: There is no doubt that rationally organized, prevention must 'pay': it 'pays' the sickness and disability institutions, that is to say, it helps them save money benefits in cash and kind; it 'pays' too, from the individual point of view, by the reduction of human suffering it determines; it 'pays' finally the national point of view, that is to say, she translates for the country by increasing the health capital of a considerable part of the population "(Circul. of 28 July 1931 on the organization of the MTPS of disease prevention).
These new provisions are implemented by a pioneer in public health medicine, Jacques Paris Dean of the Faculty of Nancy. In relation to the social works of the Lorraine steel industry, Paris develops occupational medicine, installs clinics and creates a hygiene institute Further et Moselle mainly dedicated to tuberculosis control.
By Nickeya
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