Atenstaedt R L
National Public Health Service for Wales and Institute of Medical & Social Care Research (IMSCaR), University of Wales, Bangor, Gwynedd LL57 2PX, UK.
Public Health. 2007 Aug;121(8):634-9. doi: 10.1016/j.puhe.2006.12.014. Epub 2007 May 30.
The recent 90-year anniversary of the Battle of the Somme presents an opportunity to examine the public health response to the trench diseases, new conditions which arose in the trenches of World War I. Throughout history, there have been two views of epidemic disease: the configurationist and contagionist perspectives. Most doctors responding to the trench diseases, 'contingent-contagionists', combined these two conceptions of disease. Because of the difficulty of finding a causative organism and the absence of effective treatment, the majority view became that these conditions were a product of the trench environment. Configurationism, with its emphasis on environmental and social determinants, seemed to provide the most obvious approaches for tackling the trench diseases. The diseases were effectively controlled using the tools of public health science: sanitary discipline and a battery of measures, such as improving trench construction, improving the diet, providing protective kit, regular bathing and treating lice infestation. The response demonstrates the triumph of public health science over new medical technologies. It also illustrates the importance of considering all the many determinants of health and of close surveillance, discipline and partnership working to counter ill-health. Although technology, training, doctrine and health beliefs change over time, the interaction between disease and environment remains the core challenge to public health practitioners.
索姆河战役90周年纪念活动的举行，为审视当时针对战壕疾病（第一次世界大战战壕中出现的新病症）所采取的公共卫生应对措施提供了契机。纵观历史，对于流行病存在两种观点：结构主义观点和传染主义观点。大多数应对战壕疾病的医生，即“偶然传染论者”，将这两种疾病观念结合了起来。由于难以找到致病生物体且缺乏有效治疗方法，多数观点认为这些病症是战壕环境的产物。结构主义强调环境和社会决定因素，似乎为应对战壕疾病提供了最明显的方法。利用公共卫生科学手段有效地控制了这些疾病：卫生纪律以及一系列措施，如改善战壕建设、改善饮食、提供防护装备、定期洗澡和治疗虱子感染。这一应对措施体现了公共卫生科学战胜了新的医疗技术。它还说明了考虑健康的所有诸多决定因素以及密切监测、纪律和合作对抗健康问题的重要性。尽管技术、训练、学说和健康观念会随着时间而变化，但疾病与环境之间的相互作用仍然是公共卫生从业者面临的核心挑战。
