[Blind alleys and misconceptions in public health].

The concept of hygiene was created in the 19th century although Hippocrates had already conceived an influence of atmosphere, soil and water on human health. The concept of a public health organisation, however, is a fairly recent one. Environmental and social hygiene were the two poles of the new discipline that focussed on public health. However, the ideologies of capitalism, communism and socialism as well as of social darwinism and "survival of the elite" discredited social hygiene. The decline of totalitarianism was associated with a "loss of face" of state-controlled medicine, including social hygiene. Both the post-World War II German constitution and the previous German statutory health insurance ordinance had blocked it, and hence, no Federal bill on public health was carried. The consequences of this disregard of public health are poor protection by vaccination, a gap in compulsory notification and in epidemics control and high rates of nosocomial infections. Absolutely no development of the science of epidemiology was possible whereas that of medical microbiology is choked by the system now in existence. There is a great misconception within individual hygiene by identifying it merely with cleanliness. Hygiene became a synonym for cleanliness, although that had evolved during a long cultural sociological process centuries before hygiene was established. The modern evolution of the science of hygiene shows the danger that emphasis on healthy lifestyles or on environmental protection may result in regulations and finally in a tyranny that may threaten the liberty of human rights. The so-called "principle of concern" is an example of such irrationality because there is no sensible proportion between risk and expense.