Sanitation conquered disease long before vaccines or antibiotics

I always love bringing up [Ignaz Semmelweiss](<a href="https:&#x2F;&#x2F;wikipedia.org&#x2F;wiki&#x2F;Ignaz_Semmelweis" rel="nofollow">https:&#x2F;&#x2F;wikipedia.org&#x2F;wiki&#x2F;Ignaz_Semmelweis</a>), the Hungarian physician who advocated for hand washing before germ theory was established, after observing that pregnant mothers were more likely to become infected when they were handled by doctors than by midwives. His fastidiousness made him unpopular though and he was ridiculed as a stickler by his fellow staff. When he refused to drop this theory, his colleagues convinced his wife to commit him to a mental hospital, where he died due to infection from an unsanitary operation.

Prevention vs treatment, indeed! I anticipate that as antibiotics become less effective that table manners and food handling hygiene will have a revival. For example we’ll go back to proper butter knives rather than everyone using their bread knife in the communal butter dish.

Sanitation is good, but too much sanitation is not so good. We&#x27;re only just beginning to understand our relationship with bacteria, virii and micro-organisms. While sanitation was a great boon to reducing deadly pathogens, we&#x27;re now in the process of swinging the pendulum too far, using antibacterial products that should really only be used in hospitals, keeping children out of the dirt (with growing indications that this leads to allergies), and generally living in fear of anything not institutional-clean. Our immune systems are beginning to atrophy from lack of &quot;exercise&quot;.<p>Have you ever wondered why lovers touch their lips together, effectively sharing the bacterial brew in their mouths with another? I can guarantee that such evolved behavior is not simply coincidental.

A fantastic graphical representation of this is &quot;The Conquest of Pestilence in New York City&quot;, produced by the Department of Health &amp; Mental Hygine, showing progress from 1800 to 2002:<p><a href="http:&#x2F;&#x2F;1.bp.blogspot.com&#x2F;-uTWEATUzgxk&#x2F;TXQoTibILtI&#x2F;AAAAAAAAAAM&#x2F;eyirotYDmXo&#x2F;s1600&#x2F;2004_01_healthstat.jpg" rel="nofollow">http:&#x2F;&#x2F;1.bp.blogspot.com&#x2F;-uTWEATUzgxk&#x2F;TXQoTibILtI&#x2F;AAAAAAAAAA...</a><p>This tracks <i>mortality</i> (rather than life expectency), but shows clearly the tremendous progress made from 1850, with a peak mortality rate approaching 50 deaths per thousand peak (from a baseline of ~30 - 40 per mille) to about 12&#x2F;mm in 1920, and the present rate of about 6&#x2F;mm.<p>From 1950-1970, and for a briefer period in the 1980s, progress was <i>reversed</i> with mortality increasing. There&#x27;s actually been an impressive (though small realtive to 19th century improvements) reduction since 1990.<p>Looking at that chart, realise that virtually all the improvement through about 1950 precedes <i>most</i> of what we consider to be modern medicine: advanced cancer treatments, antibiotics, most vaccines, transplant surgeries, genetic therapy, pacemakers, and more. The progress instead comes mostly through increased sanitation and hygiene, as well as reduced environmental contaminations and hazards, though it includes both antisceptics and anesthesia.<p>We&#x27;ve been paying a <i>tremendous</i> amount in medical advances for a very slight improvement in outcomes.

There’s degrees of “conquered”. Seat belts ‘conquered’ motor vehicle trauma before airbags did. Each new thing helps fill in the gaps left by the already-existing things.

I&#x27;m actually anti-sanitation, we mud people believe it causes allergies!

Note that the title chosen does not match the title of the article, which is &quot;Draining the Swamp&quot;.

rootsofprogress.org? Funded by &quot;Emergent Ventures,&quot; some affiliate of Marginal Revolution University... Whose narrative am I looking at here?<p>Honest question. Anyone know?

<a href="https:&#x2F;&#x2F;observablehq.com&#x2F;@mbostock&#x2F;the-impact-of-vaccines" rel="nofollow">https:&#x2F;&#x2F;observablehq.com&#x2F;@mbostock&#x2F;the-impact-of-vaccines</a><p>That figure is real hard to refute, or square with any other cause of reduction of measles infections except vaccination.

People should not settle this dense in the first place. I hope more people are going to rural areas once StarLink an competitors deploy universal Internet connection coverage.