MIASMA AND SOCIAL-FACTORS IN DISEASE CAUSALITY - LESSONS FROM THE 19TH-CENTURY

Conventional public health wisdom holds that the end of the nineteenth century saw a dramatic change in beliefs about what causes disease, a s early convictions about the importance of broad social factors gave way to a concentration on microorganisms. I argue, however, that in bo th the middle and late nineteenth century nearly everyone, professiona ls and laypeople alike, saw disease causality in terms of precise, inv isible entities, and that prevention policies were as reductionist and narrow as the available technology would allow. My argument is based on a rereading of the primary documents that other scholars have seen as supporting the idea of two distinct public health periods, and on a new interpretation of the revisionist history that questions the idea . I suggest that health policy analysts today are too vague about the meaning of ''social factors'' and that disease prevention policies mig ht be better if the term was clarified.