The Fall of Hygiene
A word that once named the daily specification of a life came, in little more than a century, to name only the removal of dirt.
What the word once carried
The Greek noun Ὑγίεια, Hygeia, decomposes into eu-, well, and gwiyēs, living. It named the state of being well-alive, in the fullness of what living is. The goddess so named was the daughter of Asklepios, and she personified the active maintenance of health by way of life, distinct from the correction of disease by remedy, which was her sister Panacea’s domain. The word hygiene, when it entered the modern European languages in the eighteenth century, still carried this ampler meaning. It designated the art of living so as to remain whole. It covered air, food and drink, movement and rest, sleep and waking, evacuations and retentions, the passions of the soul. It was, until well into the nineteenth century, a substantial chapter of any respectable medical textbook. This resource has already told the longer story of that ampler meaning and of the doctrinal armature it rested on (see All Medicine Is Preventive, § III). What follows is a smaller and more focused observation, at the level of the word itself.
The turn
In the second half of the nineteenth century, the word narrowed. The narrowing coincided with the germ theory and its extraordinary public health victories. Pasteur, Koch, John Snow, Edwin Chadwick, Max von Pettenkofer, Rudolf Virchow won a war against contagion whose importance no honest reader disputes. They did so, however, in a vocabulary that centred on removal, interruption, and defence. What they had to combat was the pathogen. What they had to protect was the space in which the healthy body might not be reached by that pathogen. Their achievements in sanitation, water supply, wound care, and puerperal fever gave the word hygiene a new and narrower centre of gravity. Hygiene became the discipline of keeping the invader out.
The older half of the word did not die at once. It survived in phrases such as hygiene of life and hygienic regimen well into the twentieth century. But it was steadily displaced. By mid-twentieth century, the noun hygiene, standing alone, no longer evoked a way of eating or a way of living. It evoked cleanliness.
What the word means today
The observation can be made in any ordinary sentence a contemporary speaker might produce.
Hand hygiene means handwashing. Oral hygiene means brushing and flossing. Hospital hygiene means the protocols by which a hospital tries not to infect its patients. Hygiene products means soap, shampoo, tampons, deodorant, the shelf at the pharmacy. Personal hygiene means being clean. Sleep hygiene, which sounds like an exception, is in fact the exception that confirms the rule, because it needs the qualifier sleep to signal that something other than cleanliness is meant. Without a qualifier, hygiene means keeping something out.
None of these current usages concerns what one eats, what one lacks, what one requires, what one is made of. The regime that Galen called sex res non naturales has, in the everyday sense of the word, ceased to be what hygiene names.
What the reduction costs
The reduction is not a curiosity of vocabulary. It shapes what a physician can propose, what a patient can request, what a public health authority can fund, what a school can teach. A curriculum that trains its students in the interruption of contagion but not in the specification of what the body needs is a curriculum that has taken the modern word hygiene as its brief. That curriculum exists. Its graduates staff the medical system.
The reduction also shapes what the citizen can name. A person who wants to demand attention to what their tissues need has no available word in ordinary language. The one word that once named it now means soap. The demand must be rephrased in a vocabulary that does not yet exist for the general public, which is part of why a resource such as this one has to build its own. When the vocabulary is unavailable, the demand is difficult to make. When the demand is difficult to make, the right is difficult to exercise.
What to do with the word
Two paths present themselves.
Restoring the older sense of hygiene is possible but slow. It requires a long lexical repair, one qualifier at a time, one context at a time. Hygiene of life is still available, still just about legible. A generation of writers can bring it back into common use.
The second path is to bypass the word. The physiological right does not need to reclaim the noun hygiene in order to name what it protects. It names it directly, with a vocabulary that is not shrunken. The tissues need what they need. The person is entitled to the substances and conditions their tissues require. The clinical encounter that ignores this is not a hygiene failure, in the modern shrunken sense. It is a violation of an integrity the law already claims to defend.
The resource this critique belongs to takes the second path, without giving up on the first. The word hygiene, as it stands, is too small to carry the argument. The word right is large enough, and old enough, to carry what hygiene once did.