Rola Zakładu Higieny Uniwersytetu Stefana Batorego w rozwoju i promocji zdrowia publicznego w Wilnie w latach 1922–1939

Cel badań: W okresie międzywojennym system opieki zdrowotnej przeżył dramatyczną transformację. Uważano, że medycyna zapobiegawcza jest nie mniej ważna niż medycyna lecznicza. Ponadto, bez zapobiegania tzw. chorobom społecznym wszystkie późniejsze działania stawały się kosztowniejsze i nieefektywne. Walkę z konsekwencjami zastąpiono środkami ukierunkowanymi na zapobieganie. Zwalczanie chorób społecznych wymagało odpowiedniej strategii państwowej i obszernego zestawu narzędzi. Uniwersyteccy naukowcy też mieli udział w tej walce. Badanie wykazało, że w okresie międzywojennym, na Wydziale Lekarskim Uniwersytetu Stefana Batorego w Wilnie, wartość – jaką było zapobieganie chorobom – była zrozumiała, a samo leczenie nie było oddzielone od higieny tak wyraźnie, jak to jest dzisiaj. Mechanizmy zapobiegawcze zostały opracowane zarówno przez wielu higienistów, jak i klinicystów. Szeroka wiedza lekarzy pozwoliła im dostrzec nie tylko biomedyczne, ale także społeczne i ekonomiczne aspekty choroby. Higieniści i lekarze zachęcali władze centralne i lokalne do współpracy i koordynacji działań zapobiegających chorobom oraz do edukacji lokalnej ludności.

Postęp nauk medycznych w Europie i na świecie, a także ideologia sowiecka w Europie Wschodniej, odwracały uwagę lekarzy od poszukiwań społecznej etiologii chorób. Leczenie biomedyczne było skuteczniejsze i od tego czasu rozwój badań nad higieną społeczną w Europie Wschodniej, bardzo spowolnił. Higiena społeczna w Związku Radzieckim była bardzo upolityczniona, można ją było interpretować tylko w kategoriach sowieckiego modelu pojęciowego. System opieki zdrowotnej stworzony w Związku Radzieckim został uznany za najlepszy na świecie. Dane statystyk medycznych były ukrywane przed opinią publiczną, ponieważ ich logiczna interpretacja mogła ujawnić społeczne przyczyny choroby i wady obecnego systemu.

Dzisiaj, aby ulepszyć mechanizmy zdrowia publicznego, czasami musimy powracać do podstawowych idei. Warto zastanowić się nad podstawowymi pytaniami – czym jest zdrowie publiczne i jak je osiągnąć. Szerokie podejście do problemu, wrażliwość na pochodzenie społeczne choroby i wytrwałość w walce z nią, wszelkimi możliwymi środkami, mogłaby być wzorem dla dzisiejszych lekarzy. W tamtym czasie nauka o zdrowiu zbliżyła się do idei, że najwyższym celem zapobiegania chorobom jest stworzenie zdrowego środowiska oraz zapewnienie zdrowych warunków do życia i pracy. Chociaż dzisiaj żyjemy w o wiele bezpieczniejszym środowisku niż ludzie w tamtych czasach, zmiany w technologii i stylu życia, mogą powodować nowe zagrożenia. Szerokie podejście lekarzy pozostaje dziś równie ważne, aby zwalczać nie tylko same precedensy, ale także wstępne warunki ich pojawiania się. Celem niniejszego opracowania jest ujawnienie teoretycznych wzorców w zakresie higieny i zdrowia publicznego ustanowionego przez higienistów Zakładu Higieny w Wilnie, a także prób ich zastosowania w praktyce.

Metody: Badanie przeprowadzono poprzez analizę pierwotnych i wtórnych źródeł historii. Zastosowano metodę porównawczą. Wiele danych z Lietuvos Centrinis Valstybės Archyvas (Litewskiego Centralnego Archiwum Państwowego) zostanie opublikowanych po raz pierwszy. Zgodnie z oryginalnymi danymi archiwalnymi przeprowadzono analizę publikacji naukowych Wydziału Lekarskiego Uniwersytetu Stefana Batora, aby ustalić priorytetowe kierunki prowadzonych w tym czasie badań.

Wnioski: Skomplikowane warunki ekonomiczne, brak poparcia ze strony władz lokalnych i centralnej administracji oraz niedoskonałości ustawodawstwa zdrowotnego w tamtym okresie uniemożliwiły pełne wdrożenie strategii higienistycznych wypracowanych w Uniwersytecie Stefana Batorego. Jednakże uważamy, że działania higienistów USB miały znaczący wpływ na rozwój nauki higieny i praktyki lekarskiej na Wileńszczyźnie w okresie międzywojennym (1919–1939).

Objective: During the interwar period, the healthcare system in Europe experienced a dramatic transformation. It was perceived that preventive medicine was no less important than curative medicine. Moreover, without proper prevention of the so-called social diseases, all later therapeutic measures were expensive and ineffective. The former battle against the consequences was replaced by measures targeting the causes. The fight against social diseases involved a state-owned strategy and a broad arsenal of measures. The University’s scholars also took part in this

process. Our study revealed that the significance of the disease prevention in the Faculty of Medicine at the University of Stephen Bathory was well understood. Moreover, the treatment was not segregated from hygiene as strictly as it is today. Many hygienists as well as clinicians contributed to the development of preventive mechanisms. The broad specialization of doctors enabled them to see not only biomedical, but also social and economic aspects of a disease. Hygienists and doctors encouraged cooperation and coordination of their activities with the central and local authorities as well as education of the local population.

The progress of medical science in Europe and the World, as well as the Soviet ideology in Eastern Europe distracted doctors from the search for the etiology of social illness. Biomedical treatment had become much more effective, and the development of social hygiene research in Eastern Europe had experienced stagnation. For ideological reasons the disease etiology in the Soviet bloc could not be associated with social factors. Social hygiene in the Soviet Union was highly politicized; it could only be interpreted in a frame of Soviet models. The healthcare system that had been created in the Soviet Union was named as the best in the world. The actual medical statistics were concealed from the public, since their logical interpretation could reveal the social causes of illnesses and the disadvantages of the soviet system.

Sometimes we must return to basic ideas to improve current public health mechanisms. It is worth reconsidering fundamental questions, i.e. what public health is and how to achieve it. The breadth of the approach of the interwar Vilnius hygienists and doctors, the sensitivity to the social origins of diseases and persistence in combating them by all possible means could serve as an example for today’s doctors. At that time, hygienists approached the idea that the highest goal of prevention was to create a healthy environment, healthy living and working conditions. Although today we live in a much safer environment than those individuals did, new threats are emerging because of changing technology and lifestyle. The broad approach of physicians remains equally important in order not only to combat individual precedents, but also to overcome the preconditions for emerging precedents. Therefore, the purpose of this paper is to reveal the theoretical patterns of hygiene and public health established by the hygienists of the Vilnius Hygiene Department as well as the attempts to apply them in practice.

Methods: The study was conducted by analyzing the primary and secondary historical sources using the comparative method. A lot of data from the Lietuvos Centrinis Valstybės Archyvas (Lithuanian Central State Archives) that had been used in this research were published for the first time. According to the original archival data, an analysis of the scientific publications of the Faculty of Medicine of the University of Stephen Bathory was made to find out the priorities of the research carried out at that time.

Conclusions: The complicated economic conditions, the lack of support from the local and central government as well as the imperfections in health legislation of that time hindered the full implementation of the hygienist strategies of the University of Stephen Bathory. However, the activities of the Department of Hygiene of Stephen Bathory University had a significant impact on the development of hygiene science as well as medical practice in the Vilnius region during the Interwar period (1919–1939).

Objective: During the interwar period, the healthcare system in Europe experienced a dramatic transformation. It was perceived that preventive medicine was no less important than curative medicine. Moreover, without proper prevention of the so-called social diseases, all later therapeutic measures were expensive and ineffective. The former battle against the consequences was replaced by measures targeting the causes. The fight against social diseases involved a state-owned strategy and a broad arsenal of measures. The University’s scholars also took part in this

process. Our study revealed that the significance of the disease prevention in the Faculty of Medicine at the University of Stephen Bathory was well understood. Moreover, the treatment was not segregated from hygiene as strictly as it is today. Many hygienists as well as clinicians contributed to the development of preventive mechanisms. The broad specialization of doctors enabled them to see not only biomedical, but also social and economic aspects of a disease. Hygienists and doctors encouraged cooperation and coordination of their activities with the central and local authorities as well as education of the local population.

The progress of medical science in Europe and the World, as well as the Soviet ideology in Eastern Europe distracted doctors from the search for the etiology of social illness. Biomedical treatment had become much more effective, and the development of social hygiene research in Eastern Europe had experienced stagnation. For ideological reasons the disease etiology in the Soviet bloc could not be associated with social factors. Social hygiene in the Soviet Union was highly politicized; it could only be interpreted in a frame of Soviet models. The healthcare system that had been created in the Soviet Union was named as the best in the world. The actual medical statistics were concealed from the public, since their logical interpretation could reveal the social causes of illnesses and the disadvantages of the soviet system.

Sometimes we must return to basic ideas to improve current public health mechanisms. It is worth reconsidering fundamental questions, i.e. what public health is and how to achieve it. The breadth of the approach of the interwar Vilnius hygienists and doctors, the sensitivity to the social origins of diseases and persistence in combating them by all possible means could serve as an example for today’s doctors. At that time, hygienists approached the idea that the highest goal of prevention was to create a healthy environment, healthy living and working conditions. Although today we live in a much safer environment than those individuals did, new threats are emerging because of changing technology and lifestyle. The broad approach of physicians remains equally important in order not only to combat individual precedents, but also to overcome the preconditions for emerging precedents. Therefore, the purpose of this paper is to reveal the theoretical patterns of hygiene and public health established by the hygienists of the Vilnius Hygiene Department as well as the attempts to apply them in practice.

Methods: The study was conducted by analyzing the primary and secondary historical sources using the comparative method. A lot of data from the Lietuvos Centrinis Valstybės Archyvas (Lithuanian Central State Archives) that had been used in this research were published for the first time. According to the original archival data, an analysis of the scientific publications of the Faculty of Medicine of the University of Stephen Bathory was made to find out the priorities of the research carried out at that time.

Conclusions: The complicated economic conditions, the lack of support from the local and central government as well as the imperfections in health legislation of that time hindered the full implementation of the hygienist strategies of the University of Stephen Bathory. However, the activities of the Department of Hygiene of Stephen Bathory University had a significant impact on the development of hygiene science as well as medical practice in the Vilnius region during the Interwar period (1919–1939).