[The success of hygiene in the last 40 years]

In Germany, the last period of the Second World War and the following years were characterized by deficiencies of hygiene which had not occurred previously in Middle Europe during the 20th century. There were focuses of typhus, typhoid fever, tuberculosis, diphtheria, scarlet fever, and meningitis. Insufficiencies in the removal of faeces caused high incidences of shigellosis, hepatitis A, and ascariasis. As a result of insufficient body care, many people were infested with fleas, lice and scabies. The migration of large proportions of the population resulted in an increasing prevalence of syphilis an gonorrhea. As the population resettled, the first steps towards reorganization of public health could be done. The spread of typhoid fever was controlled by drinking-water disinfection with chlorine, repair of sewage systems, and patient isolation. The application of DDT helped to reduce scabies and pediculosis, resulting in decreasing typhus risks. During the first two decades after the war, there was a steady decrease of the incidence of infectious diseases. The reconstruction of the towns resulted in improved housing conditions and a decreasing number of persons per housing area, reducing the intensity of physical contacts of the inhabitants with each other. The nutrition and clothing situation of the population improved, which, in addition to a general rise of the standards of hygiene, brought about an increase of the individual resistance to infection. A further reduction of sporadic and epidemic outbreaks of infectious diseases was achieved by the introduction of chemotherapy and antibiotics. Increasing prosperity was accompanied by new problems of hygiene. Infectious diseases almost eradicated in West Germany, were imported by air travellers. Ten imported cases of smallpox were reported between 1957 and 1972, eight of which originated from Southeast Asia. Malaria, imported by German and foreign soldiers, had not been uncommon after the end of the war but had been easy to control by insecticides and antimalarials. As tourism expanded, a new wave of imported malaria cases was reported. In West Germany there is, however, no more spread of the disease under present conditions, cholera caused similar problems. The 1961 cholera epidemic started in Southeast Asia and caused minor outbreaks in Mediterranean countries like Italy and Spain. A significant spread of the disease throughout Europe was prevented by generally high standards of drinking water and sewage treatment. Sporadic cases of typhoid fever were imported from countries with low standards of hygiene.(ABSTRACT TRUNCATED AT 400 WORDS)