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The first edition of this book was published in 1913 as Milton J. Rosenau’s Preventive Medicine and Hygiene.1 It has now persisted (and thrived) for well over a century. The editors that followed Rosenau included Kenneth Maxcy, John Last, and the current co-editors, Matthew L. Boulton and Bob Wallace. Rosenau’s 1913 first edition was a path-breaking accomplishment when it first appeared, and its successors continue to be field-defining books well into the twenty-first century. This chapter will set the stage by discussing Rosenau’s life and career, as well as by considering the state of public health and the tensions that existed in and around the writing of the first edition of book, especially regarding the relationship between public health and medicine. It will then shift to consider how and when the field of “preventive medicine” was created.


Milton Joseph Rosenau was well-suited to write this book. Born in 1869, Rosenau had a career that witnessed some of most dramatic changes in ideas about disease and disease causation that the world has ever seen. Not only a witness to these events, he was associated with (and helped to shape) some of the most important institutions for the worlds of medicine and public health.2,3

Rosenau attended the oldest medical school in the country, the University of Pennsylvania. He graduated in 1889, only 7 years after the start of the microbiological revolution. The signal event in that epochal revolution came when the German scientist Robert Koch took advantage of new technological developments, such as improved microscopes, solid culture media, and dyes that could enable objects to be seen more clearly under the microscope, to fundamentally transform the way we think about disease through the first clear explication of what is now known as the “germ theory of disease.” He not only identified the cause of tuberculosis—itself a massively significant finding, given that one out of every seven human beings was then dying of the disease—but also, and of much more importance, established a precise way of defining diseases that were caused by specific pathogenic organisms. Previously the actual cause of many diseases was a topic of heated debate. Was the disease caused by foul odors in the air? Or was it a consequence of rapid temperature change, or a family propensity to that disease? If people with a disease were found to harbor microorganisms within their body, were these microorganisms the cause of the disease, or a result of the disease? “Koch’s postulates” provided answers to these questions. His postulates included specific, systematic steps that were necessary to establish a specific microorganism as the cause of a specific disease. As such, they offered a roadmap for scientists to study disease causation and opened the floodgates of scientific discovery. The discovery of Mycobacterium tuberculosis or the tubercle bacillus as the agent responsible for tuberculosis was soon followed by ...

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