Hygiene Before Germ Theory

[Sideroxylon]

What isn't true? What is your version, what is the timeline and by all means post a link or at least cite your source.

I am saying nurses must have been credited to some degree for you to become aware of it. Here assuming you are not speaking from independent research but from the ideas of at least one historian.

 

[RussDill]

It seems that doctors did was their hands with soap and water. But any doctor or vet knows that this is not nearly enough. Here's a quote from one of contemporary critics:

http://books.google.com/books?id=sBLcu6vzHjAC&lpg=PT360&ots=JdC4rGy7hD&pg=PT360#v=onepage&q&f=false

A rapidly fatal putrid infection, even if the putrid matter is introduced directly into the blood, requires more than homeopathic doses of the poison. And, with due respect for the cleanliness of the Viennese students, it seems improbable that enough infective matter or vapor could be secluded around the fingernails to kill a patient.

They couldn't understand that just because something looks clean, doesn't mean that it is clean, and the requirement of chlorine washes.

 

[xtifr]

Prior to the development of cheap hot water, bathing (in Europe and the US, at least) was very rare.

The Ancient Romans were famous for their baths, and they were somewhat prior to the development of cheap hot water. For that matter, while I don't have a citation to provide at the moment, it's my understanding that bathing remained popular in Europe through the Medieval era. Yes, despite all the stereotypes about dung and whatnot. It really only dropped out of fashion in the Renaissance, or so I've been given to believe.

 

[catsmate]

Wasn't there also a pathological distrust of water for a very long time, prior to germ theory? Washing might have been seen as entirely counterproductive.

Given the prevalence of waterborne disease there's a reasonpeople avoided water, and drank ale/beer for so long.

I don't think in London, in the 1700's, surgeons were lacking for water to cleanse their instruments.

Then you'd be wrong. I suggest you study the history of water supply, in London and elsewhere. Water isn't the problem, clean water is.

Do you know when the first water filtration system was installed in London's water supply? 1829. This was the world's first treated public water supply, installed by James Simpson for the Chelsea Waterworks Company.
BTW that company only supplied one part of London.
Mandatory treatment was implemented in 1856, mainly because of John Snow's work on the 1854 cholera outbreak. Again this was a world first.

There is very little effort in at least rinsing your hands and the tools you'll be using. Maybe they wiped the blades on a cloth? But I never read about any sanitary measures they took. Surgery is always described as incredibly filthy.

Your'e looking at this from the perspective of someone with easy access to clean water and a range of safe, effective, cleansing productions. This wasn't the situation for most of history.


BTW if anyone's interested in the history of antiseptic surgery in the USA I recommend you look at the life of genius surgical pioneer, eccentric and cocaine addict William Stewart Halsted. (Wiki)
Imber's book (Genius On The Edge: The Bizarre Double Life of Dr. William Stewart Halsted) is an excellent recent biography. Halsted was, frankly, an odd man but he was quite probably the most important person in US medical history, pioneering proper training, anesthesia, antisepsis, animal experimentation, blood transfusion and the use of rubber gloves.
He was the first person to perform an emergency gallbladder surgery (cholecystotomy). On his mother, on the kitchen table at 2AM.

 

[Pup]

It wasn't that they were not concerned about sanitation, but that their idea of good sanitation differed greatly from ours. Just as ours will differ from future generations.

Exactly. I'm more familiar with early 19th century practices, but at that time, there was an understanding that cleanliness was important, but the focus was primarily on airborne problems. Bad odors were considered the root of problems, so people were washing down sickroom walls, rather than surgical instruments, with disinfectants like chloride of lime, because instruments were not considered to be a source of odor, but walls, sinks, chamber pots, etc. were.

 

[Pup]

And wouldnt you think even if you didnt know smoking causes lung cancer and break down of arterial walls...that repititiously breathing in concentrated smoke/particulate cant be all that good to do?...even from the standpoint of displacing oxygen that your cells need?

They did. Same story as always. Drug addicts didn't want to listen and others were too concerned about profits.

A Disquisition on the Evils of Using Tobacco, 1833

I am aware, indeed, that it may be said, if the whole company of tobacco-chewers, smokers, and snuffers, should at once abandon all use of this weed, and thus withdraw their whole patronage, this twenty-five millions of dollars, which now gives wealth to many a man engaged in growing, manufacturing, and vending the poison, would be so much capital unemployed ... Shall one sixth part of the nation continue to use this poison, because, forsooth, Reproducers and venders of it will lose their profits if it be abandoned ? Shall the intellect, and health, and comfort, and wealth, and lives of hundreds and thousands of our fellow citizens, be sacrificed yearly... and all this, that the producers and venders may feed and fatten on the gains ?

...

Some of my readers may be startled at this consideration. They may not have dreamed, even, that tobacce kills anybody. So insidious are the effects of this poison, and so insensible have the community been to its abominations, that very few have regarded the use of tobacco as the cause of swelling our bills of mortality. But though appalling, it is nevertheless true, that tobacco carries vast multitudes to the grave, all over our country, every year.

 

[catsmate]

Exactly. I'm more familiar with early 19th century practices, but at that time, there was an understanding that cleanliness was important, but the focus was primarily on airborne problems. Bad odors were considered the root of problems, so people were washing down sickroom walls, rather than surgical instruments, with disinfectants like chloride of lime, because instruments were not considered to be a source of odor, but walls, sinks, chamber pots, etc. were.

Anti-Listerism; there was a huge debate about the relative importance of cleanliness of surgeons/instruments et cetera against the environment.

 

[Pup]

Anti-Listerism; there was a huge debate about the relative importance of cleanliness of surgeons/instruments et cetera against the environment.

No, I'm talking about decades before Lister's discovery: the early 19th century.

"Disinfectants"--called exactly that--were well known long before Lister. They just weren't used where they would be most effective, because people didn't understand what needed disinfecting.

A random example, from 1828:

Besides heat, and currents of air, there are substances that are known to possess, more or less, the power of disinfection...

As a disinfecting agent, either of the following simple and easily obtained fumigations may be carried at least once a-day through the apartments of the sick...

Take nitrate of potash (nitre) four drachms
Sulphuric acid (oil of vitriol) two drachms...

A better disinfecting agent, perhaps, than either of the above, is a solution of the chloride of lime, or of the chloride of soda. A solution of either of these salts may be sprinkled over the floor, or placed in the room for a short time, in flat dishes, to favor their evaporation.

Not much changed in the ensuing decades. In 1863, right before Lister's discovery, a chapter on "Disinfectants" from A Manual of Minor Surgery:

Again, we sometimes see a tendency prevailing in a hospital, or in a single ward, to the occurrence of phagedaena; every sore already existing becoming gangrenous, and new ones of like character breaking out... We cannot but attribute it to atmospheric influence, whether we suppose organic particles or fomites floating in the air, or adopt a more purely chemical theory, such as that of catalysis.

To combat the conditions now mentioned, we use what are called disinfectants or antiseptics...

Chlorine is the best known, and perhaps the most efficient of the disinfectants properly so called. It is readily given off by many of its compounds, and thus becomes diffused in the form of vapor, so as to attack and neutralize any noxious effluvia which may be floating in the air. Chloride of lime may be placed in shallow dishes or trays here and there in the ward or room to be purified... In like manner the solution of chlorinated soda... may be sprinkled about.... Dysenteric discharges, slop-basins and jars used to contain foul and dirty dressings in a surgical ward, may be freed from all noxious or disagreeable smell by the same means.

 

[Fudbucker]

It seems that doctors did was their hands with soap and water. But any doctor or vet knows that this is not nearly enough. Here's a quote from one of contemporary critics:

http://books.google.com/books?id=sBLcu6vzHjAC&lpg=PT360&ots=JdC4rGy7hD&pg=PT360#v=onepage&q&f=false



They couldn't understand that just because something looks clean, doesn't mean that it is clean, and the requirement of chlorine washes.

So you would say they made an attempt to at least make it look clean (e.g., wiping it on their apron or something?)?

 

[Fudbucker]

Given the prevalence of waterborne disease there's a reasonpeople avoided water, and drank ale/beer for so long.


Then you'd be wrong. I suggest you study the history of water supply, in London and elsewhere. Water isn't the problem, clean water is.

Do you know when the first water filtration system was installed in London's water supply? 1829. This was the world's first treated public water supply, installed by James Simpson for the Chelsea Waterworks Company.
BTW that company only supplied one part of London.
Mandatory treatment was implemented in 1856, mainly because of John Snow's work on the 1854 cholera outbreak. Again this was a world first.


Your'e looking at this from the perspective of someone with easy access to clean water and a range of safe, effective, cleansing productions. This wasn't the situation for most of history.


BTW if anyone's interested in the history of antiseptic surgery in the USA I recommend you look at the life of genius surgical pioneer, eccentric and cocaine addict William Stewart Halsted. (Wiki)
Imber's book (Genius On The Edge: The Bizarre Double Life of Dr. William Stewart Halsted) is an excellent recent biography. Halsted was, frankly, an odd man but he was quite probably the most important person in US medical history, pioneering proper training, anesthesia, antisepsis, animal experimentation, blood transfusion and the use of rubber gloves.
He was the first person to perform an emergency gallbladder surgery (cholecystotomy). On his mother, on the kitchen table at 2AM.

Maybe so. Thanks for the links!

 

[RussDill]

So you would say they made an attempt to at least make it look clean (e.g., wiping it on their apron or something?)?

Actually using soap and water from what I understand. But like I said, that isn't nearly enough.

 

[Silly Green Monkey]

A gentleman's hands are always clean. How dare you malign the gentleman doctor by implying his hands are as dirty as those of a man of the filthy lower classes?

 

[Skeptic Ginger]

I am saying nurses must have been credited to some degree for you to become aware of it. Here assuming you are not speaking from independent research but from the ideas of at least one historian.

If you look up the history of handwashing in medicine, nurses are listed as an observation and Semmelweis^WP is credited for the discovery. It took years more before his ideas were accepted, all the while the nurses kept washing their hands and doctors kept killing their patients.

Maybe you think that's correct, nurses were no more than an observation, but I think it reflects typical male distorted history.

 

[Lowpro]

Didn't mean to shortchange Pasteur, however, Snow was first and probably contributed to Pasteur's discoveries.

http://en.wikipedia.org/wiki/1854_Broad_Street_cholera_outbreak#John_Snow_investigation


I ask again, by what time?

You're annoyed I shortchanged Pasteur, I'm annoyed you are short changing the nurse midwives who figured out hygiene long before the doctors of the day figured it out.

The fact the doctors delivering infants caused fatal puperial fever in women while the midwives had a lower fatality rate is well documented.


I beg to differ. If you think surgeons figured this out before the midwives that Semmelweis observed, by all means tell us this timeline.

The nurses figured it out, the doctors are credited by history. But I am willing to reconsider, just document the timeline.

Oh I'll be the first to admit I'm not sure about the midwives here. They need to get a better promoter for their contributions here.

And the time was probably 1500's for fomites, such as understanding that the clothing and bandages used for injured (not contagion, just injured) had to be DESTROYED to prevent contagion. It's probably earlier than 1500's.

So I really don't know too much on the midwives so I will offer my apology to that.

 

[Skeptic Ginger]

I'd be very interested in something more specific about that fomite recognition that early in history if you have it. I can imagine people were afraid of everything that touched someone who died of the plague during that era. So I can believe with a disease that included ugly black draining buboes that people burned everything.

 

[Frozenwolf150]

http://www.cracked.com/article_20186_6-ridiculous-myths-about-middle-ages-everyone-believes.html
Scroll down to #5. Bad hygiene seems to have started with superstitions surrounding the Black Plague.

Also, yes, although she didn't know of germ theory, Florence Nightingale figured out that washing wounds was a good way to keep them from getting infected. For anyone interested in this topic, and the horrid state of medical practices around the time of the Crimean War, I recommend the following book:
http://www.amazon.com/Death-Or-Glory-Legacy-Crimean/dp/0813337895

 

[Craig4]

But doctors knew that foreign matter causes all sorts of problems when it gets in a wound. They would do too much surgery, in order to remove a bullet, when they were better off just leaving it in. Why then, would you use a dirty knife blade, or dirty finger?

I can't believe they didn't at least try to clean a little, prior to surgery, but then you look at the success of Lister's hand-washing experiment, and I guess they really were content to be filthy back then. It doesn't make any sense. Although, I was re-reading Lister's experiments, and there was a lot more going on than just washing hands.

Is it possible doctors in the middle ages tried to maintain as much cleanliness as possible, and books juts exaggerate how bad it was?

I know they were worried about parts of clothes in a wound. I remember reading an account of a doctor who was going to duel with pistols and insisted that he do so naked. Reason being that he didn't want any parts of his clothing in the gunshot wound that would "fester".

 

[Skeptic Ginger]

http://www.cracked.com/article_20186_6-ridiculous-myths-about-middle-ages-everyone-believes.html
Scroll down to #5. Bad hygiene seems to have started with superstitions surrounding the Black Plague.

Also, yes, although she didn't know of germ theory, Florence Nightingale figured out that washing wounds was a good way to keep them from getting infected. For anyone interested in this topic, and the horrid state of medical practices around the time of the Crimean War, I recommend the following book:
http://www.amazon.com/Death-Or-Glory-Legacy-Crimean/dp/0813337895

Nightingale, another woman history shortchanged. Her image is one of the altruistic woman of means helping poor wounded soldiers. In reality she was a scientist who collected some of the first systematic observations of wound treatment vs healing, and used statistical analysis to interpret the data.

 

[Lowpro]

I'd be very interested in something more specific about that fomite recognition that early in history if you have it. I can imagine people were afraid of everything that touched someone who died of the plague during that era. So I can believe with a disease that included ugly black draining buboes that people burned everything.

The citation would be lecture notes during my Master's classes (MPH Epidemiology if I may strut my credentials like a boss) which covered history of diseases. Fomites aka fomes were the name for material that was related to plagues areas and were destroyed. For physicians that meant the trade goods of infected areas and those treated. Now I honest to God hate doing cursory google searches and linking them, and I'll be damned before I use Cracked.com as a resource but I don't have a proper citation on hand.

So I did a google search for fomite history and found the name Girolamo Fracastro and that seems to be a recognized publication for the idea of what are considered fomites. The concept may have been earlier and surely is more refined now but I feel comfortable with this being a reliable "source".

 

[Trakar]

Really stinky mates must have been a turn on.Because every must have been really stinky. But maybe the smell covered up the smell....

Also probably explains why oral sex wasn't much practiced outside of cultures that valued public baths and abundant clean water.