Hygiene Before Germ Theory

[Dr. Imago]

As mentioned above, we have Joseph Lister to thank in large part for bringing this to the forefront. His observations and interventions occurred well after the early 1700's, a time of poor understanding of the causation of disease.

Ignaz Semmelweis may have pre-dated Lister, but broad acceptance of techniques often follows years after an initial observation is made, especially before the dawn of the information age.

We evolved to have robust immune systems. Living in close proximity with incredibly dense populations is a relatively recent phenomenon in human existence. I think it just took a really long time to link "dirt" with infection for the reasons named in this thread. Of course, now we sanitize everything and we still have infections, something seen as less and less acceptable (and possibly fully preventable, which still may not be true) in the modern age.

~Dr. Imago

 

[Professor Yaffle]

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.

I'll admit I don't know a huge amount about this, but can you point me to some source that suggests that the midwives had anything about hygiene figured out? It was my understanding that the difference between the mortality rates of the two clinics was nothing to do with anything the midwives did with regard to cleanliness per se, but that it was their lack of contact with dead bodies (the other clinic was run by medical students) that caused the difference in mortality rates. And isn't it puerperal fever?

 

[jimbob]

This is interesting - Neonatal Tetanus in St Kilda

Until a few years ago, the explanation for the high death rate there was that the midwife smeared Fulmar oil on the umbilical cord.

It now looks more complicated than that. Still due to poor hygiene.


PDF link.

http://www.rcpe.ac.uk/journal/issue/journal_38_1/stride.pdf

 

[jimbob]

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?

Within the last decade, the Telegraph had an article about insufficient handwashing in hospitals.

It concluded with the joke:

What's the difference between a surgeon and Pontius Pilate?

Pilate washed his hands

 

[catsmate]

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.

Indeed, I wondered if there was some common inspiration for her and Snow, as they used similar statistical methodology at the same time but I never found evidence of such.
As far as the development of military medical science and practice she's there with Ambrose Pare, Dominique Jean Larrey, John Jones, Carl Reyher, Paul Leopold Friedrich, Antoine Depage and Harvey Cushing.

 

[Skeptic Ginger]

I'll admit I don't know a huge amount about this, but can you point me to some source that suggests that the midwives had anything about hygiene figured out? It was my understanding that the difference between the mortality rates of the two clinics was nothing to do with anything the midwives did with regard to cleanliness per se, but that it was their lack of contact with dead bodies (the other clinic was run by medical students) that caused the difference in mortality rates. And isn't it puerperal fever?

Interesting, I'll have to investigate.

 

[RationalVetMed]

From: p 371 of "The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present" by Roy Porter, Fontana Press, London, 1997

"The sepsis problem came to a head in the 1840s at the Vienna General Hospital, where the maternity clinic, the world's biggest, was divided into two. In Ward One childbed fever raged, and the mortality rate hit a catastrophic 29 per cent. In Ward Two, the rate was only around 3 per cent. Why? Pondering the contrast, the assistant physician Ignaz Semmelweis (1818-65) judged the only difference between the two was that births in Ward One were handled by medical students and those in Ward Two by midwifery pupils. As an experiment, they were made to exchange places: the high mortality followed the medical students. Semmelweis's suspicion that infection was communicated during delivery was conformed when Joseph Kolletschka (1803-47), professor of forensic medicine, cut his finger during an autopy and died from septicaemia.

"'Day and night, the image of Kolletschka's illness pursued me,' Semmelweis recalled. 'As we found identical changes in his body and those of the childbed women, it can be concluded that Kolletschka died of the same disease.' Since medical students came directly from autopsies with soiled hands and instruments, was it not obvious that 'puerperal fever is caused by conveyance to the pregnant woman of putrid particles derived from living organisms, through the agency of the examining fingers'? In May 1847 Semmelweis ordered hand-washing with chlorinated water before deliveries; in both wards mortality plummeted."

Mrs Nalyssus is doing one of her OU courses

Yuri

 

[Professor Yaffle]

Interesting, I'll have to investigate.

http://en.wikipedia.org/wiki/Ignaz_Semmelweis#Discovery_of_cadaverous_poisoning

 

[Beerina]

Napolean's command to Josephine, "Home in three days. Do not wash."

 

[Skeptic Ginger]

http://en.wikipedia.org/wiki/Ignaz_Semmelweis#Discovery_of_cadaverous_poisoning

I'm aware of that side of the story and the connection to the autopsies. But I was under the impression that the nurses also practiced hygiene that is often left out of the story.

Nightingale recognized hygiene and that formed the basis of modern nursing:

It worked, and after the war, in 1860, she founded the Nightingale School of Nursing at St. Thomas' Hospital in London, where nursing students would learn not only about patient care, but also about the importance of good hygiene and sanitary conditions in medicine. The school's curriculum laid the groundwork for modern nursing education.

This is what is left out of the historical accounts. But, you still may be right that I made an assumption about nursing care that wasn't true. Professional training for nurse midwifery began in Europe. Both professional nurses training and professional midwifery training included the importance of hygiene. I need to investigate further but I don't dismiss what I think I read elsewhere just because the historical accounts of Semmelweis leave out the fact the midwives washed their hands, nor am I dismissing the possibility I've read something incorrect or remembered something incorrectly.

I shall have to investigate the midwifery and nurses training of the day and it's not readily found with a Google search. Nightingale and Semmelweis are from the same timeframe. So it means I need to look at the state of midwifery before Nightingale.

 

[ddt]

A question that popped up with me reading this thread, and may not really be answerable: In 1676, Antonie van Leeuwenhoek observed for the first time single-celled organisms under his microscope. This wasn't some obscure discovery - he was, e.g., elected to the Royal Society for this discovery. Yet, it took another 2 centuries for people to come up with the germ theory of disease.

Didn't anyone in the meantime get the idea that these little critters might be responsible for diseases? It seems so natural, but maybe I suffer from the bias of hindsight.

 

[Professor Yaffle]

A question that popped up with me reading this thread, and may not really be answerable: In 1676, Antonie van Leeuwenhoek observed for the first time single-celled organisms under his microscope. This wasn't some obscure discovery - he was, e.g., elected to the Royal Society for this discovery. Yet, it took another 2 centuries for people to come up with the germ theory of disease.

Didn't anyone in the meantime get the idea that these little critters might be responsible for diseases? It seems so natural, but maybe I suffer from the bias of hindsight.

At least one person did:

Microorganisms were first directly observed in the 1670s by Anton van Leeuwenhoek, an early pioneer in microbiology. Building on Leeuwenhoek's work, physician Nicolas Andry argued in 1700 that microorganisms he called "worms" were responsible for smallpox and other diseases.

http://en.wikipedia.org/wiki/Germ_theory_of_disease#Pre-19th_century

 

[Lowpro]

A question that popped up with me reading this thread, and may not really be answerable: In 1676, Antonie van Leeuwenhoek observed for the first time single-celled organisms under his microscope. This wasn't some obscure discovery - he was, e.g., elected to the Royal Society for this discovery. Yet, it took another 2 centuries for people to come up with the germ theory of disease.

Didn't anyone in the meantime get the idea that these little critters might be responsible for diseases? It seems so natural, but maybe I suffer from the bias of hindsight.

It was a question of etiology then and Yaffle linked to Andry however the issue of pandemics and communicable disease, while the etiology being unknown, wasn't quite misunderstood either. It was easier to see a sick person and identify rudimentary vectors than to see the actual cause. I also "think" but I'm speaking from memory that toxins from a source (be it plants or bacteria) were understood though I doubt many people knew the toxins may have come from a bacteria rather than from a more macroscopic source (ie blood, saliva, damp woods or organisms).

But then again there were also wildly insane theories existing then too such as spiritual etiologies or curses to plain old "that's the way it's always been" explanations for some diseases then too which may have muddied the waters and slowed the progress of dissemination of early germ theory ideas.

 

[mijopaalmc]

A question that popped up with me reading this thread, and may not really be answerable: In 1676, Antonie van Leeuwenhoek observed for the first time single-celled organisms under his microscope. This wasn't some obscure discovery - he was, e.g., elected to the Royal Society for this discovery. Yet, it took another 2 centuries for people to come up with the germ theory of disease.

Was that before or after he looked at his own live sperm?

 

[Dr. Keith]

This is what is left out of the historical accounts.

You keep saying this, but the fact that you know it seems to tell a different story. Unless you are much, much, older than I assume. In which case, I should warn you that I always carry garlic.

As an aside, when my kids saw the news on the recent trouble in Crimea one of their first comments was asking if that had anything to do with the Crimean War, you know the one where Nightingale figured out nurses should clean stuff. That is all they really know about her or Crimea.

 

[Lowpro]

From: p 371 of "The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present" by Roy Porter, Fontana Press, London, 1997



Mrs Nalyssus is doing one of her OU courses

Yuri

Huh, funny thing is I recently found a reason to grab my copy of the book to recommend to someone and now I saw it here. i should have grabbed my copy earlier XD

 

[Skeptic Ginger]

You keep saying this, but the fact that you know it seems to tell a different story. Unless you are much, much, older than I assume. In which case, I should warn you that I always carry garlic.

As an aside, when my kids saw the news on the recent trouble in Crimea one of their first comments was asking if that had anything to do with the Crimean War, you know the one where Nightingale figured out nurses should clean stuff. That is all they really know about her or Crimea.

Ask your kids if they know Nightingale was a scientist and a statistician.

 

[Lowpro]

Ask your kids if they know Nightingale was a scientist and a statistician.

Uh, I think a lot of kids learn that now, I know my brother did because I helped him write his report XD. But maybe education has adopted that recently. Times they are a'changing!

 

[Skeptic Ginger]

Uh, I think a lot of kids learn that now, I know my brother did because I helped him write his report XD. But maybe education has adopted that recently. Times they are a'changing!

Here's an example from children's education resources in the UK:

Why is Florence Nightingale famous? How did she become famous?

Florence Nightingale went to the Crimean War to nurse wounded soldiers. She and her nurses saved many lives.

When did she live?
Florence was born in 1820. This was ten years before Britain had its first steam passenger railway. She lived through the long reign of Queen Victoria. She died in 1910, after the age of electricity, cars and planes began.

What Florence Nightingale did
Florence Nightingale made hospitals cleaner places. She showed that trained nurses and clean hospitals helped sick people get better. She was the founder of modern nursing.

See anything here about research and being a statistician?
http://resources.woodlands-junior.kent.sch.uk/Homework/victorians/florence/index.htm

She found the hospital conditions to be in a very poor state. Many of the wounded were unwashed and were sleeping in overcrowded, dirty rooms without blankets or decent food. In these conditions diseases such as typhus, cholera and dysentery spread quickly. As a result, the death rate amongst wounded soldiers was very high. Most soldiers died from infections and disease. (Only one in six died from their war wounds; the other five in six died from infections and disease.)

Florence and her nurses changed these conditions. They set up a kitchen, fed the wounded from their own supplies, dug latrines for sanitation, and asked for help from the wives of the wounded. They were then able to properly care for the ill and wounded and the death rate among the soldiers dropped.

I can't believe skeptics are arguing women's history does not have significant deficits.

Tell me, why after this knowledge were doctors so unhygienic attending women in childbirth and does it make sense the midwives in Semmelweis' day were washing their hands in the tradition of nursing in addition to not attending autopsies?

Why is it hard to find out? Is there any mention of the midwives following Semmelweis' advice, or not following it? What the women were doing during this time wasn't seen as important enough to mention, yet they had lower patient death rates. You'd think that made it worth recording the history of whether they did or did not adopt Semmelweis's suggestions.

 

[Lowpro]

Here's an example from children's education resources in the UK:

Why is Florence Nightingale famous? How did she become famous?



See anything here about research and being a statistician?
http://resources.woodlands-junior.kent.sch.uk/Homework/victorians/florence/index.htm


I can't believe skeptics are arguing women's history does not have significant deficits.

Well you definitely have a chip on your shoulder but I'm not arguing there's a deficit in women's history. But if you'd like I can send you my brother's essay on Florence Nightingale. Keep in mind it was made for his freshman high school class. You don't have a monopoly on all children's educational curriculum so you don't need to waste your time with cursory google searches to make a point that we aren't even arguing against ( skeptics denying that women get shafted when it comes to historical contributions). If you want to, go ahead and make a poll thread with the question "As skeptics, do you think that women history does not have significant deficits: Yes/No". That would be a more honest way of acting right now, otherwise this is childish.

You edited so I'll edit to the last two paragraph-ish things. To both, I have no idea. Medical policies move REALLY SLOWLY and with a lot of fighting back and forth. It's not like these things happen quickly. It took a decade after the AID's epidemic to get mandatory glove use policies past the ADA if that might demonstrate it. Consider the midwives to be innovators, but innovation to early adoption all the way to common use is a bumpy road. Always has been.