Hygiene Before Germ Theory

[RationalVetMed]

...it's not clear from the links posted so far if the midwives also knew the importance of hygiene.

In the quote I posted earlier the author reported when Semmelweiss instituted hand-washing in both the wards in the study, mortality rates improved in both groups - those attended by nurses and by medical students.

This would suggest (to me anyway) that midwives may have been cleaner at the start than medics, but this was by virtue of their not practicing post-mortems, since their standards of hygiene seem to have benefitted from the improvement.

Yuri

 

[Professor Yaffle]

A little snippet about Nightingale and hygiene:

Nightingale’s work was based in pre-germ-theory ideas about health and disease, and her concepts of illness reflected traditional humoral ideas about bodily balance and imbalance. However, in the 19th century, theories about zymotic, miasmatic, and other environmentally based sources of infection were predominant, and Nightingale took it as self-evident that filth, putrefaction, and decay—and the miasmic emanations they sent through the air—were the causes of individual diseases and epidemics. For the most part, she did not believe that diseases had specific identities, but, instead, believed that they could change from one disease to another. She also resisted the idea that disease could be contagious from person to person. To her, diseases and epidemics were caused entirely by environmental influences; this conviction was central in her evangelical devotion to hygiene and sanitation in hospitals. Nightingale advocated strongly for regular linen changing, adequate ventilation, the frequent emptying of chamber pots, and the regular scrubbing of floors and walls.

When the germ theory was developed after about 1870, Nightingale was skeptical of its importance, and remained convinced that hygienic practices were more valuable for health than knowledge of bacteriology.

http://ocp.hul.harvard.edu/contagion/nightingale.html

A case of being right for the wrong reasons. Which is often a very good step on the road to finding out the right reasons, but not quite the same as implying that the nurses had it all figured out and the doctors were just slow to catch on and then took all the credit.

 

[Skeptic Ginger]

I don't believe I said nurses had it all figured out, I said they were practicing hygiene before physicians figured it out it mattered. I did not think Nightingale had stumbled on the germ theory, just that there was a correlation between keeping wounds clean and healing.

While several sources cited here indicate Semmelweis instituted hand washing practices among the nurse midwives as well, I find it interesting the fatality rate among the midwives was initially only 2% without hand washing in a hospital setting. It makes me even more curious to find more about the whole historical story here.

 

[Dr. Keith]

I don't think I've been impolite.

You have not. And I have not said or implied otherwise.

 

[dudalb]

What is interesting about Medical Practices in the Mid 19th Century is how doctors begun to do the right things for the wrong reasons. During the Civil war, Medical officers begun to really enforce sanitation measures in army camps. They found out that if a water supply was kept clean and measures taken to avoid cotaminating it, the sick list dropped dramitically. They did not quite know why,but they knew it was a fact.

 

[Skeptic Ginger]

What is interesting about Medical Practices in the Mid 19th Century is how doctors begun to do the right things for the wrong reasons. During the Civil war, Medical officers begun to really enforce sanitation measures in army camps. They found out that if a water supply was kept clean and measures taken to avoid cotaminating it, the sick list dropped dramitically. They did not quite know why,but they knew it was a fact.

One very early study I read around the time of the 1918 flu pandemic was done by a military doctor who looked at mess kits and the spread of disease. There was less disease when the mess kits were provided by the kitchen. But oddly enough the researcher didn't notice that when the men used their own mess kits, they all lined up after eating to wash their mess kits in the same water, one after another.

 

[WhatRoughBeast]

In the quote I posted earlier the author reported when Semmelweiss instituted hand-washing in both the wards in the study, mortality rates improved in both groups - those attended by nurses and by medical students.

This would suggest (to me anyway) that midwives may have been cleaner at the start than medics, but this was by virtue of their not practicing post-mortems, since their standards of hygiene seem to have benefitted from the improvement.

Yuri

A few corrections. See http://en.wikipedia.org/wiki/Histor..._women_1833-1858_for_first_and_second_clinics

1) Semmelweis apparently instituted hand-washing only in the med-student clinic, not the midwife's clinic, which brought the rates to approximate equality. This supports the position that the midwife students were originally cleaner than the med students.

2) A comparison between the Wien and Dublin hospitals (1784 - 1849) shows the effects of instituting autopsies. If this is so, the increased exposure to sources of infection by the med students (the midwife students didn't do autopsies) might suggest that the hand washing regime of Semmelweis was more effective than whatever the midwives were doing. This is a reasonable supposition, since the Semmelweis method used chloride of lime as a disinfectant, and this seems unlikely for the midwives.

 

[RationalVetMed]

A few corrections. See http://en.wikipedia.org/wiki/Histor..._women_1833-1858_for_first_and_second_clinics

1) Semmelweis apparently instituted hand-washing only in the med-student clinic, not the midwife's clinic, which brought the rates to approximate equality. This supports the position that the midwife students were originally cleaner than the med students...

I don't want (or have the time) to get into a "references off" but there's no reason to believe that wikipedia is going to be more reliable a source than the one I quoted from, namely "The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present" by Roy Porter, Fontana Press, London, 1997, an Open University text book.

I appreciate the insight, but to call it a "correction" is perhaps a little premature.

Yuri

 

[catsmate]

A little snippet about Nightingale and hygiene:

http://ocp.hul.harvard.edu/contagion/nightingale.html

A case of being right for the wrong reasons. Which is often a very good step on the road to finding out the right reasons, but not quite the same as implying that the nurses had it all figured out and the doctors were just slow to catch on and then took all the credit.

There was a lot of fumbling around in the period 1850-1900 (and after) regarding infection control and hygiene. This (3MB PDF is a good overview of the subject, with the contributions (and errors) of Lister, Koch et al, the various techniques and the splitting between antiseptic and aseptic practice.