When the Cleaning Began: A Medical History


Today’s hospital environments are expected to maintain a significant amount of cleanliness. Procedures aimed at keeping the environment sterile are strictly enforced on a daily basis.

This does not rule out all risk of infection in a hospital environment, however. There are often still stories of staph and other pathogens that abound in medical buildings. There was a time when hospitals were incredibly dangerous. The large amount of illness and death surrounding health care in the past was greatly increased by cross-contamination. Historical care for patients took on a variety of methods while humans worked towards the hospitals we know today. Modern hygiene methods have evolved from years of trial and error.

Past Solutions

The most compelling evidence towards the early existence of a hospital type of environment is from Sri Lanka in the year 431 BC. India is thought to have been on the same page around 230 BC. Prior to this there were some interesting approaches to medical issues. Required quarantines were put into place for sick individuals and their entire families. Imagine how many people would be out of commission if we did this during a modern day flu season. It is, however, an effective way to contain an outbreak of disease. Ancient Babylonians made the cure of community members a group effort. The ill person was set out in the street. This allowed those passing by to share advice on how to treat the problem.

The realization that pathogens were being spread due to lack of handwashing and other sanitation measures, was not considered until around the 19th century. Wound washing with thyme oil and vinegar was one of the early cleansing methods. Wine, copper, silver, pitch, and mercury were also used as antiseptics. Unfortunately, there were many deaths prior to the discovery of contagion in medical settings.

The Women 

The first clue that something was wrong took quite some time to decipher. Pregnant women preferred giving birth with a midwife because a rise in deaths was associated with births assisted by medical students. The phenomenon was called “childbed fever.” The proper term was puerperal sepsis. A man by the name of Dr. Ignaz Semmelweis was a Hungarian doctor who spent some time assisting in the maternity ward of a hospital in Vienna. The complications of illness at the hospital were well-known by women nearing their time of birth. They expressed extreme fear at the thought of being tended to by the medical students. The rate of puerperal sepsis when students delivered the women was three times higher than the midwife deliveries.

The Discovery

Dr. Semmelweis eventually noticed some correlation between the activities of the medical students and the women who became ill. It took a while to make the discovery, however. Childbed fever affected about 25 percent of women. These statistics include European and American hospitals, alike. We now know that the culprit was Streptococcus pyogenes bacteria. The high number of cases made it a common occurrence, and much more difficult to pinpoint a cause. Over time, Dr. Semmelweis observed the procedures of the medical students. He noticed that one difference between the students and the midwives involved classroom cadavers. The medical students would tend to their academic studies and then report directly to birthing rooms. The rooms where cadaver dissection took place was called the Pathology Unit. Delivery of babies happened with no handwashing between the two activities. Dr. Semmelweis immediately incorporated handwashing regimen for all members of the staff that assisted in the delivery of babies. He introduced a chlorinated solution to kill pathogens.

The Results 

The mortality rate of mothers immediately dropped once the new routines were put into action. April of the year 1847 brought a mortality rate of 18.3 percent. With regular handwashing, these rates were down to 2.2 percent by June of the same year. July saw a drop in mortality that was reported as 1.2 percent of mothers. August was slightly higher at 1.9 percent mortality. At one point there were two full months with not reported deaths. These results easily showed the difference made by simple hygiene practices. Handwashing should not be underestimated.

Rejection

Dr. Semmelweis made it his mission to speak regularly to the medical community about his discovery. He wanted to make sure that diseases were prevented from this time on. He was, however, met with significant resistance. It can be difficult to imagine the rejection of a method that saves lives. The beliefs of the time, however, were deeply rooted. The doctors may not have been willing to admit their role in causing unnecessary deaths, as well. The insinuated blame may have been overwhelming. Scientists during this time believed that illnesses were caused by an imbalance in the basic humours of the body, not pathogens.

Those scientists who did consider the possibility declared that the necessary amount of handwashing was too difficult to adhere to. It would be 14 years later, in 1861, when a book by Semmelweis was completed, documenting his ideas. He had been fighting for his methods this entire time. His book was not well-received, and Semmelweis had to continue to argue for the relevance of handwashing. He was committed to an asylum in 1865 due to a nervous breakdown. The stress of continuously fighting against popular ideals may have overcome him. He died there shortly thereafter, never seeing the full acceptance of his theories. His fight was not without purpose, however. Semmelweis planted the seed that later became the germ theory of disease. His selfless persistence has led to the saving of many lives.

Health history consists of a series of eerie practices and gruesome activities. It is difficult to understand why anyone would refrain from washing their hands after handling a human cadaver. Cleanliness was simply not a huge part of life in the past. This can be seen from studying many historical facts. Sewage in the streets was another common contributor to disease. Hygiene has significantly improved in the medical field, as well as in personal situations.


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