“Antisepsis”
Ingaz Semmelweis was a surgeon who worked in Vienna at the obstetrical clinic there in 1848. He noticed that the infections rates for the obstetrical clinic run by the physicians (“puerperal fevers”) were at least twice that of a second clinic run by midwives. Apparently, the doctors were teaching anatomy in the mornings in the postmortem area, and then moving on to their operating duties thereafter. The midwives, on the other hand, came straight from the home.
Semmelweis came up with the idea of hand washing and the use of an antiseptic solution for hands and surgical instruments for the physicians when they moved from the autopsy area to the operating theater. This was certainly the idea of a crazy person.
He met great resistance. Within two years of his idea, he was forced to quit medicine altogether. In the end, he died in an asylum for the mentally unstable.
It took another 40 years for the stubborn and persistent Joseph Lister to put forth, and finally have accepted, the same idea. He showed that limb amputations became infected 47% of the time before hand washing and carbolic acid antisepsis, and only 15% of the time after this ritual was introduced.
Separately, Florence Nightingale demonstrated that hygiene made a difference. In 1854, across the Bosphorous during the Crimean War, she demonstrated that cleaning up the military hospital there with fresh linens, rat poisons and scrub–brushed floors would ultimately result in a reduction of the combat wounded death rates from 40% to 2% in a matter of six months. Ironically, she was able to match the same 2% infection rate that is the accepted “risk standard” for modern surgical procedures today.
Hospital surgical infection rates remained between 2–15% until the advent of production-level penicillin in 1941. Thereafter, post-operative pneumonia death rates fell from over 30% to below 10%, and surgical wound infection rates fell to below 5% towards the end of World War II. With the gradual introduction of an ever-widening array of the sulfas and other antibiotics, surgical infection rates fell to as low as 2% by the 1960’s.
