Friday, March 19, 2021

In What Situations was Hygiene "Discovered" by Semmelweis and Lister?

I had a conversation on Medieval Hygiene. What exactly did Ignaz Philipp Semmelweis stop or try to stop, and when did it start?

Well, the problem at the hospital where he was, was that docctors in training for obstetrics would first go to autopsies, then without washing hands to act as midwives ...

In the Middle Ages, only midwives did obstetrics, and not only that, but autopsies were strictly forbidden. In the Renaissance, doctors wanting bodies for this illegal practise were body-snatching in graveyards. St. Francis of Sales, in his teens, volunteered to donate his body in case of death so one body-snatching could be avoided. Obviously, in Semmelweis' day, autopsies had been legalised over almost all of Europe. And you got doctors training for obstetrics.

This is in fact not all, here is how wikipedia describes where Semmelweis was working:

Semmelweis was appointed assistant to Professor Johann Klein in the First Obstetrical Clinic of the Vienna General Hospital on July 1, 1846. A comparable position today in a United States hospital would be "chief resident." His duties were to examine patients each morning in preparation for the professor's rounds, supervise difficult deliveries, teach students of obstetrics and be "clerk" of records.

Maternity institutions were set up all over Europe to address problems of infanticide of illegitimate children. They were set up as gratis institutions and offered to care for the infants, which made them attractive to underprivileged women, including prostitutes. In return for the free services, the women would be subjects for the training of doctors and midwives.

Two maternity clinics were at the Viennese hospital. The First Clinic had an average maternal mortality rate of about 10% due to puerperal fever. The Second Clinic's rate was considerably lower, averaging less than 4%.

Why would this have been impossible in the Middle Ages? Not only was infanticide heavily punished in the rare cases, and abortion as well, outside Jewish settlements (yes, Jews had the horrible distinction of pioneering abortion "rights"), namely with death penalty, but the motive for these infanticides would have been lacking, since the chief offenders in making illegitimate children were noblemen and these were fond of either legitimising illegitimate children or spoiling them, giving them comforts without responsibility - they thought of them as a tribute to their own virility.

This was also the case with priests having mistresses - like Alexander VI had had, and we know he took care of Cesare and Lucrezia.

So, in the Middle Ages, women with illegitimate children would not line up at hospitals, they would get taken care of. A midwife would attend very individually to them. And in those cases, I don't think you had even 4 % puerperal fever.

Now we come to Joseph Lister:

Lister promoted the idea of sterile surgery while working at the Glasgow Royal Infirmary. Lister successfully introduced carbolic acid (now known as phenol) to sterilise surgical instruments and to clean wounds.

Perhaps a bit more?

Before Lister's studies of surgery, many people believed that chemical damage from exposure to "bad air", or miasma, was responsible for infections in wounds. Hospital wards were occasionally aired out at midday as a precaution against the spread of infection via miasma, but facilities for washing hands or a patient's wounds were not available. A surgeon was not required to wash his hands before seeing a patient; in the absence of any theory of bacterial infection, such practices were not considered necessary. Despite the work of Ignaz Semmelweis and Oliver Wendell Holmes Sr., hospitals practised surgery under unsanitary conditions.

Hospital wards? In the Middle Ages, hospitals were primarily institutions for the homeless and other poor, who could not afford a physician calling at home and who were also not employed with one who could afford it. Care was given among other people volunteering by homeless of sound body who were paying their stay that way. As this was not the safest lodging from health points of view, beggars had a way of trying to avoid them as long as they stayed healthy. Only Lewis XIV had the bad taste to change that habit and started chasing homeless to stop them from begging freely (and about a century later, you get a Revolution). In this era, a Saint Vincent of Paul was at one point, as I recall from a book in a library in Beauvais, at first refusing to send Lazarist priests to the hospital. He arguably would not have liked Lewis XIV's approach, perhaps understandably for one who had spent two years as a slave to Tunisian Muslims. In the Middle Ages themselves, the Hospital of Paris was more likely to be avoided by healthy homeless and the ones who went there were not in a ward of surgery, the illnesses varied considerably and they were tended by physicians, not surgeons, and in the Middle Ages, this was not the same profession. Surgeons were fairly ill considered and operated most often after battles or accidents, like cutting off legs. Then bandages were obviously changed by somewhat better personnel. So, a hospital would not be the likeliest place to meet a surgeon in the first place. Hygiene was arguably far better than at the war where Joseph Lister was working.

Oliver Wendell Holmes Sr studied puerperal fever too and this in a place called Boston Medical Dispensary. Boston was arguably more flooded by poor than Medieval Paris and so the dispensaries were diversified ... and a purely medical one was where the conditions Homes found were prevailing in 1837,* when he arrived there.

Hans Georg Lundahl
St. Joseph's Day

* You might try to multiply centurial number by the number within the century, and you may already know the result.

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