Hospital Infections: Past, Present and Future

Exploring the history of hospital infections from early pioneers in hospital cleanliness to the rise of the so-called 'Superbugs'.

In the Crimean War patients admitted to Florence Nightingale's legendary field hospital in Scoutari were significantly less likely to survive than those taking part in the Charge of the Light Brigade. The comparison though is of course a statistical outrage. Most of those admitted to the hospital in Scoutari were already dying from infected wounds, blood loss and exposure or, most commonly, a combination of all three. Their chances of survival were probably better than if they had been left to rot on the battlefield (as tens of thousands were). Yet hospitals in the mid nineteenth century were undoubtedly dangerous places where patients expected to die and mostly did.

The change, when it came, was largely the achievement of a few remarkable individuals. (The politically correct notion that great medical advances are the products of team work is a modern figment.) Among the pioneers, was a young Hungarian doctor called Ignác Semmelweis who, in 1846, found himself working as a junior assistant in the Midwifery Department of one of Europe's most prestigious hospitals, the Allgemeines Krankenhaus of Vienna. Prestigious but also dreaded among the young women of the Imperial Capital. At times 1 in 5 healthy young mothers-to-be admitted to give birth never left the building alive; and their mode of death, childbed fever, usually striking within a few hours of labour, was one of the most painful at a time when physical suffering was commonplace. Nobody knew the cause: lunar radiations and other lunacies were widely canvassed. The problem drove young Semmelweis to distraction, the more so since the catastrophic mortality in his own department contrasted with the comparatively low death rate in the adjacent department staffed entirely by midwives.

His "moment of truth" came on his return from a holiday when he was told that his closest friend, Kolletschka, a forensic pathologist, had suffered a cut finger performing a post-mortem examination and had died a few days later from blood poisoning. The symptoms and the lesions at his own post-mortem seemed to be exactly the same as those Semmelweis had seen in hundreds of young women who had died in childbed fever. Semmelweis realised that the mothers' illness was caused by infection introduced into the open wound of the womb by doctors and medical students, often arriving in the labour ward directly from performing post-mortem examinations in the mortuary. Midwives did not perform post-mortem's: hence the lower mortality in the midwives' ward. To clinch the evidence, the introduction of thorough scrubbing of hands with carbolic acid before entering the labour ward, slashed the incidence of childbed fever.