Hospital Infections: Past, Present and Future

The Allgemeines Krankenhaus University in Vienna

Semmelweis was a short-tempered and inpatient foreigner in the hierarchical setting of Imperial Vienna. When the hidebound obstetric establishment failed to be convinced by what seemed to him the "blazing truth", he threw up his job and returned to his native Pest (today's Budapest). From there he dispatched a stream of open letters to the leading but benighted obstetricians of Europe, telling them that they themselves were responsible for millions of young mothers dying unnecessarily and comparing some of them unfavourably to Nero. This was ill received. Eventually he was declared insane and lured to a lunatic asylum in Vienna. During a scuffle as he was put into a straightjacket, he cut his finger. Ten days later he was dead himself from blood poisoning.

It is uncertain if Semmelweis's beloved doctrine of cleanliness would ever have prevailed without the brilliant work of the English surgeon, Joseph Lister. By the 1860s epidemics of "hospital sepsis" both in Britain and on the Continent were becoming catastrophic. Those outbreaks killed not only patients but also hospital staff and even visitors. It was seriously suggested in Parliament that all hospitals in Britain should be closed to be replaced by hutted encampments in open spaces like Hyde Park and the New Forest. Lister, the scion of an English Quaker family, was at that time professor of surgery in Glasgow. His "moment of truth" came when a colleague, a professor of chemistry, drew his attention to the work of the French chemist Louis Pasteur. Pasteur had discovered - and had indeed demonstrated beyond doubt - that the atmosphere was teeming with millions of invisible but living "germs". An inspired piece of lateral thinking convinced Lister that if these "germs" could spoil wine and sour milk, they could also be responsible for wound infection and hospital sepsis. He proved his idea by eliminating germs using a device known as the antiseptic spray. This was like a giant insect spray but containing an antiseptic fluid. It enveloped the operating theatre in a highly irritating cloud of vapour; but, for the first time, open fractures, which used to be inevitably fatal unless the limb was immediately amputated, healed without infection and without causing general blood poisoning.

Credit Moody Medical Library Joseph Lister, 1827-1912

Unlike Semmelweis, Lister was part of the Victorian establishment, surgeon to the Queen (if only in Scotland), a man on friendly terms with some of the leading doctors of his day. Even so, it took him the best part of thirty years to convince his colleagues that germs were real, that they caused wound infections and that they could be eliminated. His doctrine which he called antisepsis was more readily embraced on the Continent, especially in Germany. It was adopted by the great surgeon Billroth in Vienna, though he continued to operate smoking a giant cigar.