The Day the Universe Changed - James Burke [108]
A malignant tumour is removed in a Dublin doctor’s drawing-room under primitive conditions. Typically, the patient died within a month of the operation.
Patients usually slept in the same sheets as those used by the previous occupant, on sodden mattresses which were never changed. In 1851 Nightingale described the nurses as ‘whores brought in from the streets’, generally drunk, continuing to ply their trade in the hospital and only giving patients medication when it occurred to them to do so.
The surgeons and doctors did little to help. Most of them walked the wards with handkerchiefs to their noses. There was little water available for washing. Operating rooms were ill-lit and filthy. Surgeons wore their own personal ‘operating coat’, an ordinary outdoor coat which often went blood-encrusted and unwashed for six months. Fires would burn in the corner of the operating room. Sawdust on the floor soaked up the blood as well as the mud from the shoes of the students who came straight to the operating room from the street. In these conditions, compound fractures had always been the surgeon’s dread. They involved breaking the skin, with the consequent danger of infection. Blood poisoning, erysipelas and hospital gangrene were the scourge of the wards. The standard phrase was: ‘A successful operation, though the patient died.’
There were two conflicting views of how infection spread. One was that the sick gave off a kind of invisible gas, a miasma, which was also given off by any kind of filth. The other, slow to gain ground before the advent of bacteriology, was that putrefied matter in contact with wounds would cause infection.
In the 1850s Ignaz Semmelweis in Vienna had shown that students eager to correlate physical symptoms with conditions observed at post-mortems were returning to the wards from the dissecting rooms without washing, thus carrying infection to the living patients. Once Semmelweis had persuaded his students to wash their hands in chlorinated lime the mortality rates at his clinic dropped like a stone.
However, the reason why the infection had occurred in the first place was still unknown. In all hospital wards broken skin usually led to death within two weeks. The safest thing was considered to be removal of the patient from the hospital as soon as possible after an operation.
There were various approaches to the problem of infection. The Germans favoured fresh air. Cold water bandages were tried, together with hot linseed poultices. Continuous irrigation and even ice compresses were used. In mid-century conditions were so bad that at University College Hospital, London, a death rate of 25 per cent was considered satisfactory compared with rates of 39 per cent in Glasgow, 43 per cent in Edinburgh and a staggering 59 per cent in Paris.
In 1829 concern for the mechanism by which disease spread was made even more desperately urgent by events outside the hospitals. That year a new and unknown disease arrived in Europe. The symptoms were severe diarrhoea for two or three days, gradually growing more intense, together with extremely painful retching. The stricken victim experienced terrible thirst as a result of dehydration and loss of body fluid. There followed severe pains in the limbs, stomach and abdominal muscles. The colour of the skin changed to bluish grey and the patient died soon after.
A poster circulated throughout London in November 1831, just before the arrival of cholera in the capital, describing the symptoms of the disease and its remedy. A note at the bottom claims prevention through ‘moderate and temperate living’.
The new mid-nineteenth-century interest in the living conditions of the poor, shown by this rather too wholesome contemporary illustration of a London slum. Note the patched clothing on the line.
This terrifying new plague, so different from the diseases to which Europe had become accustomed, reached Paris and took the lives