Bare Below the Elbow

Another great 'evidence based' piece of guidance, condemning wristwatches and rings to the same bin as ties and white coats.

Personally, I like a white coat, and when I started out was able to get a fresh, clean one from the sewing room daily. Seems like a good idea, no? But cheaper not to, and just fuck 'em, instead.

The idea that disease is caused by organisms, and organisms that can be transmitted by hand seems commonplace now, but is, in fact, relatively new. This doesn't stop the idea that making me roll up my sleeves will prevent nosocomial infection being, simultaneously, clutched at by infection control nurses as the next big thing, and utter cock.

Where does it all begin?

Who is the daddy of cleanliness?

May I propose Ignaz Semmelweis. (1818 - 1865)

In my experience, very few infection control specialists have heard of him; and fewer DoH inspectors. History? Why should we care about the past...?

Alexander Gordon, and Oliver Wendell Holmes both had an idea that sepsis after childbirth (puerperal fever) might be caused by the introduction of 'putrid matter' by the delivering doctor or midwife. Influential practitioners such as Charles Meigs were quick to deny this idea.

Semmelweis however, working at the world's biggest maternity clinic in Vienna, found it hard to deny the evidence before his eyes. Those mothers attended to by medical students had a far higher rate of puerperal sepsis than those attended by midwives.

His suspicions increased when a colleague died after cutting his finger during an autopsy.

By introducing something as simple as routine hand washing, he was able to slash mortality rates. His work was published, but largely unrecognised by his contemporaries, and it is sad to report he died in a mental institute.

Hand washing, yes. Rolling my sleeves up...? Still waitin' for the evidence.

"I Dressed The Wound, And God Healed Him"

First in an occasional series of my personal medical heroes.

Ambroise Pare practised in the 16th century; he came from a family with strong surgical connections: his brother was a Master Barber-Surgeon and his sister married one. He served on the House at the Hotel Dieu for a few years, but appears to have been too poor to pay the barber-surgeons union dues, and joined the Army.

Gunpowder had been deployed on the battlefields of Europe since the 14th Century, and had completely changed the pathology of wounds received there. The military surgeon, was, at that time, of a mind to treat gunpowder wounds in a way designed to destroy the 'poison' such wounds were thought to contain. The 'obvious' way to do this was through extensive cautery, or by pouring boiling oil into the wound.

Pare, however found himself forced to improvise; having run out of "oil of elders, mixed with a little theriac" (which was applied boiling t the wound), he was forced to use an alternative - "a digestive made of egg yolk, rose oil and turpentine"

On reviewing his patients early the next morning, he found those on whom the digestive had been used in an altogether better state, and resolved "never again to so cruelly burn the poor wounded by gunshot"

He also went on to describe the technique of ligating blood vessels in the context of amputation.