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Getting a grip on sanitation and germs

The BMJ suggests sanitation is another major medical milestone since 1840, and introduces us to the unusual ideas of sanitation's champion, Edwin Chadwick:

Chadwick was neither a medical doctor nor a sanitary engineer but a lawyer who had designed the 1834 Poor Law Amendment Act and who wanted to cut the costs of poor relief by preventing a major cause of poverty: acute infectious diseases that killed male breadwinners. Chadwick believed that these diseases were caused by air contaminated as a result of poor urban drainage. He developed a comprehensive solution: new technologies (sewers rinsed by water, his main reason for bringing piped water to individual homes) and the legal and administrative structures needed to build these expensive works.

Britain led Europe in the "sanitary revolution," population soared, and many Brits moved to Australia, New Zealand, and Canada with happy results.

The BMJ says that another major medical advance is the discovery of germs and the importance of hygiene:

Semmelweis's work [with germs] influenced Joseph Lister, working in Glasgow. Lister was probably also influenced by his father, Joseph Jackson Lister, a Quaker wine merchant, who invented the bichromatic microscope (which uses reflected and transmitted light). This itself was an important event in medical history and possibly meant that Lister was alert to the idea of micro-organisms causing disease. Lister introduced antisepsis to his surgical practice. He was aware that carbolic acid was used to treat sewage, and he concluded that the same microbes that caused wound putrefaction might be killed through use of carbolic acid solutions to dress wounds. He also insisted that instruments and surgeons' hands should be washed with the solution. Mortality from compound fractures fell in his wards as a result of these measures.

A glance at NHS hospitals appears to indicate that standards of hygiene and cleanliness are not as good as they were when I worked in the NHS thirty years ago. The Government has found it is unable to reduce MRSA infections (a highly resistant strain of staphylococcus aureus) in NHS hospitals.

This website/blog celebrates the best of the Brits, but we sometimes find ourselves looking into the past at achievements that have been forgotten. If Lister’s lessons were relearned by everybody that worked in hospitals, I have no doubt that hospital-acquired infections, including MRSA, could be drastically reduced. It's an easily tested idea. . .

Have a favourite medical milestone? You can vote here for the most important medical advance.