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The History of Ophthalmology

Part 3: Anesthesia and Infection

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Preventing Infection

There was no knowledge of bacteria until the 19th century. Surgeons went from patient to patient and from the morgue to patients without washing their hands or instruments, and had no idea that they were spreading infection. The accepted theory of disease causation was the miasma theory, which taught that disease arose because of something in the air – never something in food or water, on a person’s hands, or on any object such as a surgical knife. The word malaria comes from this theory, being the Italian words for Bad Air – mala aria.

Ignaz Philipp Semmelweis

Dr. Ignaz Semmelweis was the first physician who worked to reduce what we call nosocomial infection – infection caused by the hospital or clinic environment. He worked in obstetrics at Vienna General Hospital. In 1847 he discovered that deaths of the young mothers from childbed fever could be reduced if physicians washed their hands in a chlorinated lime solution.

Childbed fever was infection caused by bacteria introduced into the young mother’s womb by the surgeon’s hands or instruments. Most women had their babies at home, with a local midwife (with no medical training but lots of practical experience), or with no help at all. Far fewer deaths occurred among these women than among those in the hospital.

For a while Semmelweis succeeded in having other obstetricians wash their hands, and reduced the deaths from 30% to 2%. But still his theory was not well received. Physicians were insulted by the idea that they were spreading infection, that they were somehow dirty. They regarded each case of infection as an individual matter and assigned a variety of causes to the deaths. Semmelweis was fired from Vienna General hospital and ridiculed by the entire medical profession.

He was unable to find another job and became angry, writing letters to obstetricians about how they were causing deaths. They decided he was losing his mind, and even his own wife agreed. He was tricked into entering a lunatic asylum, and locked up. After he tried to escape, guards gave him a severe beating and put him in a straitjacket. He died two weeks later, of septicemia (blood infection) from a gangrenous wound. Tragic and ironic.

The Germ Theory Of Disease

Physicians continued spreading infection until years later, when the work of Louis Pasteur, now considered a founder of microbiology, supported Semmelweis’ theories. Pasteur advanced the germ theory of disease to replace the miasma theory.

Cholera occurred worldwide in a series of epidemics through the entire 19th century (and much of the 20th century in some areas). London had epidemics in 1832, 1849, 1853, and 1854 which killed over 37,000 people. The city began a major renovation of its sewage and water systems after Dr. John Snow made the connection between cholera and contaminated water.

The miasma theory of infection caused uncountable deaths, but was received truth from the Middle Ages until Pasteur’s work expanded understanding of infection and disease.

Page 1

History of Ophthalmology Part 1: The Ancient World
History of Ophthalmology Part 2: The Middle Ages: Spectacles
History of Ophthalmology Part 4: The Nineteenth Century: Seeing the Eye
History of Ophthalmology Part 5: The Twentieth Century: Swift Progress
History of Ophthalmology Part 6: What is a Laser?
History of Ophthalmology Part 7: Leading up to LASIK
History of Ophthalmology Part 8:LASIK Into the Twenty-First Century


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