The moustachioed soldiers of WW1

As October draws to a close men all over the world are getting ready for Movember, an annual event that gives them a chance to raise money and awareness for men’s health issues by sporting a moustache in the month of November. However, in the era before safety razors and shaving foam personal grooming was a much more difficult affair. Men faced many challenges whilst attempting to maintain their facial hair in the trenches of WW1 as this post by Dr Alun Withey explains.

Scrubs: a tale of surgical attire

Medical/Surgical Operative Photography

Medical staff wear specially designed clothing to reduce the spread of disease in hospital settings. However, this wasn’t always the case, as up until the late 1800s most doctors performed surgery whilst dressed in ordinary clothing. The “scrubs” – so called because they are worn by those who have “scrubbed up” to prepare for surgery – that we see today didn’t appear until well into the 20th century.

For centuries doctors wore ordinary clothes in operating theatres and worked bare handed with non-sterile instruments. Having to wear special surgical attire was unpopular as uniforms were associated with the lower classes, but by the 1890s surgeons started to wear surgical gowns over their clothing to protect them from bloodstains. Yet these garments did little to reduce the spread of disease as they were rarely washed and usually stained with flecks of dried blood and pus.

After World War One and the outbreak of Spanish influenza in 1918, growing acceptance of the germ theory of disease meant surgeons and their assistants began to wear gowns, caps, rubber gloves and gauze masks. However, these practices were not universally adopted and the purpose of these measures was primarily to protect surgeons from catching diseases from their patients rather than for the prevention of intra-operative infections. It wasn’t until several decades later that medical professionals began to pay greater attention to maintaining a sterile environment.

By the 1940s, advances in aseptic techniques and better understandings of the aetiology of wound infection meant that more stringent measures were put into place to reduce the spread of germs in operating theatres. Instruments and dressing were routinely sterilised with steam and having standard surgical attire became regarded as an important way to prevent post-operative infections. White was associated with sterility and cleanliness and was used for surgical gowns until it was found that the glare it caused under the bright theatre lights created eye strain for surgeons. By the 1950s, most hospitals has switched to surgical attire in jade green or ceil blue instead as those colours reduce eye fatigue and provide a high contrast against the reddish colours of body tissues and blood.

Two-piece outfits consisting of a tunic shirt and pants were introduced in the 1960s and 1970s and have remained largely unchanged since that time. Worn by both men and women, scrubs are designed to be comfortable, durable and wrinkle resistant.  Their simple design aims to limit the places that pathogens can proliferate and the cotton/polyester blend of the fabric is able to withstand laundering at high temperatures for sterilisation purposes. Scrubs are also cheap enough to be easily replaced if they become badly stained or contaminated. The medical attire worn nowadays has come a long way from the unsanitary surgical practices of previous centuries.

Image credit

Ooi, P. (2012). Medical/surgical operative photography [Image]. Retrieved from https://www.flickr.com/photos/phalinn/8116024703

References

Belkin, N. L. (1998). Surgical scrubs – where we were, where we are going. Today’s Surgical Nurse, 20(2), 28-34.

Houweling, L. (2004). Image, function, and style: A history of the nursing uniform. American Journal of Nursing, 104(4), 40-48.

Joseph Lister: the father of antisepsis

445px-Joseph_Lister_1902

Hospitals have not always been the places of cleanliness we know them as today. For centuries they were places where people were just as likely to die as they were to be cured. Even if a person was able to survive the ordeal of surgery without anaesthesia, the unsanitary conditions of operating rooms meant that a postoperative infection was likely to result in their demise. By the late 19th century this began to change, thanks to the work of English surgeon Joseph Lister.

Born in 1827, Lister graduated as a doctor in 1852 and spent much of his early career working in Scotland. It was there that he noticed a mortality rate of nearly 50% in patients following surgery. Infections in wounds resulted in fatal systemic inflammation known as sepsis and this phenomenon was so common in hospital settings that it earned the nicknames “ward fever” and “hospitalism”.

Infection was poorly understood at the time and most people subscribed to one of two alternative theories. The first was known as miasma and stated that infectious diseases were caused by impure air and noxious gases. The second was called contagionism and proposed that infections in wounds arose spontaneously by an unknown action of the tissue itself. Neither explanation connected the practices of doctors to the outcomes of surgery and although French chemist and microbiologist Louis Pasteur had demonstrated the existence of micro-organisms in the mid-1860s, germ theory was not yet accepted by the medical establishment.

After witnessing how patients with simple fractures survived whilst those with compound fractures in which the bones pierced the skin often died, Lister became convinced that infections in surgical patients were being caused by outside agents. After reading the work of Pasteur, he took measures to kill the pathogens that he believed were causing infections in wounds. Suspecting that it was an antiseptic, Lister diluted the carbolic acid used to treat sewage and applied it to dressings. He also used it to sterilise surgical equipment and wash his hands. He sprayed it around operating theatres to eliminate airborne pathogens and soaked catgut sutures in the solution in further attempts to reduce infection.

His techniques were remarkablly successful and the incidence of infection was drastically reduced. The death rate of Lister’s surgical patients fell from 45% in 1866 to just 15% by 1870. He took measures to eliminate pathogens that had already entered wounds and prevent others from entering sterile operating rooms (antiseptic and aseptic techniques).

After publishing his results in the Lancet, Lister’s work began to receive a great deal of attention. While some hailed his findimgs as a breakthrough in surgical technique, others viewed it with scepticism. His methods were not immediately adopted as it took over a decade of work before he could convince others of his theories and sanitary surgical procedures became accepted as common practice. Yet once doctors began paying better attention to hygiene in hospitals patient health dramatically improved and the field of surgery was able to advance rapidly. Joseph Lister continued to refine his surgical techniques for the rest of his life and was knighted for his services to medicine in 1883.

Image credit

Unknown. (1902). Joseph Lister [Image]. Retrieved from http://commons.wikimedia.org/wiki/File:Joseph_Lister_1902.jpg?uselang=en-gb

References

Osborn, G. G. (1986). Joseph Lister and the origins of antisepsis. The Journal of Medical Humanities and Bioethics, 7(2), 91-105. Retrieved from JSTOR.