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The story of disinfectants

"Disinfectants" in the medical field have become commonplace. Especially under the COVID-19 epidemic, it is indispensable. It exists for hygiene control. But it wasn't long ago that hospitals became truly hygienic. That's because there was a long way to go before the idea of ​​disinfection was discovered, disseminated, and established.

The story of disinfectants(1)

Spray your child's hands with disinfectant spray

According to a 2014 survey, the average life expectancy of Japanese people is 86 years for women and 80 years for men. Women live longer than men, and this tendency is common in developed countries. There may be various factors involved, but basically the life expectancy given to women is thought to be several years longer for women than for men.

However, looking at the average life expectancy per 1900, for example, men were 43 years old and women were 44 years old, and women's life expectancy was relatively shorter than it is now. This is due to the fact that at that time there was a great risk of life at the time of childbirth.

By about 1900, 400 per 100,000 pregnant women, or 1 in 250, died during childbirth in Japan. In 1950 this was 160 per 100,000 and is now down to 3 per 100,000. This is an amazing rate of decrease. In addition, the number of births per person in a lifetime has decreased significantly, so it is almost impossible to talk about losing lives at the time of childbirth.

Many of the causes of a woman's death shortly after childbirth are a disease called puerperal fever. "Postpartum" is originally a bed used at the time of childbirth, and refers to the period from immediately after childbirth until the mother recovers. Postpartum fever is a condition in which fever of 38 ° C or higher continues for 2 days or more within 10 days of browning after 24 hours after the end of labor. The cause of this is the invasion of bacteria from the detached surface of the placenta and the lacerations caused by childbirth. 』\

Symptoms include fever and cough, severe headaches, and in some cases, bloating to the point of thinking that she was pregnant again, and after suffering for several days, she died. In a sense, this illness is more tragic than any other illness, snarling at the most wonderful moment of life, giving birth, to a loved one.According to Buddhist legend, Mrs. Maya, who gave birth to Buddha two thousand and several hundred years ago, died seven days after giving birth. Many sources attribute this to puerperal fever. Such stories can be found in various old stories.

For example, in Rome BC, Julius, the daughter of Julius Caesar, also died at birth. Julia was married to military commander Pompey according to her father's policy, but despite the age difference of over 20 years old, it is said that the couple had a very good relationship. He played a role in acting as an intermediary between two important people, Caesar and Pompey. However, this Yuria dies with the girls born.

After Yuria's death, Caesar and Pompey gradually deepened their conflict, and five years later they finally entered a civil war. Caesar wins the battle and establishes a path to revolutionize the deadlocked Republic of Rome. If there was a concept of disinfectant in this era and Julia was in the world, this Roman history might have changed considerably.

Even the women of the royal family, who should have been able to give birth under the best conditions at the time, were in a worse situation for the general public because of this situation.Then, this disease, which has occurred sporadically, will occur outbreaks after people become densely populated with urbanization. The first case occurred in a hospital in Paris in the mid-17th century. The hospital's policy was to accept all poor women and treat them indiscriminately, so the number of patients coming in was hopelessly huge. ..

A large number of fleas and lice settled on the sheets, which were rarely washed, and several people were laid down in one bed. Surgery was often performed in a room crowded with large numbers of patients, rather than in a separate room. The water used in the hospital was drawn directly from the Seine, where all the sewage in Paris flows untreated.

In my current sense, it would be strange that this would not cause any infectious disease, but at that time there was no concept of bacteria, let alone the occurrence of puerperal fever and this hygienic environment. There are many such conditions in other cities, and puerperal fever has become an epidemic that spreads throughout Europe and the United States. It is said that in 1772, when the epidemic peaked, one in five pregnant women was killed by the disease.

This situation did not improve significantly until the mid-19th century. The cause is still unknown, and although there are various theories such as the miasma rising from the body of a pregnant woman, the decay of the tissue remaining in the uterus during delivery, and the alteration of breast milk, there was no definitive decision.

The story of disinfectants(2)

surgeon during surgery

It was Ignaz Philipp Semmelweis, a Hungarian doctor who worked at the University of Vienna General Hospital, that made a big difference in this situation. He wanted to somehow reduce puerperal fever, so he first analyzed the data in detail.

The hospital had the following story. Of the first obstetrics department where professors and students work and the second obstetrics department where midwives work mainly, the former is said to be much more prone to puerperal fever. This was true when Semmelweis examined the records. The incidence of puerperal fever was several times higher in the first obstetrics department, where professors and students with a wealth of medical knowledge gave birth, than in the second obstetrics department. As a test, Semmelweis replaced all staff in the first and second obstetrics, and puerperal fever began to occur in the second obstetrics.Initially, this phenomenon could not be explained by any possible cause.

One day, a Semmelweis colleague doctor dies in an accident during surgery. The colleague had accidentally cut his hand with a scalpel when performing an autopsy on a pregnant woman who died of puerperal fever. And the process leading up to his death was exactly the same as the puerperal fever patients he had seen so far. In other words, it was thought that some infectious substance adhered to the doctor's hands from the body of a woman who died from puerperal fever, and this was transferred to the next pregnant woman, causing illness. The low incidence of puerperal fever in obstetrics where midwives work can be explained by the fact that they do not dissect and therefore do not transfer infectious substances. The discovery that their doctors were the carriers of puerperal fever stunned Semmelweis.

So Semmelweis devises a way to wash your hands with soap after dissection, then soak your hands in chlorine water and rub them with a brush. To avoid getting poison between the nails, I cut the nails as short as possible and also brushed them well. He ordered his students to do the same, and the rebels yelled at him to obey him.

The effect was excellent, and within a few months after starting hand washing, the mortality rate of the first obstetrics department decreased significantly. Furthermore, when the underwear and medical equipment were thoroughly disinfected, the mortality rate dropped further.

And, as you know, his method of hand-washing is basically inherited by the modern doctors.However, this groundbreaking discovery was not well accepted by academic societies at the time. Among them, Professor Rudolf Wilhyo, an authority on the German medical community, who was even called the "Pope of Pathology", attacked the Semmelweis theory without a clue and completely denied it. Virchow argued that puerperal fever was caused by "miasma," and admitting the theory of the fledgling young Semmelweis was not something he could do with his pride.

However, some doctors have tried Semmelweis' recommended hand-washing method and found that it drastically reduced puerperal fever. Some were shocked by the fact that they had driven many women to death, and some even committed suicide. It was such a groundbreaking discovery.

However, many doctors could not bear to admit that they were murderers and turned to the side of violently attacking the Semmelweis theory. In addition, the professor who was Semmelweis' boss also attacked the infection theory, probably to protect himself, and finally Semmelweis was expelled from the hospital.

Semmelweis returns to his hometown of Hungary in disappointment and strives to popularize disinfection methods. However, perhaps because he was exhausted from the long struggle, he was hospitalized with a mental illness. At the end, he was beaten by a facility employee who tried to take control of him, and it is said that he died. For a person who greatly contributed to the fight between humankind and infectious diseases, his life was too fortunate and his death was too sad.

After this, it was necessary to wait for Florence Nightingale to play an active role in order for the sanitary environment in the medical field to really improve. She is also known for her accurate situational analysis based on statistical data and for her fruitful reforms. It is the power of accurate data and the will that is backed by it that will change the world in all ages.

The story of disinfectants(3)

Doctor performing surgery with a microscope

Naturally, bacterial infections from wounds do not occur only during childbirth. During surgery, the wound often becomes purulent and fever, which is called "surgical fever" and has plagued 19th century surgeons. There were even hospitals where the mortality rate of patients with amputated limbs reached 90%, and even minor appendicitis surgery was often fatal.

The issue was addressed by the British surgeon Joseph Lister. He witnessed a very poor prognosis for "open fractures," in which bones pierced the skin, whereas simple fractures healed spontaneously if fixed. This clearly indicated that the exposure of the wound to the outside air had some adverse effect.

Lister linked this fact to the French Pasteur theory. Pasteur found that the gravy that was left in the air quickly spoiled, whereas the gravy did not spoil if it was heated and kept free of germs.

So how do you keep germs out of your wounds? As Lister continued to think about this issue, he was struck by a newspaper article he saw. It was reported that residents who could not tolerate the stench of sewage tried various measures and the creosote oil obtained by distilling coal tar was effective. If sewage putrefaction-stopping ingredients are contained in creoso oil, does this also stop the patient's wounds from rotting? Lister tried the chemicals that make up coal tar and came up with a compound called phenol.

This was a simple compound with only one hydroxyl group on the benzene ring.

If the records are certain, the day before Zemmelweiss's death: On August 12, 1865, Lister — applied phenolic disinfection for the first time to surgery on a boy who had a broken leg in a carriage accident. The broken bone and its surroundings were wiped with a cloth soaked in phenol, and the wound was wrapped with linen soaked in phenol. As a result, the boy did not even have a fever and was completely cured. Lister will continue to apply phenolic disinfection to several surgeries with great success. In addition, Lister has devised a method of spraying a phenol solution into the operating room and performing the operation in a sterile condition.

At first, many doctors did not believe in invisible things such as bacteria, but the accumulation of successful cases drowns out such voices. Advances in bacteriology have also helped this. Eventually, Lister witnessed Queen Victoria's abscess surgery and was appointed as a surgeon for Edward VII's appendicitis surgery. He was also elected president of the Royal Society and became the first doctor to receive the baron. This was the exact opposite of Zemmelweiss. Lister lived an honorable life as a hero who banished surgical infections. The name of Lister is still strongly associated with the image of disinfection. For example, the brand name of the oral disinfectant "Listerine" seems to be named after Lister. ("Listerine" does not contain phenol.)

Reference: Phenol toxicity

Phenol is very well absorbed and is rapidly absorbed not only through the digestive tract but also through the skin and inhalation. In addition, it is more toxic when absorbed from the wound site or body cavity than when taken orally.

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