Book: Hospital Infection: From Miasmas to MRSA
Authors: Leyla Sanai
Journal: BMJ (2003)

Next time you wash your hands before or after examining a patient, stop and consider how your action would have been viewed 150 years ago. Your colleagues would have looked at you askance; although a few would have been familiar with the work of various doctors—including John Pringle, James Lind, Alexander Gordon, Oliver Wendell Holmes, and Ignaz Semmelweis—who advocated washing yourself before contact with patients, most would have told you derisively that washing would not affect the miasmas, or air corruption, that brought disease.​disease.




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Graham A J Ayliffe, Mary P English

Cambridge University Press, £24.95/$38, pp 274 ISBN 0 521 53178 0

Rating: ★★★




This book is a comprehensive history of the major theories and discoveries about hospital acquired infection through the ages. Despite a daunting remit, the authors accomplish their task with panache, incorporating history and science in a book that manages to stay fresh and readable where the nature of the subject matter could have rendered it dry.

As well as outlining the work of seminal figures chronologically, the authors devote separate chapters to important topics in the area of infection, such as puerperal fever, sterilisation and disinfection, the emergence of resistance to antibiotics, and infection surveillance. A potentially huge and straggling subject is therefore divided into manageable sections.

The book is full of fascinating snippets of information, such as the fact that as early as the 13th century some workers recognised the need for cleanliness and good bed spacing, with the Hotel Dieu in Paris (which became notoriously dirty and overcrowded in later centuries) using 1300 brooms a year and washing and storing the clothes of patients when they were admitted. Similarly, in 1795 J M Good, a physician who carried out a painstaking examination of diseases of prisons and poorhouses, wrote, “No medicine is much more advantageous than the daily changing of linen.” The book has numerous humorous touches, such as the insight that the French pathologist Davaine (1812-82) kept his study animals that were infected with anthrax in a friend's garden.

The only minor quibble I have with the book is that in describing the soaring numbers of hospital acquired infections in the United Kingdom at present the authors have not mentioned the political angle. Thus, although it was recognised as far back as the 13th century that overcrowding contributed to the spread of disease, many major London teaching hospitals still cram five beds in every ward designed for four. Furthermore, although the authors note understaffing as a factor they don't analyse the fact that chronic understaffing of nurses and contracting out of cleaning and laundry services to the cheapest provider have led to major deficiencies in standards of ward hygiene and availability of clean bedding. Nurses regularly travel to work on public transport in their uniforms because of the lack of laundry facilities in hospitals.

Nevertheless, the book is a valuable history of an extremely important subject, one that is often neglected in medical schools.