Hospital Infection: From Miasmas to MRSA

Abstract

Hospital Infection: From Miasmas to MRSA By Graham A. J. Ayliffe and Mary P. English (New York: Cambridge University Press, 2003) (288 pages; $100 cloth, $40 paper) For centuries, there has been much discussion about the problem of infections. In this book, Graham Ayliffe and Mary English, both distinguished scientists with extensive research backgrounds, provide a comprehensive, detailed account of the history of hospitalism, the word Sir James Simpson, professor of midwifery at Edinburgh in 1859, coined to describe hospital-acquired septic (p. 83). Beginning with the ancient belief that bad air (miasma) arising from decaying organic matter, cesspools, and marshes led to epidemic diseases, the authors highlight the commonly accepted theories of the spread of infection as well as the contributions of numerous physicians and scientists related to microbiology and the discovery of antibiotics. The authors also discuss in depth the major infectious diseases that have plagued nations throughout history and conclude with an account of the emergence of methicillin-resistant staphylococcus aureus (MRSA) in the 20th century. In the first three chapters, Ayliffe and English trace theories of infection from the Middle Ages through the 17th century, focusing on the universal acknowledgment of divine wrath and putrid air as the causes of disease. They highlight the Bubonic plague of the 14th century, and recount early attempts to control disease through fumigation, burning clothes and bedding, and quarantine. In the fourth chapter, the authors describe epidemics of typhus in military and civilian hospitals in the 18th and 19th centuries, discussing in detail how the pioneering work of British army surgeon John Pringle (1707-1782) was critical to the prevention of hospital infections in general and the control of typhus in particular (p. 41). In this chapter, Ayliffe and English address the contagion theory of disease, examining how contact between patients was responsible for such diseases as leprosy, smallpox and plague. Concentrating on the 19th century before Lister, the authors argue that the Norfolk and Norwich Hospitals were typical of many other hospitals in the 19th century, all of them affected severely by the rapid population increase and the consequent pressure on their wards and rise in the infection rate (p. 78). Paying particular attention to erysipelas, pyaemia, and hospital gangrene, Ayliffe and English examine the roles that overcrowding, defective ventilation, and inadequate nursing care played in the problem of hospital infections. In later chapters, the authors discuss theories of infection, highlighting the fact that it was Richard Mead, a leading London physician, who first suggested the idea that contagion was at least as important as aerial transmission in the spread of epidemics, and concluded that quarantine was most important in preventing the onslaught of plague in England. According to the authors, Mead's studies, first published in 1720, were a milestone in epidemiological thought ( p. 88). The book succeeds in many ways, one of which is the consistent recognition of lesser-known scientists and their achievements. …