When tar water was universal cure

An Aberdeen man driven out of the city for suggesting that dirty hands could lead to the spread of infection may finally get the recognition he deserves as his previously undiscovered notes are published.

For years, the discovery that infections such as Puerperal Fever could be spread by medical staff who were not washing their hands was attributed to Dr Ignaz Semmelweis, who published a report with the findings in 1847.

Aberdeen doctor Alexander Gordon made the same connection 50 years earlier in 1795, however, but the extent of his findings went undiscovered – until now.

Retired physician and clinical pharmacologist Peter Bennett, originally from Aberdeen but now living in Bath, cameacrossGordon’s unfinished manuscript, The Practice of Physick in Aberdeen University’s King’s College library while working on a project for a diploma in 2008, and it wasn’t long before he realised the phenomenal importance of Gordon’s findings.

“Forgetting all of the recognition and fame that would have come to Gordon, and indeed Aberdeen, perhaps the saddest fact is that hundreds of thousands of new mothers died in the time between Gordon’s findings and the realisation of the medical community that the simple act of washing your hands could prevent eventual death,” said Mr Bennett.

“It’s just so terribly sad. He had these findings that showed things could be easily changed, yet no one would take him on, and so many mothers continued to contract Puerperal Fever and die.”

Dr Ian M. Gould, consultant microbiologist and service clinical director at the department of medical microbiology at Aberdeen Royal Infirmary, said it is incredibly important that this discovery of Gordon’s work be celebrated.

“Gordon is the unsung hero of modern infection control practices. While he wasthe first toscientifically demonstrate the importance of hand hygiene in preventing the transfer of childbed fever from one mother to the next, Sem- melweiss gets all the credit for this discovery.”

Written in 18th century Scots language, Gordon’s manuscripts have barely been opened since they weredonatedto the university in 1913.

“It describes life as a doctor in the 18th century, but it also lets you see what the poor patients were experiencing,” said Peter Bennett.

“Most interestingly though, the last page of the book had a half-written sentence. I realised that poor Gordon had been chased out of the city before he’d even finished it, and that this brilliant, forward- thinking man had never got the credit, or respect he deserved.”

Back in Alexander Gordon’s day, hospitals were only just appearing across the UK. Perhaps hand washing seemed odd as a lack of indoor plumbing made it difficult to get water. Besides, contact with water was associated with diseases such as malaria and typhoid fever.

It was during 1789–92 that two epidemics –

“So many mothers continued to die”

erysipelas and puerperal fever – struck Aberdeen, and Gordon, having documented his patients, made his staggering discovery.

“Gordon was appointed a physician to the dispensary, where poorer people could go and get treatment, or ask for a house visit,” said Mr Bennett.

“He was the only obstetrician in the city, so when hevisited patientshetook a note of theirname, address, condition, treatment and outcome to build up some records.

“He soon realised if city midwives who were treating the infected in the city went out to somewhere like Nigg, the new country mothers would get the dis- ease too, yet if a country midwife, who had no contact with the disease came into the town, the patients were fine.

“It didn’t take him long to realise that the nurses, and indeed he himself had been spreading the disease. To acknowledge this in a time when no one knew microbes existed was a huge discovery.

“Gordon instructed doctors and midwives to fumigate their clothes, andwash their hands, and soon the mortality rate of those with Puerperal Fever dropped to 30% in Aberdeen from something like 80%.”

Gordon published his findings, hoping that they would promote hand washing and better hygiene standards.

“The problem was that he published the names of the patients, their families, and most importantly, the midwives who were spreading the disease,” said Peter.

“The midwives didn’t appreciate having the finger pointed at them, the doc-

tors still didn’t agree that hygiene was the solution, and basically they forced him out of Aberdeen.

“He joined the Navy as a surgeon, and remained there until he contracted TB, and died aged 47 at his brother’s home in Aberdeenshire.”

Peter spent years transcribing Alexander Gordon’s notes, and has finally had them published under their original title, along with his own notes on the manuscript.

“His scrutinyof theuse of medicines is illustrative: despite an interval of over two centuries, his counsel emergesas rationalandhumane, and indeed resonates with that which underpins much of our present perspective on medicinal drug therapy,” he said.

Perhaps now, almost 250 years after Gordon was driven out of his home town, it will give him the recognition he deserves.

Peter Bennett’s book is available on Amazon.

The NHS uses a universal, 12-step hand-cleaning system, to ensure every part of your hands and wrists are cleaned thoroughly.

Hand gel throughout all NHS Grampian hospitals, for visitors, patients and staff. The routine use of hand gel came in the 21st century.

Regular audits of hand hygiene compliance in hospitals

Alexander Gordon was practising at the time of the Enlightenment, when scholars and doctors were questioning the theory that had been in use since Hypocrites.

Doctors had still been treating patients on their personality – whether they were earth, wind, water or fire, and still practised blood-letting, with various painful procedures such as cupping. Tar water was used as a universal cure, and there was no limit on how many drugs a doctor could prescribe to a patient.

Alexander Gordon was a well-learned man who had studied in Holland, Edinburgh and London, and after working as a ship’s surgeon, set up his own practice in Aberdeen, and took inspiration from the white-washing and burning of infected clothes as seen in military practice.

“He was one of the first to look at existing treatments such as cupping, and leechi ng, and s ay ‘ why are we still doing this, it doesn’t work’,” said Peter Bennett.

Thousands of women went on to die from Puerperal Fever in the UK after Gordon’s discovery that washing hands stopped the spread of the disease.

It was an excruciatingly painful condition. Patients suffered from intra- abdominal poisoning. The inf ection would enter through the uterus, spread out to the abdominal cavity, and into the blood stream, which led to septicaemia.

“They basically suffered from peritonitis, and had – the results are displayed outside wards in NHS Grampian.

There are 10 standard infection control precautions which all contribute to reducing infection.

The materials used for wards and furnishings are designed to be easy to clean and maintain.

Healthcare staff follow the World Health Organisation’s an extremely painful death, but one which was unfortunately commonplace,” said Mr Bennett.

“There were open sewers, no plumbing, and so it wasn’t easy to live cleanly.

“It was only in 19th century that The Great Stink led to the Embankment, proper sewers and the public health movement.

“It’s difficult to imagine just how disgusting it was. People didn’t think about hygiene, they didn’t have any reason to.

“It wasn’t until 1880, when streptococcus was discovered in Aberdeen, and other strains were identified, that doctors clicked that transmission of microbes was what was spreading illnesses.”

When Semmelweiss treated his hands with antiseptic solution before treating new mothers, the number of childbed fever fatalities was reduced by

90%. As he too was ignored, mortality rates from Puerp e r a l Fever remained high until the arrival of antibiotics in the 1930s. Five Moments of Hand Hygiene – a simple guide which protects patients and healthcare staff from infection.

Puerperal Fever is now rare due to both hygiene and antibiotics.

The organism that caused Puerperal Fever is carried by about one in five people, and normally causes them no problems.

Antibiotics are used only when essential. This reduces the risk of organisms becoming resistant.

Surgeons work on a patient in Aberdeen in the 1860s. Doctors had just begun to spray equipment with antiseptic solutions. At this time, about 50% of hospital patients died due to infection after surgery. Doctors would not start wearing coats, gloves or...

Inset picture: In recent years, Aberdeen Medico-Chirurgical Society arranged for a plaque bearing Alexander Gordon’s name to be placed in Belmont Street, before being relocated a short distance when it was realised it was hidden from public view. Plans...