Claire and the Case for Cleanliness

"...she began digging in a painted wooden chest by the hearth, emerging finally with a pile of ratty cloths.

 'No, that won't do,' I said, fingering them gingerly. 'The wound needs to be disinfected first, then bandaged with a clean cloth, if there are no sterile bandages.' 

Eyebrows rose all around. 'Disinfected?' said the small man, carefully.

 'Yes, indeed,' I said firmly, thinking him a bit simpleminded, in spite of his educated accent. 'All dirt must be removed from the wound and it must be treated with a compound to discourage germs and promote healing.'"

- From OUTLANDER,  Chapter 3, "The Man In The Wood" by Diana Gabaldon

Discouraging "germs" is a bit off- topic for a plant blog. But we are talking here about the Outlander books and Claire Fraser's pragmatic approach to healing. She could use "Russian penicillin," also known as garlic, to treat infection, but why allow infection to take hold in the first place? An ounce of prevention is worth a pound of cure. I'm sure Claire would agree.

In Claire's time, dramatic improvements in human health had been achieved as a result of good hygiene and sanitation practices. But in the 18th century, no one understood that tiny, invisible-to-the-naked-eye organisms were responsible for a host of infectious and deadly diseases. Even though "germ theory" had been around a long time (Aristotle, in 350 BC, advised Alexander the Great to "boil drinking water and bury feces, to prevent disease."), the idea didn't really begin to gain widespread attention until the mid-19th century.

In the 1850s, John Snow, a British obstetrician, became convinced that drinking water contaminated with sewage was responsible for outbreaks of cholera in London. His conclusion was met with derision from his contemporaries who "knew" that diseases like cholera were caused by "vapors" or "miasma." The Reverend Henry Whitehead sought to discredit Snow's conclusions, claiming that the disease was an act of God.

But Snow ignored his critics and continued observing and collecting data. In August of 1854, a particularly severe outbreak of cholera occurred in Soho, a London suburb. Determined to prove that contaminated water was the cause, he conducted a study of the victims and where they got their drinking water. Writer Kathleen Tuthill quotes Snow as saying, "Within 250 yards of the spot where Cambridge Street joins Broad Street there were upward of 500 fatal attacks of cholera in 10 days. As soon as I became acquainted with the situation and extent of this irruption (sic) of cholera, I suspected some contamination of the water of the much-frequented street-pump in Broad Street."

In spite of all the evidence he collected, connecting hundreds of cases of cholera with drinking water from the Broad Street pump, his conclusions were still met with skepticism. He finally convinced town officials to take the handle off the pump, at least temporarily, so that no one could draw water from it. The cholera epidemic came to an immediate halt.

Despite this dramatic proof, city officials still refused to clean up sewage systems and assure that drinking water was clean. But Snow's conclusions eventually won out.  In the 1880s, a German doctor, Robert Koch, identified the bacterium, Vibrio cholerae, that causes cholera. His work showed that cholera is spread by way of fecal contamination of food or water.

By the end of the 19th century, cities in Europe and the United States had improved sanitation systems, keeping drinking water separate from sewage. Outbreaks of cholera in those cities became a thing of the past.

Snow is considered a pioneer in public health research, but he was not alone. Louis Pasteur, for whom the process of pasteurization is named; Robert Koch, the founder of modern bacteriology mentioned above; Charles Chamberland, whose filter was used in the discovery of viruses; Miles Berkeley, who discovered that potato blight was caused by fungal disease - all made significant discoveries in the last half of the 19th century.

As the chart below illustrates, the benefits of all this knowledge were profound. In the first half of the 20th century, improved sanitation systems, combined with public health education about the importance of cleanliness to prevent the spread of disease, reduced mortality rates from infectious diseases dramatically. The one notable spike in those years was the 1918 flu pandemic, nicknamed the Spanish flu. (Fans of Downton Abbey will remember the episode when Lavinia Swire, Matthew Crawley's fiance, died of the disease.)

By the time Claire was serving as an Army nurse during WWII, mortality rates from infectious diseases had declined by 75% since the turn of the century- and that was before penicillin was widely available. As you can see from the graph, antibiotics did have an effect, but nothing compared to the difference made by good sanitation and hygiene. Let's remember that. Three cheers for soap and clean water!

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