RE: healthy vs not sick and symptom suppression
Actually, it was the overwhelming evidence in favour of it that changed minds. No one got into fisticuffs over it. But some bright boys got the idea to see what happens if you DO wash your hands, etc (you would be surprised how much medicine is advanced because of statistical analysis - scary, really). What made the difference in hand washing was the Semmelweis' germ theory, introduced in the 1840's or so, near as I can recall. He did it by crunching numbers and ask which of these things is not like the others? It took a while to catch on, not least because despite his delivering the paper, he did not follow up, having been committed to a mental asylum not long after delivering the paper (some suspect he had syphilis, which can cause erratic behaviour) and he died in the asylum, probably from sepsis, which is somewhat ironic for the discoverer of germ theory. Let me rephrase that - his ideas became quickly accepted, but the practice didn't - getting people to change their habits when there was no one to force them to, unlike today, was very hard, and is one reason I am glad we have some overseers in the government, even above the medical licensing board and the FHM (or version of the ACP and FCP). Sure the BAG can be a pain at times, but it is an important pain, so long as there are real scientists an doctors advising it and it is not just a bunch of functionaries and bureaucrats.
While the habits and practices he recommended eventually caught on and by the early 20th century had more or less become recognised, there was no standard of hand hygiene in medicine until 1980, when clear guidelines were established, again based on number crunching. M&M statistics were analysed from participating clinics world wide, and, after various practices were taken into account, clear indications of procedure were arrived at (and not just for hand hygiene, btw, but for a lot of areas). In the process, long held ideas about certain sterile practices were also forced to be abandoned in favour of new models, which are being refined even today. I point out, for instance that liquid hand disinfectant dispensers only became common in hospitals, clinics and public buildings very recently, many in response to the bird-flu epidemic and the swine flu before it. In fact, new guidelines are constantly being handed down as evidence becomes clearer as to the most effective procedures. I had to attend a new hand washing clinic a few months back to acquaint our staff with new methods and procedures deemed more effective than our normal standards (based on a study of all the major Swiss clinics and their procedures, and comparing them to other studies in 30 other countries, after which the BAG (our version of the Health Administration in the US, or whatever you call it (I have forgotten tonight - senior moment) decided on new guidelines, then tested them on one hospital that was showing poorer results than others, saw the improvement, tried it on the top of the league, saw the improvement again then handed it down to all hospitals as new guidelines)..
If you want a good snapshot of what medicine was like in Semmelweis' time, look no further than The Doctor's Dilemma, a play by Shaw that shows how much quackery was going on at the time (there is a wonderful film version with the amazing Dirk Bogarde) - the story concerns the moral dilemma of who to save given limited resources, but it is the collection of doctors, most of them quacks, that is of interest here - it took some time before medicine became the standardised system we see today, based exclusively on evidence based science. To compare modern medicine to how it was at the beginning of the 20th century is to compare modern computing to Victorian computing. Medicine was one of the last industries to benefit from the boon of the Industrial Revolution, namely, standardisation in all areas - training, procedure and technology. I think the last time I saw a near knock down drag out fight amongst doctors was back in the early days of the AIDS epidemic, when some Wisenheimer or other tried to advance the idea that it was based solely on lifestyle and not on immunological infection (which it was pretty clearly based on from the earliest description of it). That was a pretty wild conference. I was tempted to punch a colleague in the nose because he was convinced that genital herpes was treatable by anti-fungal creams, but that was because I thought he was a quack and dangerous to his patients. He now runs a massive walk in clinic sponsored by one of the biggest insurers in this country. Go fig.... I should have tried to get him struck off. Ah well, so long he doesn't treat anyone with herpes, I guess he's harmless. The rest of his medicine was more or less in line with standard procedure.
(This post was last modified: 05-03-2015 06:56 PM by DocWils.)