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although the importance of hand for the transmission of infectious diseases was not demonstrable before the 19th century when medicine began to adopt scientific ways of thinking，an idea of their role must have existed long before the Hungarian obstetrician Ignaz Philipp Semmelweis made his epidemiologic observations on the horrible spread of puerperal fever, which caused maternal mortality rates of up 18% in some months at a Vienna, Austria, lying-in hospital during the years 1841 to 1847. At least from examples of the historical tradition, it may be concluded that hand washing is an old cultural heritage of human civilization. The idea has been handed down to us that this procedure not only served for the removal of dirt but also to deliver people symbolically from physical and moral evils, such as illness and sin。It is characteristic of the efficacy of modern scientific methodology that hands were identified as transmitters of disease even at a time when microorganisms were not yet recognized as a cause of infection. Semmelweis applied epidemiologic rather than microbiologic methods to test his hypothesis that preventing hands from introducing a fatal something into the maternal birth canal during vaginal examination would also end the hyperendemic situation of puerperal fever at his hospital. His attention was especially drawn to the markedly lower maternal mortality at the second obstetric department of the same hospital where,in contrast to his working place ,where usually midwives conducted deliveries. He identified the distinguishing moment in the incidence of puerperal fever by the fact that midwives had no contact with the autopsy room where, he postulated , hand were contaminated with the fatal etiologic agent.
虽然 19 世纪医学开始采用科学思维方式前，对手传播疾病的的重要性并没充分认识，但在这之前，这种想法在匈牙利产科伊格纳•茨菲利普•塞梅尔魏斯医生应用流行病学方法对可怕的产褥热传播进行观察时就考虑到了。在1841 至 1847 年期间，在奥地利维也纳，莱茵医院有几个月造成18%的孕产妇死亡率。至少从历史上的例子，可以得出结论，洗手是人类文明的一种传统文化。这一思想一直流传下来，洗手不仅有助于清除污垢，而且还能象征性地显示人们爱护身体和行为的好坏，如疾病和罪孽。它是现代科学方法，在当时手尚未被确认为能传播由微生物引起的感染性疾病。塞梅尔魏斯应用流行病学，而不是微生物方法来测试他的假设，在进行阴道检查时防止了一个致命的东西进入产妇产道，也结束在他的医院产褥热高度流行的情况。他特别注意到，在他工作的同一家医院的产科二部通常由助产士进行交接，产妇死亡率显著降低。他确定事实，助产士没有接触过解剖室，推断解剖室与产褥热发病率的显著增高有关，接触解剖室手被致命的病原体污染了。
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发表于 2011-11-25 12:16
