Answering Ackerknecht: infection control practice in Scottish hospitals in the early 'antibiotic era', 1928-1970

Gardiner, Susan (2017) Answering Ackerknecht: infection control practice in Scottish hospitals in the early 'antibiotic era', 1928-1970. PhD thesis, University of Glasgow.

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This thesis examines infection control practice in Scottish hospitals in the early years of the ‘antibiotic era’, from approximately 1928 to 1970. Hospital infection and its control has, in recent years, received increasing attention from historians. But there is a notable absence of work uncovering the details of infection control practice, particularly in Scottish institutions in the 20th century. Thus, this thesis provides a comprehensive study of practice, influenced by Erwin Ackerknecht’s behaviourist predication. Using case studies, it explores how concerns about infection and its control were manifest in the daily work of clinicians, nurses and bacteriologists, over an especially important 42-year period, at the Glasgow Royal Infirmary and the Royal Infirmary of Edinburgh. This study utilises an extensive range of sources. These include, but are not limited to: hospital administrative records, ward journals, case notes, films, architectural plans, lecture notes, medical textbooks, correspondence and the medical literature. It also draws on oral history interviews, using both existing collections and carrying out new interviews. Infection control practices between 1928 and 1970 were constantly evolving, adapting and refined. Concerns about infection and its control were generally of paramount importance to clinicians, nurses and bacteriologists, although, for a brief period after about 1948, some clinicians developed relatively lax attitudes towards infection in light of the increasing popularity of antibiotics. In the years before antibiotics, a multitude of methods were adopted to control or prevent hospital-acquired infections. These infections were manifest in numerous forms, from burns infections to post-operative tetanus. Sulphonamides represented a modest advance over other, more traditional treatments. When penicillin appeared during WWII, it prompted numerous investigations into its cultivation and possible uses, and it found an important application in treating a vast range of conditions, from wound infections to burns and osteomyelitis. Penicillin was deployed in various ways and, in Glasgow, new aseptic techniques were introduced to complement it. Preparing and administering penicillin became an important part of routine nursing work, work which was, in many ways, imperative to infection control. But the drug’s shortcomings – of which bacterial resistance was one – were evident from the beginning. After 1948, antibiotics became the mainstay of hospital infection control and the methods by which they were used became increasingly diverse. For a short while, for some clinicians, infection and its control represented less of a problem than before. But growing infection rates in the 1950s, particularly late in that decade, prompted renewed enthusiasm for new methods for its control. Antibiotics were gradually used with greater restraint. Laboratory work expanded into new areas and the work of new infection control committees and new sterilisation procedures led to heightened standards of asepsis in the clinic. Changes in the education and daily work of nurses also had important implications for infection control. This thesis also adds new perspectives to debates within the historiography of hospital infection and its control and within the wider medico-historical literature. In the years from 1928 to 1970, methods of control became increasingly uniform not only between hospitals, but also within hospitals. This was especially the case from the late 1950s, owing largely to the work of new infection control committees and new systems for sterile supply. Hospital bacteriologists gradually became authorities on infection control, but they had been important at the beginning of the period and had influenced methods for infection management, in both the laboratory and the clinic, throughout the period. Largely in connection with infection control, the daily work of nurses and perceptions of their work changed considerably and generally for the better. Changes in nurse education and a reconfiguration of their daily duties allowed nurses to carry out increasingly stringent aseptic techniques. This contributed to changing perceptions of their work and expertise. Senior nurses played key roles on infection control committees and in central sterile supply facilities, influencing how infection control was practised on the ground level. There is a strong relationship between strategies for infection control and hospital economics. Supply issues and, in later years, concerns about hospital expenditure both exerted a great influence on methods for infection control and vice versa, and they often influenced the success of those methods. 20th-century military conflict led to positive progress in infection control. Both World Wars and, to a lesser degree, military cooperation following the Suez Crisis, provided the impetus for new anti-infection treatments and techniques which still found application in peacetime. WWII also provided opportunities, not least for bacteriologists, for important clinical research. The founding of the NHS in 1948 greatly influenced the landscape of hospital infection and its control. The increasing demand for hospital care and pressures on infrastructure largely explain the growing rates of infection in the early years of the new service, while these pressures also influenced the shape that new strategies for infection control took.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Additional Information: Due to copyright restrictions the full text of this thesis cannot be made available online. Access to the printed version is available once any embargo periods have expired.
Keywords: History of medicine, antibiotics, antibiotic resistance, hospital infection, infection control, history of bacteriology, history of nursing.
Subjects: D History General and Old World > DA Great Britain
H Social Sciences > H Social Sciences (General)
H Social Sciences > HN Social history and conditions. Social problems. Social reform
Colleges/Schools: College of Social Sciences > School of Social and Political Sciences > Economic and Social History
Funder's Name: Leverhulme Trust (LEVERHUL)
Supervisor's Name: Dupree, Professor Marguerite and Nicolson, Professor Malcolm
Date of Award: 2017
Embargo Date: 8 September 2020
Depositing User: Miss Susan Gardiner
Unique ID: glathesis:2017-8382
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 08 Sep 2017 15:13
Last Modified: 06 Nov 2019 14:13
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