The health of hospitals and lessons from history: public health and sanitary reform in the Dublin hospitals, 1858-1898

Abstract

Aims and objectives: The aim was to examine, critically, 19th century hospital sanitary reform with reference to theories about infection and contagion.

Background: In the nineteenth century, measures to control epidemic diseases focused on providing clean water, removing waste and isolating infected cases. These measures were informed by the ideas of sanitary reformers like Chadwick and Nightingale, and hospitals were an important element of sanitary reform.

Design: Informed by the paradigmatic tradition of social history, the study design was a historical analysis of public health policy.

Method: Using the methods of historical research, documentary primary sources, including official reports and selected hospital archives and related secondary sources, were consulted.

Results: Emerging theories about infection were informing official bodies like the Board of Superintendence of Dublin Hospitals in their efforts to improve hospital sanitation. The Board secured important reforms in hospital sanitation, including the provision of technically efficient sanitary infrastructure.

Conclusions: Public health measures to control epidemic infections are only as effective as the state of knowledge of infection and contagion and the infrastructure to support sanitary measures.

Relevance to clinical practice: Today, public mistrust about the safety of hospitals is reminiscent of that of 150 years ago, although the reasons are different and relate to a fear of contracting antimicrobial-resistant infections. A powerful historical lesson from this study is that resistance to new ideas can delay progress and improved sanitary standards can allay public mistrust. In reforming hospital sanitation, policies and regulations were established--including an inspection body to monitor and enforce standards--the benefits of which provide lessons that resonate today. Such practices, especially effective independent inspection, could be adapted for present-day contexts and re-instigated where they do not exist. History has much to offer contemporary policy development and practice reform and is a relevant method for health professionals.