The Medical History and Uses of Disinfectant and Anti-septic Agents

By Snohomish Brown December 11, 2010 Final Term Paper Medical History

The history of disinfectant use may span back further in time than the discovery of microorganisms and bacteria, however, in terms of medical history there is some evidence of the uses of soap and other cleaning agents well before this discovery. Medical practices have changed much over the course of human history and it comes as no surprise that as cultures developed separately, their ideas of personal hygiene did too. Trade routes between different cultures eventually opened up new possibilities for the spread of diseases as well as new treatments for them. As more methods for maintaining health and hygiene became available, the choice of which disinfectant cleansing agent to use and for what purpose relied upon on several factors. The trade-off between the anti-bacterial strength and how corrosive any given product can be greatly determines how safely it may be used. This research illustrates the wide variety of different substances used to disinfect and the history of their use. Additionally, the purpose of this present writing is to bring into perspective how even modern day practices may yet prove to be controversial in terms of their absolute efficacy as the understanding of the microcosmic world continues to unfold. In present times, it might be said that cleanliness is next to Godliness, but in the beginning, before it was well established that bacteria and micro-organisms spread infection, people seldom used disinfectants or anti-bacterial agents intentionally. In some parts of Asia we may hear rumors of soap being used in early civilizations, however, it was never exported as a product and so the information we have to determine whether or not this is true is scarce. According to popular legend, soap making in the Western world may have been around before 2200 BC, but that is the earliest known record of any kind of recipes for it. A Babylonian clay tablet from that date records a recipe consisting of water, alkali and cassia oil, however, its intended use was for washing stones and nothing more. The Egyptian Papyrus Ebers describes a treatment for enlarged glands as a result of purulence attack with a recipe for a balm which included heating natron and ox grease. This is one of the oldest known medical payri and dates back to 1550 BC. It is also perhaps one of the most important for it contains the largest volume of ancient Egyptian medicine known with nearly 700 magical remedies and formulas. Historically, natron was a salt solution of soda ash and baking soda that was collected from dry alkaline lake beds in Egypt and other countries. None of these formulas indicate that these materials were used for their detergent qualities.

Although it could easily be said that the natural saponification process occurring from the ashes of certain wood lye mixed with melted fats from animals or plants produced a material that found its way into the water supply where Roman women washed their clothes, perhaps this tale deserves a more discerning mind. There hardly any evidence to suggest the widespread use of soaps before the first millennium AD. The disinfectant properties of the ammonia found in boiled, decaying, human or animal urine might have been better known to most sheep herders who washed their wool in urine and fresh pig feces. The fact is that urine was so inexpensive and plentiful that it was generally used by most cultures especially for cleaning wool. It stands to reason that if soap making were common enough, then these other methods would not have been so readily employed. Besides urine and feces, however the standard practice of cleaning linens involved using clay, scented water, or certain plant oils mixed with soda. It is possible that in early civilizations, alkaline salt solutions and herbs may have been used to clean the body, and do the laundry. Processes utilizing substances like soap were certainly used in many cultures including Egyptian, Roman, Greek, Phoeneican, and Sumerian. We do not see any evidence that it was used as it is today, or called by anything that could be used to identify it until the writings of Pliny and Galen. Pliny first uses the word soap in his Naturalis Historia and describes it being used as pomade for hair dye and Galen describes two kinds of soap to be used for washing the human body and clothes. Other early accounts for the use of antiseptics include would care instructions from a Sumerian tablet suggesting washing the wound in beer and hot water, with poultices from wine dregs and lizard dung. Obviously, these practices did not have a clear understanding of what we know today about microbiology and the spread of disease. It was not until the costs associated with the production of soap were made considerably more affordable by the gradual industrialization of the textile producers of Europe that negative attitudes toward cleanliness began to change. Owing to the extensive deforestation of most of Europe, until this point, alkali which was important in making glass, paper, soap and textiles and had to be imported. In 1783, King Louis XVI and the French Academy of Sciences organized a contest to see who could solve the problem of obtaining alkali from sea salt. The reward of 2400 livre should have gone to Nicolas Leblanc, physician to Lous Philip II, Duke of Oleans who patented a solution in 1791, although one of the results of the French revolution made this impossible. His process eventually became known as the Leblanc process and yielded batches of

black caustic soda from sea salt heated with Sulfuric acid. This process was further enhanced by Michel Chvreul, the father of lipid chemistry. Chevreuls fame as a lipid chemist peaked in 1823 when he published his research on animal fats. He was able to unravel the nature of the saponification reaction and demonstrated how fatty acids and glycerol can be made into esters, of which most oils and fats we are familiar with are composed. These two discoveries revolutionized the soap making industry and the popularity of French soaps boomed as inexpensive methods to produce high quality soaps were soon easily implemented. Medical practices in India were considerably more advanced it seems, since as early as 500 BC. The principles of Hindu Dhanvantri medicine as described by Shusruta admonished surgeons to wash their hands, clean their nails before operating, wear clean garments and wrap wounds with clean bandages as well as spraying fresh-smelling vapours and generally keeping a clean environment for surgical procedures. It is not known, however, if he understood the importance of these practices. On the other hand, it was common for European doctors not to wash their hands, especially within the more northern temperate zones where temperatures were often much colder. Heironymous Fracastorus, also known as Girolamo Fracastoro published a book in 1546 that may have lead to the discovery of bacteria. Having studied in Padua, he researched what we now recognize as Syphilis, thanks to his work entitled: Hieronymi Fracastorii Syphilidis sive de morbo gallico. His thoughts on the subject led him to postulate the existence of germs, with the ability to multiply inside an organism and infect others via the breath or other forms of physical contact. Although no evidence during his life was produced to verify his claims, his hypothesis was later found to be correct. A Dutchman by the name of Antonie Van Leeuwenhoek developed an interest in microscopes that were being used for making textiles at the time. His curiosity and experimentation with glass processing led him to make one of the most astonishing discoveries in medicine. By placing the center of a small rod of soda lime in a hot flame, Van Leeuwenhoek was able to pull the hot middle section apart and form a tiny glass sphere on one end of the rod by placing it back into the flame. These spheres made excellent lenses and the smaller they were, the better they were able to magnify. Van Leeuwenhoek used samples of his own saliva took measurements to estimate the numbers of microorganisms per units of water. Leeuwenhoek made good use of the huge lead provided by his method of lens making. He explored a broad range of microscopic phenomena, and shared his observations freely with groups such as the

English Royal Society. In 1673 his earliest observations were published by the Royal Society in its journal: Philisophical Transactions. In 1676, he sent to the Royal Society a copy of his first observations of microscopic single-celled organisms, which initially were received with much skepticism since previously, the existence of single-celled organisms which he termed animalcules was entirely unknown. Eventually, his findings were verified as accurate and his place in history vindicated. Unfortunately his methods of designing lenses died with him and it was not until nearly two centuries later that the basis of the germ theory of disease was established. Ignaz Semmelweis was a Hungarian physician who first demonstrated that puerperal fever was contagious and could be prevented from spreading by the simple act of enforcing appropriate hand washing principles by surgeons and other health caregivers. His discovery in 1847, however, failed to convince his fellow doctors and led to tragic conclusions. After observing that cases of childbed fever (as it was more commonly known) were more common in one of the wards than in others where he worked, he tested some hypotheses and found that infections were reduced if doctors carefully washed their hands before dealing with pregnant women and especially after dealing with corpses. His conclusion was that some unknown material from the dead bodies was causing the epidemic. The medical community at the time received his public lectures on the subject coldly, if not with hostility. His findings contradicted current scientific opinion which blamed the existence of disease upon imbalances of the four basic humours in the body. Doctors unwilling to consider that they may have been the cause of so many deaths argued that the practice of hand washing would be too much work. Semmelweis eventually published a book in 1861 that communicated the ideas he had been developing for nearly 14 years. His work was never accepted in his lifetime, however, and he was later committed to an insane asylum where died. Even though in Paris, doctors were using ethanol as an anti-septic to dress wounds as early as 1763 and in 1840 Jakob Henle postulated the theory of the contagion, it was not until the pioneering work of Loius Pasteur and Joseph Lister that hand-washing became as widely practiced in medicine as it is today. Pasteurs contribution to the germ theory of disease is often credited with instituting changes in hospital/medical practices to minimize the spread of disease by microbes or germs. Also, he is credited with the discovery that weak forms of disease could be used as an immunization against stronger forms and furthermore that rabies is transmitted by

viruses too small to be seen under the microscopes of the time. For that matter, he is also credited with introducing the medical world to the concept of viruses. Originally, he had set out to help French distillers prevent spoilage due to germs and he developed the slow heating process we now know as Pasteurization that stops bacteria from forming. Following this discovery, he opened the Pasteur Institute in 1888 and worked to convince others of his ideas, controversial as they were in their time, but considered absolutely correct today. He fought to convince surgeons that germs did exist and that they carried diseases. Dirty instruments and hands were capable of spreading germs too and therefore also spread diseases. Pasteurs pasteurization process killed germs and thus prevented the spread of disease. When Lister was working in Glasgow in 1860, he was introduced to some of Pasteurs ideas about germ theory and corroborated it with his own ideas about the spread of infections. Pasteur had demonstrated that the problem with spoilage of wine was due to the germs which had interfered with the fermentation process by entering through the air. His theory, that germs must give rise to contamination and did not occur spontaneously from non-living matter indicated that life begat life unlike the ideas held by most evolutionists at the time. Lister immediately recognized the validity and practical application of Pasteurs work and theorized that if infection arose spontaneously within a wound then little could be done to prevent it. However, if germs entering from the outside are were responsible instead (in much the same way that wine could go bad) then if the germs could be killed, the possibility for infection could be eliminated. After learning that a certain phenol, carbolic acid, was being used effectively to disinfect sewers and could be safely used on human flesh, in 1865, he began using it to wash his hands, instruments and bandages used in operations. He also would spray the air with carbolic acid to kill airborne germs. Over a year later, he had enough data and refining of his techniques to demonstrate success and by 1879, methods proposed by Lister were finding acceptance among even English doctors. While at this time the scientific applications of disinfectants were gaining ground, it was mainly due to the pioneering work in microbiology during the 1800s that led to the widespread acceptance of the germ theory of disease. Many disinfectants were being used as antiseptics at this point and it was not well known which were most effective or safest to use. In 1811, Iodine was discovered and found useful in dressing wounds by John Davies in 1839, especially for boils and abscesses. Louis Jacques Thenard, a French chemist, is credited with discovering hydrogen

peroxide in 1818. Still highly effective as an oral anti-septic and in the cleansing of open cuts, hydrogen peroxide is also used in low temperature sterilizers for heat-sensitive equipment used in hospitals. Other more anti-septic compounds were also being introduced such as ethanol, isopropyl alcohol and chlorine. More recently, commonly used household cleaning products contain harsh chemicals that can sometimes do more harm than good. There have been a few studies conducted that seem to implicate over-cleanliness to be a health problem too. Last year another study from the Northwestern Universitys Weinberg College of Arts and Sciences and the Institute for Policy Research led by Thomas McDade, suggests that, contrary to what previous research has shown, ultra-clean, ultra-hygienic environments early in life may contribute to higher levels of illness as an adult, which in turn increases risks for a wide range of disease. He believes that we may be depriving developing immune systems of important environmental input needed to help guide their function throughout childhood and into adulthood. His team examined data from a study in the Philippines, which followed participants from birth to 22 years of age. The data was compiled by tracking children born in the 1980s to 3,327 Filipino mothers. Visits with the children were as frequent as every two months for the first two years of their lives and then later adjusted to every four or five years until the children reached their 20s. Hygiene assessments of the household environment included whether domestic animals such as pigs and dogs roamed freely and the familys socioeconomic resources. Findings suggest that early exposure to infectious microbes may help protect individuals from cardiovascular diseases that can lead to death as an adult. It also suggests that immune systems may need a higher level of exposure to common everyday bacteria and microbes to guide their development. This supports what Wang Nianrong, a doctor from Beijing Woman and Childrens Health Care Hospital, has published the year previously in 2008. Wang said that one three-year-old boy she treats ends up with a cold, fever, diarrhea or a skin infection whenever he goes to kindergarten; however, he recovers rapidly as soon as he returns home. Then she determined that the boys mother was obsessed with cleanliness and the boy had never been exposed to a natural environment. She recognized that the mother worried too much, even ordering the babysitters to change the boys clothes every day, never allowing him to touch dirty things like mud or wood without washing immediately afterward. As a result, Wang believes that the boy has a very weak immune system due to living too long in a clean

environment. In her opinion, the best way to build the immune system is to let children experience nature. A persons ability to fight off diseases can only be developed gradually over repeated exposures. She also said that children who play around dirt, plants and germs and even some viruses will gradually adapt to these pathogens. Furthermore, Dan Chang, PhD, a professor of environmental engineering at U.C. Davis has uncovered some startling new discoveries concerning anti-bacterial soaps now popular in the United States. Two chemicals commonly found in most of these liquid hand soap products, triclocarban and triclosan, were developed in the 1950s and 60s and first used mainly as antiseptic agents in hospitals. Although it has been shown that these disinfectants are no more effective in preventing the spread of germs and disease than the standard practice of using soap and water, studies now indicate that they may have some undesirable side effects. One test-tube study showed that triclosan attaches to the surface molecules of some cells and overexcites them with too much Calcium, possibly causing harm to developing neural circuits in fetuses of pregnant women. Triclocarban has been shown to be an endocrine disruptor possibly responsible for early puberty among girls and increased likelihood of cancers developing. There is still more research to be done to show that these chemicals are harmful to most people, but the evidence in support of anti-bacterial soaps fostering more resistant strains of bacteria and micro-organisms is more conclusive. In conclusion, it is clear that the stakes continue to be high in this search for healthy medical practices. Even with the advent of new technologies and newer chemicals, it seems as though current sentiment on these issues has swung from one extreme to the other. In the history of disinfectant use, there seem to be many conflicting views and constantly new information to guide our choices. We owe many thanks, however, to the continued explorations into the microbial world of our many learned and skillful scientists. Without the persevering efforts of men and women like Semmelweis, Pasteur, Lister, and even the more recent efforts of Dr. Wang and Dr. Chang, many lives would continue to be lost due to microbial infection.

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