Hospital Hygiene, looked at from a holistic perspective
Heinz Flamm 11 Emeritus Director of the Institute for Hygiene and Microbiology at the University of Vienna, Austria
Preamble
Remembering a person who’s life for the most part consisted of serving the goddess Hygieia you find depicted on the medal affords a good opportunity to find out why this medicinal discipline is bearing just this name. Therefore we have to move onto the highest level of the Greek heaven:
The beautiful, but brutal Apollon, son of Zeus and grandfather of Hygieia, was throwing thunderbolts bringing death and mischief, but besides that was also responsible for healing and the oracles often needed therefore. The latter, thus the medicinal function, had later on been passed on to his son Asklepios (Aeskulap), born per sectionem. This one, however, did not content himself with healing sick people but also resurrected the dead which was misdoing against Hades, the lord of the underworld. In punishment thereof he was killed by his grandfather Zeus by the help of a thunderbolt.
Fortunately for us Asklepios has married Epigone (“the alleviating”) and fathered 12 children. In the hygienic group of 4 children we find Hygieia, amongst the 8 children of the therapeutic group Panakeia (“the universal healer”) is the most prominent. Incidentally Hygieia, due to lack of demand, remained a virgin for all her life. The hygienists are still fighting this lack of procreation until this very day. In the Hippocratic oath Apollon, Asklepios, Hygieia and Panakeia are called upon to witness the oath. Grandfather Apollon, father Asklepios as well as daughter/grand-daughter Hygieia are symbolising today’s medical science.
- The Apollonian aggressive medical science disesteems and misuses the human being, at present it is looking for biological, chemical or atomic weapons in order to fight humanity.
- The Asklepian medical science, the healing-skill in the proper sense, is concentrating on the healing or at least the alleviation of the individual’s medical conditions. It is concentrated on the individual, who’s interests need to be safeguarded.
- Hygienic medical science on the contrary is working for the future: the hygienic worker does not wait until the sick person comes to him. In fact he has to forestall that by avoiding with best effort that persons fall ill at all.
It might well be that the representative of the hygiene sometimes has to deal with a single person, but generally he has to keep an eye on the welfare of the mass.
Thereby necessary hygienic measures for the common welfare might by all means interfere with the interests of some individuals. The orders for isolation measures or forced vaccinations might at times mean discomfort up to health hazards for some individuals.
Thus hospital hygiene does not belong to prophylactic medicine in the broadest range of view. Todays generally accepted meaning of hospital hygiene is therefore a little on the short side. Since many years I have pointed out that a hospital is much more than a building for taking in and treating sick people. Beyond that a hospital is the working place for employees of many professions as well of specific professional dangers and it is an operation influencing the environment by its emissions.
Since the xenodochies of the old ages on to the Medieval and early modern history hospitals named after different saints up to the monster hospitals of the present time those two aspects have never been taken into consideration. The “concept of a general hospital” by Johann Peter Xaver Fauken dating from the year 1784 gives a detailed description of an ideal hospital from the point of view at that time, which is completely concentrated on the patients. Fauken, a doctor of the Marxer Hospital sited on the outskirts of Vienna, has by all means been aware of the dangers patients might meet in a hospital. Even before Semmelweis he suspected the connection between an epidemic of childbed fever to the epidemically upcoming spotted fever. You find the same orientation as described by Fauken in the hospitals located in the Austrian provinces of Northern Italy which were exemplary for the health care by the end of the 18th and the beginning of the 19th century (Malaspina die Sannazaro, Pavia 1793, translated with addenda by Salomo Constantin Titius “Remarks on hospitals, especially their inner organization of providing and caring for the sick”).
For a hospital – as a place of work – appropriate hygienic measures apply to different non-medicinal areas such as i.e. kitchen, laundry, shop floor, power supply, waste disposal, transportation of patients and goods, animal husbandry, office and library. But assigned or superordinated thereto are hospital specific requirements such as infection prevention. Those hospital specific measures protect the patients against the staff and the environment as well as acting as profession-specific measures for the staff against infection risks caused by patients.
So the hospital – as the emissary influencing the environment – also has to fulfil the hospital specific requirements besides the construction and operating conditions being determined within the usual environmental compatibility processes for enterprises. For example the emission of harmful agents needs to be prevented whereas this does not only refer to germs but also to chemical agents like i.e. disinfectants.
And this is where we get back to the beginning of the retrospections, the reminiscences of not only the hospital hygiene but also of a lot of meetings and conversations with Hans-Joachim Molitor during quite a few decades.
He was always concerned to think and take on responsibility in a holistic sense, which means it to fulfil both of the requirements for disinfectants: the optimum efficacy against germs paired with the lowest possible toxicity for men and the environment.
Curriculum Vitae
Univ. Prof. Dr. med. Dr. med. h.c. Heinz Flamm
Figure 1 [Fig. 1]
Specialist for Hygiene and Microbiology, Director (emeritus) of the Vienna Hygiene Institute
Prof. DDr. h.c. Flamm’s fields of activity show clearly the broad range of the subject of hygiene: he takes his doctorate at the Medicinal Faculty of the Vienna University, habilitates only a few years later in the subjects of hygiene and microbiology and starts teaching: general microbiology, hygiene for schools, hygiene for pharmacists. In 1966 he becomes Director of the Hygiene Institute which he will direct for almost 30 year thus shaping several generations of hygienists.
Besides this function he works as consultant for the city of Vienna, is Senior Councellor of Health, member of the Codex Committee (Austrian Foodstuffs Act), works for the Executive Board of the WHO, takes on the responsibility for the regions of New Delhi, Kashmir & Jamm, East-Uttar Pradesh of the WHO’s International Commission for the Certification of Smallpox Eradication and much more…
There is not enough space to name the many academic distinctions he received during the course of his very successful imposing life as a hygienist. In 2001 he finally was awarded the Hygieia Medal of the Rudolf-Schuelke-Foundation for his impressing life’s work.
