an autodidact meets a dilettante…

Florence Nightingale

Jacinta: Well hello Canto, let’s welcome each other to the Urbane Society of Skeptical Romantics, where we like to talk… and not much else.

Canto: Very productive and constructive talk Jacinta, but the proof will be in the pudding.

Jacinta: Well I hope it’s not a recipe for disaster. What shall we talk about today?

Canto: Well I’m thinking medicine today – the discipline, not the stuff you consume.

Jacinta: Well I don’t consume much medicine at the worst of times, being fit, positive, eternally youthful and beautiful.

Canto: That’s okay, I’ll take your share – so you know there’s a bit of a crisis with antibiotic resistance.

Jacinta: Yes, natural selection in action, or is that human-induced, unintended-consequence-style artificial selection?

Canto: Well I’m not intending to delve into the natural v artificial quagmire here, or even into the science of antibiotics. I’ve just been reading about a couple of alternative ways – one old and one new – of killing off nasty infecting bacteria in hospitals. Ever caught one of those secondary infections in hospital Jass? No of course you haven’t.

Jacinta: Last time I was in hospital I was the infection – had to be forcibly removed from the victim by a crack team of medicos and placed in isolation until deemed safe to take my chances at thriving and multiplying along with my fellow bugs.

Canto: Well I’m sure they made the right decision.

Jacinta: The jury’s still out. Tell me of the ways.

Canto: Remember Florence Nightingale?

Jacinta: One of my heroes, apart from her valetudinarianism. Though I suspect that might just have been her way of keeping everyone at a distance so she could get on with things in her way. She was a voluminous correspondent just like Darwin, another sufferer from mysterious ailments. So what about her?

Canto: She revolutionised nursing and hospital treatment, sanitation and such, right? One of her many insights was that patients convalescing from the Crimean battlefields benefitted enormously from throwing open the windows of the rather unhygienic field hospitals set up for them. Nightingale wards were built to her design, with high sash windows kept open to renew the air around the sick. This worked a treat, though it took more than a century to verify the effect experimentally, using E coli in an open rooftop environment. The bugs died within 2 hours in the open air, but in an enclosed environment they lived on.

Jacinta: Right, so this has obvious relevance to those horrible superbugs they talk about…

Canto: Like MRSA?

Jacinta: Yeah. What’s that?

Canto: Multi-resistant, or more accurately methicillin-resistant staphylococcus aureus.

Jacinta: Yeah, golden staph, just as I thought. So that’s interesting. I don’t see modern hospitals blowing in the wind really. Sounds far too hippy for the 21st century. Isn’t it all tightly controlled and air-conditioned these days? Recycled air and legionnaire’s disease? Okay, only kidding, I’ve not heard of any hospital outbreaks of that, but these hospital superbugs must surely be caused by a contaminated environment, yes? Should we bring back Nightingale wards? And why did they go out of fashion?

Canto: Well, not only did she get fresh air right, she had the windows faced to let in as much sunlight as possible, and it was only learned later that sunshine was a great germ-killer, especially in the case of tuberculosis, which ravaged all the crowded cities…

Jacinta: Yeah and picked off all those writers, like Chekhov, and the Brontës, and D H Lawrence, and Keats. Didn’t he write an ode to Florence Nightingale?

Canto: No no that was another nightingale, but at its height TB was killing one in five in the cities; but it’s probable that the sunlight was boosting levels of vitamin D, which in turn boosts the immune system. So by the turn of the century, fresh air and sunlight was all the go. TB patients were wheeled onto balconies, to be exposed to the bracing elements.

Jacinta: Ah, but of course all that changed with the discovery of antibiotics.

Canto: Right, and thanks to these miracles of modern medicine, rotten air and dark dankness came back into fashion, sort of. I mean, all sorts of infections were being vanquished by these pills and it seemed as if diseases would fall like ninepins.

Jacinta: I suspect you’re oversimplifying..

Canto: Well it must’ve seemed that way to the general public. And of course fresh air could turn into howling winds, and sunlight into clouds and rain. Controlled temperatures and conditions might’ve seemed safer, and the cleansing power of aircons was over-estimated.

Jacinta: Oh yes… Climat air-conditioning, Breezair, Bonaire – more than an air-conditioner, a tonic to the system.

Canto: But now of course the diseases are returning in resistant forms, and we’ve hit a wall in terms of antibiotic manufacture. There’s very little new stuff coming on-stream. And now, hospitals are being seen as a problem again, just as in Ms Nightingale’s day.

Jacinta: Yes, but there are new post-antibiotic treatments in the pipeline, such as phage therapies, in which bacteria are destroyed by genetically engineered viruses, and drugs that…

Canto: Okay Jass, that’s for another conversation, and these new treatments are a bit futuristic as yet. Meanwhile, we need to heed Ms Nightingale’s hygienic advice. Apparently, the recent emphasis on simple hand washing has been paying huge dividends, in reducing the incidence of MRSA and Clostridium difficile.

Jacinta: So we were getting complacent, forgetting the basics?

Canto: Well, we’d been lulled by the success of modern medicine into thinking the old precautions needn’t apply. And further studies have confirmed the cleansing power of even the mildest breezes, and hospitals have begun to open up in response.

Jacinta: But not only that, we now know more about good old-fashioned sunlight and its curative powers, don’t we?

Canto: Okay, the stage is yours.

Jacinta: Well, there was some breakthrough research done using standard UV lamps in a TB ward. Guinea pigs were used (I mean real guinea pigs), and their signs of infection were drastically reduced. Now, there are some regions of the world with high rates of TB, and of HIV, which of course weakens their immune system and makes them susceptible…

Canto: I thought TB was just about eradicated.

Jacinta: Well it’s now resurgent in some parts, so we’re back to looking at other modes of prevention. So UV lighting is proving very effective, but not applied directly, because direct exposure is quite dangerous – think of tanning beds and the like. But what is interesting is that they’ve experimented with different UV wavelengths – ultraviolet light covers the spectrum from 10 to 400 nanometres – and found a sweet spot at 207 nm. At that wavelength the UV light is absorbed by proteins and penetrates a little way into human cells but doesn’t reach any DNA to effect mutations. But it does affect bacteria, drastically. They absorb the light and die.

Canto: Very clever.

Jacinta: Quite. This sweet spot technology was first used in operating theatres, to kill airborne bacteria that could immediately settle in open incisions and the like. There’s a suggestion now that UV lamps at that wavelength should be deployed in all hospitals.

Canto: So that’s one solution, but getting back to fresh air, has anyone found a solution that eliminates the drawbacks? I mean, knocking equipment around, bringing in pollution and pathogens from outside, not to mention patients falling out of windows?

Jacinta: Well, some of those risks could easily be minimised, but there are more technological fixes. The production of hydroxyl radicals has been shown to kill bacteria…

Canto: Hydroxyl radicals? WTF?

Jacinta: Molecules with a short lifespan, produced in the atmosphere when ozone, the unstable allotrope of oxygen, reacts with water. This reaction is catalysed by organic molecules in the air, and a while back a company managed to build machines that produce these hydroxyls, for use in hospitals. They were quite effective, but the company went bust. So we’re back to good ventilation and getting patients out on balconies. And perhaps locating hospitals out of the way of cities.

Canto: Okay, so back to the future.

Jacinta: Or forward to the past.

Canto: Well thanks for this charming discussion and we look forward to many more.

Here’s an interesting commercial video about how a hydroxyl generator works
https://www.youtube.com/watch?v=a_V9HbBVM6Q
hat-tip to: Frank Swain, ‘A breath of fresh air’ in New Scientist Collection: Medical Frontiers.