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Abstract only
Marguerite Dupree, Anne Marie Rafferty, and Fay Bound Alberti

The introduction sets out the scope of this book, an interdisciplinary volume that includes work from ten leading historians, healthcare professionals and policy makers who consider the history, practice and future of infection control since the mid-nineteenth century. Infection prevention and control is one of the twenty-first century’s most challenging problems, as indicated by global concerns about antimicrobial resistance (AMR). But most attention has been paid to antimicrobial drugs, rather than the personnel, practices and alternative technologies associated with hospital infection control, or the history of hospital practice. The essays in this volume bring a new perspective to a pressing global problem.

in Germs and governance
A practical application
Susan Macqueen

This chapter reflects on the author’s experiences and memories of infection control through her nurse training and career. Having been taught microbiology, common infectious diseases and how to prevent the spread of infection in the 1960s, the author explores the differences between theory and practice in nursing, the roles of human actors, and the ways the culture of the ward shifted over the course of her nursing career. One of the first infection control nurses and the first Director of Infection Prevention and Control at Great Ormond Street Hospital for Children in London, she also stresses the importance of political will for implementing effective infection control measures.

in Germs and governance
How ‘dirt’ shaped surgical nurse training and hierarchies of practice, 1900–1935
Pamela Wood

During the period between 1900 and 1935, surgical success depended not only on the surgeon’s operative skill in the face of difficult challenges during surgery, but also on the prevention of sepsis. Pre- and post-operative care was mainly directed at preventing or managing infection, and was the relatively new professional sphere of the nurse. Training nurses skilled in surgical nursing was therefore vital to both the patient’s recovery and the surgeon’s success. This chapter uses the idea of ‘dirt’ to explore how sepsis, particularly in its most dangerous form of pus, shaped surgical nurse training and practice in the 1900-1935 period.

in Germs and governance
Abstract only
Infection and occupational illness in British hospitals, c. 1870–1970
Claire L. Jones

This chapter examines how doctors, nurses and other hospital staff, groups often overlooked in favour of patients, experienced septic finger, wound sepsis and related diseases within the British hospital between 1870 and 1970. The focus on sepsis, as opposed to other types of infection, is significant. Hospital staff were, of course, at risk of contracting all manner of diseases. Yet, widespread concern over sepsis and hospital attempts at prevention and control of sepsis in pre- and post-operative wounds form an often neglected part of the story and span this hundred-year period, as well as recent history with rising antibiotic resistance and hospital mismanagement of infections. While other infections tend to fit more neatly into epidemic periodic cycles, wound sepsis was and still is a continual chronic challenge, one that becomes more important following a serious outbreak or death. Drawing on hospital ledgers and reports, this chapter pays particular attention to occurrences of wound sepsis among staff at four of Britain’s large teaching hospitals, two in England – King’s College (KCH) and St Thomas’ – and two in Scotland – the Royal Infirmaries in Edinburgh (RIE) and Glasgow (GRI).

in Germs and governance
Alternatives to surgical gloves for infection control, 1880–1945
Thomas Schlich

In This chapter explores the use of innovative technologies for infection control in surgical operations. Beginning with the uptake of surgical gloves in the late nineteenth century, the author explains the relative disinterest of many surgeons by situating their use in the context of other contemporary strategies of infection control. He demonstrates that technological change in surgery and infection control does not happen in a vacuum: understanding of the alternatives to surgical gloves that were not taken up is necessary to explain the evolution of modern surgery and infection control.

in Germs and governance
Intercession and integration in the medieval English leper hospital
Carole Rawcliffe

Much has been written about the attractions of lepers as agents of redemption in the Middle Ages. They were, above all, regarded as representatives of the tormented Christ, whose appearance quasi leprosus during his Passion became a theme in art and literature. Assumptions about their special status were further encouraged by the belief that they belonged among the fortunate few who would be ‘purified’ of sin on earth through physical suffering, bypassing purgatory and ascending ‘straightway into heaven’. Less attention has been paid to how these ideas influenced responses to leprosy, both before and after the Black Death. This chapter explores the intercessionary role undertaken by hospitalised lepers and their priests in medieval England, and the extent to which it fostered the social and spiritual integration of leprosy sufferers. Adherence to a prayer regimen was facilitated by the availability of a church or chapel, which gave structure to the religious round, but was also necessary for the celebration of Mass. Noting the ubiquity of wayside chapels attached to suburban leper houses, we turn to the spiritual services offered there by sick men and women. Yet funding was precarious, and few leper hospitals survived the upheavals of the fourteenth century unscathed. A decline in the number of functioning institutions undermined the idea of leprosy as a religious calling, and from the 1340s patrons were preoccupied with the sanitary imperatives that prioritised the segregation of lepers. At the same time, other charitable enterprises began to offer competition for financial support.

in Leprosy and identity in the Middle Ages
New perspectives on iconography
Luke Demaitre

In the conventional view that fear, revulsion and exclusion characterised the medieval response to leprosy, the clapper served merely to keep patients and bystanders apart from each other. This chapter is part of a broader effort to arrive at a less one-sided and more informed assessment. It presents a comparative analysis of the pictorial evidence provided by some 300 images produced in different parts of Europe, half of which show a clapper. Most of the images illustrate biblical scenes, but they nonetheless reflect contemporary perceptions and mores. The preponderance of two narratives, namely the encounters of Jesus Christ with leprosi and the parable of the rich man and Lazarus, creates a thematic slant. However, these very themes reveal the essential significance of the clapper, as well as of other implements and features that marked leprous patients, particularly wandering leprosi. The common view is that these signs were intended to scare people away and thereby to protect them from horror as well as infection. However, their primary purpose was not to alarm but to alert bystanders, not to trigger fear but to call for mercy – misericordia – for the poor and helpless misellus, or ‘little wretched one’. Indeed, the images discussed in this chapter were aimed at celebrating and stimulating generosity towards the leprous. The common themes were inclusion and attention, not exclusion and rejection.

in Leprosy and identity in the Middle Ages
The construction of the leper in Narbonne and Siena before the plague
Anna M. Peterson

The identity of the medieval leper is complex, often contradictory, and frequently constructed by a third-party observer. Not all leprosi were the same, and the leper had a different significance to different groups and individuals. The leper’s identity has also been formed through historiography, originally founded upon the narrative of exclusion, long clouding our understanding of the identities of lepers. However, by incorporating the newer historical framework developed by François-Olivier Touati and others, we can begin to reconstruct the leper’s place in medieval society. This chapter takes a comparative approach, exploring how lepers were perceived in Narbonne (southern France) and Siena (Italy), and how these perceptions changed from the foundation of the leper hospitals in each city to the Black Death. One of the overarching discussions concerns whether medieval communities sought to exclude people labelled as lepers. Narbonne’s records concerning lepers are largely transactions or bequests initiated by individuals, though there are also relevant municipal documents. Siena’s sources consist of the legislation preserved in the city’s constitutions from 1262. The documentation in these cases makes for a useful comparison regarding how different groups in society perceived leprosy sufferers. While both cities worked to provide spaces of protection and support for lepers, their approach was different, a picture that is shaped by the nature of the extant sources. Fundamentally, in both cities, lepers were identified collectively as the sick residents of leper houses. However, the sources examined here also enable a more dynamic reconstruction of lepers’ identities.

in Leprosy and identity in the Middle Ages
Elma Brenner

Food and drink had special significance in medieval leprosy hospitals, since providing sustenance to the sick formed part of both the practice of charity and bodily care. Giving food to the hungry and drink to the thirsty were two of the biblical works of mercy, charitable acts that medieval Christians needed to fulfil to ensure their future salvation. The charters and statutes of northern French leprosy hospitals shed light on dietary arrangements in these institutions, revealing how the consumption of food and drink was a marker of identity for both the leprous and the non-leprous members of the community. These were monastic or quasi-monastic institutions, where communal eating was a central aspect of devotional and social life. The provision of food and drink also formed part of palliative care, with medical texts advising that the leprous should consume mild, moist substances. Yet diet also served to distinguish leprosy sufferers of differing social and religious statuses from one another. Similarly, the diet of the non-leprous monks and nuns, lay brethren, and servants varied according to status. The practical arrangements surrounding meals reflected status and identity, and changed over time. Issues of contamination and contagion also came into play, with leprosy sufferers prohibited from contact with the food and utensils of the non-leprous, but themselves sometimes served contaminated food. The chapter considers how information about diet reveals the range of identities of people with leprosy, and others who resided within leprosy hospitals, as well as the identities of the institutions themselves.

in Leprosy and identity in the Middle Ages
The leper as a scapegoat in England and Normandy (eleventh–twelfth centuries)
Damien Jeanne

In central medieval sources, lepers are represented as both impure (tainted) and pure (holy) beings. These sources suggest that leprosy was accepted both as a sign of divine election and as a curse. How can we explain this dichotomy in the way that leprosy sufferers were perceived in medieval society? Lepers’ dual representation is even more surprising because they were viewed as Christ’s privileged sick. Why was leprosy seen as a disease that was representative of the sickness and suffering of Christians? And why did lepers benefit from specialised care centres that developed thanks to the generosity of clerical and secular donors? After exploring earlier medieval ideas about leprosy, this chapter examines the complex religious identity of lepers by focusing on miracle accounts associated with the tomb of Saint Thomas Becket at Canterbury, England, written down in the 1170s by Benedict of Peterborough and William of Canterbury. Miracle accounts shed light on medieval attitudes towards sickness and disability, as well as on the identities of those who sought saintly assistance at shrines. The collections of miracles associated with Thomas Becket are unusual because they contain accounts of the healing of lepers, a category of the sick that does not often feature in miracle stories. This chapter considers why lepers feature in Becket’s miracles, and what is signified by the language used to describe them and their suffering. More broadly, it probes the possibility that lepers served as scapegoats for ills in society, as well as being models of Christian suffering.

in Leprosy and identity in the Middle Ages