Kernal: Germ Theory, Medical, Health and Hygiene
Kernal: Germ Theory plus Medical, (Public) Health, Hygiene
Contents: Hippocratic Oath, Germ Theory, Personal Hygiene (soap and water), Food Safety, Burial Guidelines, Public Health concepts and practices, Basic Epidemiological Concepts and Practices, Principles of Nursing, Basic Anatomical Info
The Classic Hippocratic Oath
"I swear by Apollo the physician, and Aesculapius the surgeon, likewise Hygeia and Panacea, and call all the gods and goddesses to witness, that I will observe and keep this underwritten oath, to the utmost of my power and judgment.
I will reverence my master who taught me the art. Equally with my parents, will I allow him things necessary for his support, and will consider his sons as brothers. I will teach them my art without reward or agreement; and I will impart all my acquirement, instructions, and whatever I know, to my master's children, as to my own; and likewise to all my pupils, who shall bind and tie themselves by a professional oath, but to none else.
With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage.
Nor shall any man's entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will give no sort of medicine to any pregnant woman, with a view to destroy the child.
Further, I will comport myself and use my knowledge in a godly manner.
I will not cut for the stone, but will commit that affair entirely to the surgeons.
Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient; and I will willingly refrain from doing any injury or wrong from falsehood, and (in an especial manner) from acts of an amorous nature, whatever may be the rank of those who it may be my duty to cure, whether mistress or servant, bond or free.
Whatever, in the course of my practice, I may see or hear (even when not invited), whatever I may happen to obtain knowledge of, if it be not proper to repeat it, I will keep sacred and secret within my own breast.
If I faithfully observe this oath, may I thrive and prosper in my fortune and profession, and live in the estimation of posterity; or on breach thereof, may the reverse be my fate!"
This Hippocratic Oath has been modified and revised several times. In 1960, the words “utmost respect for life from its beginning” were added, making it a more secular concept, not to be taken in the presence of gods but in front of other people.
The Oath was rewritten in 1964 by Dr. Louis Lasagna, Academic Dean at Tufts University School of Medicine and this revised form is widely accepted in today’s medical schools. The modern or revised version of Hippocratic Oath is:
The Revised Hippocratic Oath
"I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know.
Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty.
Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter.
May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help."
Thus, the classical Oath of Hippocratic involves the triad of the physician the patient and God, while the revised version involves only the physician and the patient, reliving the Gods of a few responsibilities.
American Hospital Association Patient’s Bill of Rights
These rights can be exercised on the patient’s behalf by a designated surrogate or proxy decision-maker if the patient lacks decision-making capacity, is legally incompetent, or is a minor.
- The patient has the right to and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment, and prognosis.
- Except in emergencies when the patient lacks decision-making capacity and the need for treatment is urgent, the patient is entitled to the opportunity to discuss and request information related to the specific procedures and/or treatments, the risks involved, the possible length of recuperation, and the medically reasonable alternatives and their accompanying risks and benefits.
- Patients have the right to know the identity of physicians, nurses, and others involved in their care, as well as when those involved are students, residents, or other trainees.
- The patient also has the right to know the immediate and long-term financial implications of treatment choices, insofar as they are known.
- The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. In case of such refusal, the patient is entitled to other appropriate care and services that the hospital provides or transfer to another hospital. The hospital should notify patients of any policy that might affect patient choices within the institution.
- The patient has the right to have an advance directive (such as a living will, health care proxy, or durable power of attorney for health care) concerning treatment or designating a surrogate decision-maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy. Health care institutions must advise patients of their rights under state law and hospital policy to make informed medical choices, ask if the patient has an advance directive, and include that information in patient records. The patient has the right to timely information about hospital policy that may limit its ability to implement fully a legally valid advance directive.
- The patient has the right to every consideration of privacy. Case discussion, consultation, examination, and treatment should be conducted so as to protect each patient’s privacy.
- The patient has the right to expect that all communications and records pertaining to his/her care will be treated as confidential by the hospital, except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law. The patient has the right to expect that the hospital will emphasize the confidentiality of this information when it releases it to any other parties entitled to review information in these records.
- The patient has the right to review the records pertaining to his/her medical care and to have the information explained or interpreted as necessary, except when restricted by law.
- The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and/or referral as indicated by the urgency of the case. When medically appropriate and legally permissible, or when a patient has so requested, a patient may be transferred to another facility. The institution to which the patient is to be transferred must first have accepted the patient for transfer. The patient must also have the benefit of complete information and explanation concerning the need for, risks, benefits, and alternatives to such a transfer.
- The patient has the right to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patient’s treatment and care.
- The patient has the right to consent to or decline to participate in proposed research studies or human experimentation affecting care and treatment or requiring direct patient involvement and to have those studies fully explained prior to consent. A patient who declines to participate in research or experimentation is entitled to the most effective care that the hospital can otherwise provide.
- The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate.
- The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities. The patient has the right to be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics committees, patient representatives, or other mechanisms available in the institution. The patient has the right to be informed of the hospital’s charges for services and available payment methods.
Words to live by.
Words to die by.
Really, what's the difference?
Being Mortal by Atul Gawande
See also this review by Maria Popova
All boldface below are quotes from Dr. Gawande's book.
In Being Mortal, Dr. Gawande writes:
This is a book about the modern experience of mortality -- about what it’s like to be creatures who age and die, how medicine has changed the experience and how it hasn’t, where our ideas about how to deal with our finitude have got the reality wrong.
Our main take-aways from the book:
Quality of life is preferable to mere quantity for the vast majority of us.
Care should be determined - in discussion with one’s family, doctors and care-givers - by asking...
What is our understanding of the situation?
What do we fear?
What do we hope for?
What are the trade-offs we are willing to make?
What are the trade-offs we are not willing to make?
What is the best course of action which serves this understanding?
Consider, answer and communicate, if possible, before the onset of care…
Do you want to be resuscitated if your heart stops?
Do you want aggressive treatments such as intubation and mechanical ventilation?
Do you want antibiotics?
Do you want tube or intravenous feeding if you can’t eat on your own?
Hospice approaches and attitudes appear to serve the terminal patient much better than standard medical interventions.
In the Epilogue, Dr. Gawande writes:
We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive.
Those reasons matter
not just at the end of life,
or when debility comes,
but all along the way.
Germ Theory
Germ theory states that specific microscopic organisms are the cause of specific diseases.
- The air contains living microorganisms.
- Microbes can be killed by heating them.
- Microbes in the air cause decay.
- Microbes are not evenly distributed in the
air.
Koch's Postulates
1. The suspected pathogen should be
found in all instances of the disease in
question, and its distribution in the host
should correspond with the distribution of
observed lesions.
2. The organism should be cultivated
outside the body of the host in pnre culture
for several generations.
3. The infectious agent so isolated should
produce the disease in other susceptible
hosts
4. The responsible agent must be recoverable from the experimental host.
Proposed fifth postulate...
5. Under specific therapy, when the suspect pathogen is reduced and eliminated,
there should be concomitant resolution and
elimination of the associated active lesions.
Hygiene
Core Community Hygiene and Sanitation Practices Include:
- Washing hands with soap and water
- Keeping dishes and utensils clean and off the ground
- Using a toilet to keep feces separate from people
- Sweeping the home and keeping rubbish off the floor to prevent environmental contamination
- Keeping livestock separate from the home
- Washing bodies regularly to maintain physical cleanliness
Community hygiene is vital to keeping everyone healthy, but especially those with weakened immune systems, those under the age of five years old, and the elderly.
Source: https://lifewater.org/blog/hygiene-community/
WASH (Water Access, Sanitation and Hygiene) Concept
Hygiene Overview: https://en.wikipedia.org/wiki/Hygiene
Poetic Rendition (Draft)
1. The Healer's Oath
I swear to fulfill
To the best of my ability
To the best of my judgment
This covenant
I will put well being before mere survival
My highest concern
Will be the well being of my patient
Will be the well being of my community
Will be the well being of all
I will respect the knowledge
Passed to me by those who have gone before
And will pass what knowledge is mine
To those who follow
I will inform my patients
Of my diagnoses and reasons
Of preferred and alternative treatments
Of known risks
Of likely outcomes
Of what I do not know
I will obtain my patients consent
I will preserve my patients privacy
I will respect my patients choice of treatment
I will respect my patients refusal of treatment
I will attend my patients
Regardless of their station
With kindness
With consideration
With sympathy
With respect
With integrity
With propriety
I will attend my patients
With my best knowledge
With my best judgment
With my best skills
With awareness of the limits thereof
I will endeavor to do no harm
I will do no less than is needful
I will do no more than is needful
I will ease suffering where I can
I will ease those who wish it from life
I will not withhold treatment
From the poor
From the outcast
From the prisoner
From the stranger
From the enemy
From any
2. Contagion
In times of contagion
The duty of the healer is to all
The duty of the healthy is to the sick
The duty of the sick is to the healthy
Specific organisms
Too small for eyes to see unaided
Are the majority of life
We name them microbes
Microbes
Cause decay
Cause fermentation
Cause proliferation of toxins
Cause specific diseases
Microbes live as we
By cycles
Find the cycle
Break the cycle
End the cycle
Microbes bring health
As well as illness
Microbes bring life
As well as death
Seek balance
Microbes persist
In the air
In liquids
In soil
In food
In cloth
In the organs of infected bodies
In the flesh of infected bodies
In the bones of infected bodies
In the fluids of infected bodies
In the wastes of infected bodies
In the bite of insects
In the bite of animals
In the fluids of all bodies
Microbes may infect the body
Entering the body
Through ingestion
Through inspiration
Through the eyes
Through the skin
Through lesions of the skin
Through intimate contact
Through bite of insect
Through bite of animal
The body resists infection
With mucus
With coughing
With sneezing
With vomiting
With shitting
With fever
With inflammation
With encapsulation
With wondrous means
Thus does the body resist infection
Yet are these defenses imperfect
And by their action may spread disease
From the infected to the healthy
Or bring death to the body
Within the susceptible body
Microbes compound in number
From a few is growth slow
From many is growth rapid
The body’s defenses may be overwhelmed
When balance is overthrown
Disease ensues
Limit exposure
Intervene sooner than later
Each microbial kind
Compounding in a body
Is the source of specific disease
Disease is a process unto itself
Without reason
Without intent
Without malice
Without compassion
Without mercy
By their symptoms you shall know them
In the progress of their diseases
And their means of healing
In the body of those infected
Thus runs the course
A time of microbial growth
With little ability to spread to others
A time of microbial abundance
With much ability to spread to others
By breath and cough and sneeze
By mucus and spittle
By contact with fluids of the body
By contact with wastes of the body
By contact with skin and all things touched
By contact with clothing
By contact with bedding
By contact with bandaging and wipes
This is the time to tend the sick
In isolation from the healthy
A time of recovery
With little ability to spread to others
As microbes abate
Or return to balance
Microbes are mortal
And may themselves be killed
Or their multitude reduced outside the body
Sanitized
By soap and water
By alcohols
By alkalisBy acids
By heat
Be ever mindful that microbes live
Thus adapt in their generations
Evading their abatement
Be ever mindful that pressures we bring
Cull susceptible microbes
Leaving those more tolerant to multiply
In sanitation
In hygieneIn healing
Do not treat the body without cause
Or cleanse beyond need
Lest the microbe adapt to endure
3. Response
In times of contagion
Practice cleanliness always
Prevent infection where you may
Reduce exposure where you may
Strengthen the body where you may
Sanitize where you mayAbate the microbe where you may
Wash often with soap and water
Mask mouth and nose
Guard the eyes as best you may
Sick and healthy alike
Air enclosed spaces well
Keep a little distance one from another
Isolate and tend the sick
Take care with all they have touched
Record the symptoms of the sick
Record the number of the sick
Record those the sick have approached
Record that which is not yet known
Record the symptoms of the sick
That you may know the course of disease in each
Record the number of the sick
That you may know the prevalence of disease
Waxing and waning among the people
Record those the sick have approached
That you may know the chain of contagion
Record unknown diseases
To learn their symptoms
To learn their spread
To learn their easing
To learn their cure
So is the art of healing advanced
You shall know those diseases recorded
And what of them is known
If you would know more of this
Follow the Way of Knowing
3. Hygiene and Sanitation
Hygiene by each
Guards the health of all
Hygiene by all
Guards the health of each
Your body’s health
Is the beginning of all health
Eat clean food
Harvest clean
Prepare clean
Store clean and dry and cool
Breathe clean air
Free and abundant
Free of smoke
Free of dust
Drink clean water
Keep water free
Of dead bodies
Of bodily wastes
Of all refuse
Of all poisons
Establish a place of elimination
At a distance from your dwellings
At a distance far from water
Dig for the purpose a pit
And shit you there
Not where you live
Not where you drink
Not in the field from which you eat
Clean your surroundings
Of all that brings disease
Of rubbish
Of food remains
Of mildew
Of dead bodies
Of shit
Clean your clothing
Clean your place of living
Clean your place of sleeping
Clean your place of elimination
Clean your place of eating
Clean your place of preparing food
Clean your tools for food preparation
Clean your tools for eating of food
Control incursions
For all may bring disease
Of insects
Of rodents
Of animals
Of growths
Clean as best you may
With water
With soap
With vinegar
With alcohol
Clean your body
Especially the hands
With soap and clean water
Before preparing food
Before giving birth
Before piercing the body
After contact with blood
After elimination
After sexual intimacy
After contact with the sick
After contact with what the sick have touched
After contact with what is unclean
After contact with fermentation
After contact with decay
After contact with soil
Clean your teeth
With water and brush of chewed twig
Or what you may devise
Rinse and spit
Often and always after eating
Clean a wound
Of contaminants
Of dead flesh
Of pus
By rinse with clean water
By infusion of such herbs
As have been found beneficial
Protect the wound from microbial infection
Until it shall be healed
Sanitize the tools
That cut
That pierce
That tend wounds
That aid in birth
That clean the teeth
That remove teeth
With strong alcohol
With boiling water
With flame
Give to fire
That which cannot be made clean
4. The Making of Soap
Be ever mindful
And take care for
Hot fat and lye and lyewater
Burn the body
Lye and lyewater
Even when cool
Guard well your skin and eyes
Use wooden spoons to stir
Use no metals with lye
Render animal fat
Skim liquid fat from solids
Make lyewater
Boiling white ash of hardwoods
Covered in rainwater
Skim liquid from ash
Boiling further to concentrate
Until dipped feather dissolves
Add liquid fat to lyewater
And boil until thick mush
Add one twentieth part salt
For hard soap
None for soft
Pour into wooden molds
And cool
If you would know more of this
Follow the Way of Knowing
[Consider separating the following into a separate 'Book']
5. The Making of Wine
Of microbes carried by air
Some eat what is sweet
These piss alcohol
These exhale the same gas
As do we
Sap of wholesome trees
Especially those whose leaves fall
May be boiled to concentrate
A syrup to sweeten
That which is not sweet
Contrive a container well rinsed
Fill with sweet fruits
Or sweetened herbs
Cover with clean water
Set in a warm place
Quiet and clean
After the first day
Cover with cloth well rinsed
Or plank well rinsed
Or broad leaves well rinsed
So to let out the breath of fermentation
And forbid the open air
In about half a moon
On the day that bubbling is done
Separate the liquid wine from the fruit
If the wine be good
For this purpose or that
Dry and save
The slurry of wine
To seed anew
According to purpose
Wine may be used
To drink in moderation
To flavor foods
To make vinegar
To make strong alcohol
Beware wine
Mindful that excess is ruinous
Mindful that it is poison
If you would know more of this
Follow the Way of Knowing
6. The Making of Strong Alcohol
Make strong alcohol
By distilling wine in four passes
Heated but not to boiling
Contrive to gather its vapors
Cool its vapors to liquid
Gather this liquid
Which is strong alcohol
Strong alcohol may be used
To preserve
To cleanTo burn
Beware this strong alcohol
Mindful that it is inflammable
Mindful that it is poison
If you would know more of this
Follow the Way of Knowing
7. The Making of Vinegar
Of microbes carried by air
Some drink the alcohol in wine
These piss vinegar and water
Make vinegar by allowing wine to sour
Sitting open in the air
Set in a warm place
Quiet and clean
Vinegar may be used
To flavor foods
To preserve foods
To clean
If the vinegar be good
For this purpose or that
Dry and save
The froth of vinegar
To seed anew
According to purpose
Concentrate by chilling vinegar
Pour liquid off the cloudy portion
Beware this strong acid
Mindful that it is corrosive
Mindful that it is poison
If you would know more of this
Follow the Way of Knowing
[NOTE: Add Section on The Dead, with instructions for burning, burial and making quicklime.]
