Kernal: Germ Theory, Medical, Health and Hygiene

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

Source: https://doctors.practo.com/the-hippocratic-oath-the-original-and-revised-version/

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.

1. 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.
2. 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.
3. 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.
4. The patient also has the right to know the immediate and long-term financial implications of treatment choices, insofar as they are known.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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.
13. 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.
14. 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.

1. The air contains living microorganisms. 
2. Microbes can be killed by heating them. 
3. Microbes in the air cause decay. 
4. Microbes are not evenly distributed in the air.

Source: https://www.colfox.org/wp-content/uploads/2019/09/History-10.1.1.pdf

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 alkalis

By 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 hygiene

In 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 may

Abate 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 clean

To 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.]