Mikulicz-RadeckiJan

During a pandemic, you can’t buy bread without a protective mask, however, more than a hundred years ago, surgeons performed surgeries without masks. And everything was fine. But we are not sure.

In the 19th century, surgeries were performed in the amphitheater hall, the operating table was in the center, and there was also a tiered seating area for students, and for the audience who was just willing to see the process. Students were often allowed to examine the patient before or during surgery, even if they performed an autopsy an hour ago. At that time, people wash hands with ordinary soap, but not properly enough, and medical gloves did not exist at all until 1889–1890. No one worried much about the sterility of medical devices. Infectious diseases and the contact method of their transmission were not known at that time, so the different reasons including the act of providence were discussed to explain the high mortality rate which reached more than thirty percent.

In 1847 doctors were ordered to wash their hands in chlorinated lime water before examining patients or performing surgeries and were prohibited from entering the operating room after visiting the morgue for at least 24 hours. The starting point was the Vienna Central Hospital, where the innovation allowed to lower the mortality from infection after surgery to several percent.

In 1865, the Glasgow Royal Infirmary also began to use carbolic acid (phenol) to clean hands, medical devices, and even surgery areas trying to lower the percentage of the mortality from infection after surgery. The substance ruthlessly killed germs and irritated the hand skin of nurses and surgeons. A way out of this situation was found at the Johns Hopkins Hospital in Baltimore. There, nurses began wearing rubber gloves. The first pairs of gloves were made for them by Goodyear Rubber Company specialists. Founded by Charles Goodyear, the inventor of vulcanized rubber, the company is now the largest tire manufacturer. Following the nurses, the surgeons began to wear gloves too. First, it was easier to keep instruments with gloves on, and secondly, as it turned out, gloves also reduced the percentage of postoperative complications.

Professor Jan Mikulicz-Radecki closely monitored all innovations. At that time he was the Head of the Surgery Department at the University of Breslau. “Breslau” is the old Ukrainian name of the now Polish and at that time German city Wroclaw.

Although the team of surgeons he led washed their hands properly, disinfected instruments and all work surfaces, performed surgeries with rubber gloves on to eliminate the chance of direct contact transmission, complications did occur from time to time. So at the end of the winter of 1897 Mikulicz-Radecki started looking for a reason.

His colleague at the Department of Hygiene was Professor Carl Flügge could not give up one idea for several years. He was thinking that a huge number of drops that fly out of the mouth of a person who sneezes or talks contain bacterias. That implies that in addition to contact transmission, there is also an airborne way of spreading the infection. Mikulicz-Radecki decided to test this theory. That was when Pavlo Lashchenkov, a hygienist from Kharkiv, was working as Carl Flügge’s intern and volunteered to join the experiment.

And so in an empty operating room, they placed Petri dishes filled with agar, a kind of jelly, falling on the surface of which, the bacteria replicate rapidly.

Then in another room, they prepared a solution with ​​Serratia Marcescens bacteria. Lashchenkov rinsed his mouth with this solution and went to the operating room. He stayed there as long as the operation usually lasts. He was just standing and talking like surgeons do. Then he came out and the operating room was locked. When the door opened in the morning, they saw that the entire operating room was splattered with blood. But in fact, it was not blood. This was blood​​-red bacteria Serratia marcescens which got from Lashchenkov’s mouth in a Petri dish and on other surfaces and began to replicate.

Scientists conducted several more experiments and realized that the bacteria settled on the surfaces only when Lashchenkov talked, sneezed, or coughed, and when he spent the same time in the operating room in silence, the surfaces remained clean. So they proved that the airborne way of spreading the infection exists, and came up with a multi-layer tissue surgical mask.

Simultaneously with Jan Mikulicz-Radecki the French surgeon Paul Berger. realized the need to wear a mask during surgeries. He even calculated that covering the surgeon’s mouth and nose with a mask reduces the number of complications by six times.

Did all the other surgeons start wearing masks after that? Of course not. They found a million excuses not to do so: uncomfortable, shortness of breath, they even said that research was false, and so on. Even in the 1920s, no more than half of surgeons wore masks. They became mandatory during surgeries only in the 1930s.