History of a lethal scourge of the hospital wards

A CONDITION known as hospital gangrene was once the scourge of 19th-century medical practice, and streptococcal group A infections were largely responsible.

Patients who were recovering from illness and surgery, often fell victim to the gangrene and blood poisoning which spread rapidly. Repeated amputations of parts of a limb or removal of increasingly large areas of tissue were often necessary - but met with limited success.

'It was a very common and widespread, and much-feared thing in the 1860s,' according to Professor Hugh Pennington, of the University of Aberdeen, who studies the history of bacterial infections.

With understanding of the 'germ theory,' the onset of aseptic practices and the use of carbolic acid in operating theatres, the incidence of hospital gangrene began to fall.

However, the virulence of the bacterium was also on the wane. Other illnesses caused by streptococci, such as scarlet fever, rheumatic fever, and puerperal fever - which killed one in three women who had given birth - were becoming less common and fewer people were dying from them, Professor Pennington said.

'Medical practice was improving all the time but the bacterium was moving from virulent to avirulent strains too. We don't know why, it is just one of those things, a evolutionary change.'

In addition, undernourishment resulting from widespread poverty in some cities, such as Glasgow, was improving with a resulting improvement in people's general health and ability to fight disease.

So, contrary to popular belief, the advent of antibiotics in the 1930s was not entirely responsible for fewer deaths from streptococcal infections.

However, the bacterium remains 'exquisitely sensitive' to antibiotics, including penicillin, according to Dr Cliodna McNulty, a microbiologist with Gloucestershire Health Authority.