Cleanliness was utterly disregarded. Physicians not only frowned upon, but actually opposed bathing. Surgeons performed operations without washing their hands and the operating rooms of hospitals were veritable pig sties. Physicians would go from the post-mortum room directly to the delivery room and assist in the birth of a child without washing their hands. Child-bed fever was a very common disease and the death rate in this condition was very high.

Dioclesian (Dio) Lewis, M.D., writing to the Journal from Paris under date of November 12, 1856 said: "Dear Journal--I have now been in Paris ten days, and several hours of each day walked the hospitals. I need not tell you that no hospitals have a more exalted and world-wide reputation. Nowhere on earth have the refinements of medical science been so completely elaborated. For instance, gentlemen of the highest attainments spend a long life in the study of one single species of the diseases of the bones. They pursue the study with the zeal of an apostle, and exhaust fortunes in purchasing the most advantageous opportunities for thorough research. Large works, filled with exact illustrations, appear from time to time, and a fine hospital is thrown open for the gratuitous treatment of this particular specialty. There is scarcely a human disease that has not in this city its special professors and hospitals, and every thing is free, not only to the patients, but to students. I believe it is not extravagant to say, that there is more of this special, high-toned, gratuitous intellectual labor performed in this city in one year than in all the rest of the world in ten years.

"But notwithstanding all this, I believe there is no civilized city in which disease is treated so unsuccessfully. This apparent paradox needs no solution to those who visit the hospitals, and observe the utter disregard of the most common laws of hygiene. With one exception, I have not visited a hospital in which ventilation receives any systematic attention; and as to bathing, I must give you a fact or two. Yesterday I spent two hours in L'Hopital de la Charite, and followed in the train of Broca, who is perhaps the most promising medical man in Europe. The first patient I saw was a young lad whose foot had been seriously cut with an axe. Broca gave the facts in the case, then removed the strips of adhesive plaster, and ordered some new ones. These were immediately put on, and then Broca proceeded to put over the wound a large mass of lint, several thicknesses of linen, and bound over all this a thick, strong roller. But in addition to this miserable hot-bed, the foot and leg were completely covered with a crust of black dirt. Just about the incision the scab had been softened, and evidently scraped off, but the rest of the limb bore the accumulations of months. Of course the wound wore a very unhealthy appearance. I whispered to an intelligent student that I thought that foot only needed thorough soaking and cleansing, and I added, that I thought the incision would at once put on a healthy appearance if the patient, in addition to this local purification, could have his whole skin purified, and the window near him opened. The student replied by asking whether I did not think he might take a cold.

"The next was a case of scrofulous enlargement of the knee. Broca informed us that the patient had been in the hospital two months, and it was clear enough that during the whole time the limb had not been even washed. A new liniment was advised, and the crowd passed on. I delayed a little. and, upon examining the patient, found that his whole skin was dirty, dry, and feverish; and so on to the end of the long list of sufferers. The stumps of amputated limbs were dressed with lint and linen to the thickness of an inch or two, but no water.

"It is to me utterly inexplicable that a people so incomparably vigorous and progressive in all the higher and more abstruse departments of medical science, should so utterly neglect these common necessities of a successful treatment . . ."

Patients were dosed heroically, had their veins and arteries emptied of blood, were denied water to drink and fresh air to breathe and stuffed on slops. Is it any wonder that otherwise simple diseases were regarded as very malignant and the death rate was high? Should we marvel that the people lost confidence in their physicians and began to (correctly) suspect that they were being killed by them? A real revolutionary situation existed. The time was ripe for a change. No mere reform would suffice.