Nearly 150 years have passed since the groundbreaking contributions of Louis Pasteur and Robert Koch helped lay the foundation of the germ theory of disease. Yet, its still a challenge to persuade healthcare providers to take hand-washing seriously. The Centers for Disease Control and Prevention estimated that improper sanitization practices and cross contamination in hospitals results in roughly 1.7 million infections in the US alone, contributing to nearly 99,000 deaths each year. Hand hygiene is the single most important measure to reduce such infections.
The importance of hand washing for human health was first recognized in the mid 19th century by a Hungarian physician named Ignaz Semmelweis.
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In 1846, Ignaz Semmelweis, who had recently received his medical degree from the University of Vienna, was appointed assistant at the maternity clinic of the Vienna General Hospital. His duties included examining patients each morning in preparation for the professor's rounds, supervising difficult deliveries, teaching students of obstetrics, as well as maintaining records.
The hospital had two maternity clinics. One was staffed by all male doctors and medical students, and the other by female midwives. Semmelweis noticed that mortality among the patients in the clinic staffed by male doctors and medical students was two to three times higher than that in the midwives’ clinic. This puzzled Semmelweis. Surely, the doctors and the students were as trained as the midwives, if not better, in handling deliveries. So why are so many women in the first clinic dying of puerperal fever (also known as “childbed fever”)?
Semmelweis set out to investigate. He examined all the similarities and differences of the two clinics to rule out possible causes. The first difference he discovered was that midwives gave birth to women on their sides, while in the doctor’s clinic, women gave birth on their backs. So he had women in the doctors' clinic give birth on their sides, but to no avail.
Semmelweis then noticed that whenever someone on the ward died of childbed fever, a priest would walk slowly through the doctors' clinic, past the women's beds with an attendant ringing a bell. Semmelweis theorized that the priest and the bell ringing so terrified the women after birth that they got sick, developed a fever and died. So Semmelweis had the priest change his route and took away his bell, but still it had no effect.
Ignaz Semmelweis.
Semmelweis' breakthrough occurred in 1847 when his friend Jakob Kolletschka died after accidentally poking himself with a scalpel while performing autopsy on a patient who had died of childbirth fever. An autopsy of Kolletschka revealed a pathology similar to that of the women who were dying from puerperal fever. Semmelweis could immediately see a connection.
Semmelweis realized that there was one major difference between the two clinics that he had overlooked. Doctors and students started their day by doing autopsies on women who had died on the previous night. From the autopsy room, they proceeded directly to labor room, rarely washing their hands in between, and delivered babies for the rest of the day. The midwives, on the other hand, did no autopsies.
Semmelweis proposed that certain “cadaverous particles” stuck to the hands of doctors and medical students when they performed autopsies, which were then transferred to healthy women in labor, causing them to develop puerperal fever.
Semmelweis’s solution was simple—he mandated hand-washing across his department. Before they entered labor room, doctors and medical students were forced to brush under their fingernails and wash their hands in chlorine water. Chlorine is a powerful disinfectant, although Semmelweis wouldn’t have known that. He chose chlorine simply because it was effective in removing the putrid smell of infected autopsy tissue.
After he imposed hand-washing, the rate of childbed fever fell by ninety percent, and for a period of two months, there was no deaths in his division.
Ignaz Semmelweis washing his hands in chlorinated lime water before operating.
But not everyone was thrilled by this dramatic discovery, especially his seniors, because Semmelweis' hypothesis put the doctor’s lack of hygiene in bad light. Doctors were offended at the suggestion that they should wash their hands, feeling that their social status as gentlemen was inconsistent with the idea that their hands could be unclean. Besides, the theory of “cadaverous particles” transmitting diseases went against the prevalent theory that diseases were caused by an imbalance of the basic “four humours” in the body.
The medical community largely ignored, rejected, and sometimes ridiculed Semmelweis for his ‘dirty hands’ theory. Semmelweis was outraged by the indifference of the medical profession and began writing open and increasingly angry letters to prominent European obstetricians, at times denouncing them as irresponsible murderers or ignoramuses. Semmelweis’s lack of tact made him many enemies forcing him to leave Vienna for Budapest. In Budapest, Semmelweis became the head-physician of the obstetric ward of a small hospital. After mandating hand-washing there, Semmelweis virtually eliminated the disease. In 1855, Semmelweis became the professor of obstetrics at University of Pest. He instituted chlorine washings at the University of Pest maternity clinic, and once again the results were impressive.
In 1860, he published The Etiology, Concept and Prophylaxis of Childbed Fever describing his findings and lamenting the slow adoption of his ideas. The book was heavily criticized, and Semmelweis spiraled deeper into depression, rage and frustration. He ended up in a mental asylum in 1865, where the guards subjected him to severe beatings. He died two weeks later from a gangrenous wound he received from the beatings. An autopsy revealed that he had died of the same disease against which he had struggled all his professional life.
His death received few mentions in medical periodicals in Vienna and Budapest. The Hungarian Association of Physicians and Natural Scientists had a rule that a commemorative address be delivered in honor of a member who had died in the preceding year. There was no address for Semmelweis. His death was never even mentioned.
After his death, János Diescher was appointed Semmelweis's successor at the Pest University maternity clinic. Immediately, mortality rates increased sixfold, but the physicians of Budapest said nothing. There were no inquiries and no protests. “Almost no one—either in Vienna or in Budapest—seems to have been willing to acknowledge Semmelweis's life and work,” wrote Codell and Barbara Carter in Childbed Fever: A Scientific Biography of Ignaz Semmelweis.
It would take another 20 years after his death for the germ theory of disease to be acknowledged by the medical community. Today he is recognized as the pioneer of antiseptic procedures, and hailed as the “Father of hand hygiene,” and “Savior of mothers.”
References:
# Ignaz Semmelweis, Britannica
# The Doctor Who Championed Hand-Washing And Briefly Saved Lives, NPR
# Ignac Semmelweis—Father of Hand Hygiene, National Library of Medicine
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