WSJ -- The Unsung Pioneer of Handwashing .................................................................................
March 19, 2020
The Unsung Pioneer of Handwashing
In 19th-century Vienna, Ignaz Semmelweis fought to convince his fellow doctors that washing their hands could save patients’ lives.
By Lindsey Fitzharris
It’s difficult to feel any sense of optimism during the Covid-19 pandemic, but one source of encouragement is that simple soap and water can be a powerful defense. The coronavirus that causes the disease is enveloped in fatty layers that are easily dissolved by detergents, exposing the core of the virus and causing it to perish. That’s why public health authorities keep stressing the importance of washing our hands.
Handwashing to kill germs might seem like basic hygiene today, but it is a relatively recent discovery in the history of medicine. In the early 19th century, even hospitals had no inkling of the importance of cleanliness. They were breeding grounds for infection, often referred to as “houses of death.” Hospitals provided only the most primitive facilities for the sick and dying, many of whom were housed on wards with little ventilation or access to clean water. In 1825, visitors to St. George’s Hospital in London discovered mushrooms and maggots thriving in the damp, dirty sheets of a patient recovering from a compound fracture. Mortality rates for hospital patients were three to five times higher than for people treated in domestic settings.
The first doctor to understand the importance of hygiene in stopping the spread of infectious disease was Ignaz Semmelweis, a Hungarian physician, who in the 1840s was working in the maternity department of Vienna’s General Hospital. At the time, the idea that the squalid conditions in hospitals played a role in spreading infection didn’t cross many doctors’ minds. Among those most at risk were pregnant women. When they suffered vaginal tears during delivery, the wounds provided openings for the bacteria that doctors and surgeons carried on them wherever they went.
Semmelweis, then in his late 20s, noticed an interesting discrepancy between the hospital’s two obstetric wards. One was attended by male medical students, while the other was under the care of female midwives. Although each ward provided identical facilities for its patients, the one overseen by the medical students had a mortality rate that was three times higher. Those at the hospital who noticed the imbalance attributed it to the idea that male students handled patients more roughly than female midwives did, thus making the new mothers more susceptible to developing puerperal fever, a dangerous postpartum infection.
Semmelweis wasn’t convinced. In 1847, he had a breakthrough when one of his colleagues became ill after cutting his hand during a postmortem examination. Semmelweis noticed that the man’s symptoms were remarkably similar to those of women suffering from puerperal fever. What if doctors working in the dissection room were carrying “cadaverous particles” with them onto the wards when they assisted in the delivery of babies?
At the time, doctors didn’t wear protective gear such as gloves when dissecting the dead, or take care to wash their hands afterward. Perhaps the big difference between the students’ ward and the midwives’ ward was that the students were the ones performing autopsies.
Believing that puerperal fever was caused by “infective material” from dead bodies, Semmelweis set up a basin filled with chlorinated lime solution in the hospital and required all doctors to wash their hands in it before attending to patients. In April 1847, the mortality rate for new mothers on the students’ ward was 18.3%. After handwashing was instituted in May, it fell to just over 2%
Semmelweis’s results were compelling, and no doubt he saved the lives of many mothers during that period. However, he was not able to convince his colleagues that puerperal fever was caused by contamination through contact with dead bodies. Even doctors willing to carry out trials of his methods often did so inadequately, producing discouraging results. And Semmelweis himself could never completely eliminate cases of puerperal fever, even when his protocols were strictly enforced. After a number of negative reviews of a book he published on the subject, in 1861, Semmelweis lashed out at his critics, going so far as to call doctors who didn’t wash their hands “murderers.”
Semmelweis’s theories about hygiene and infection never won acceptance beyond the walls of his own hospital.
In time his behavior became erratic, an embarrassment to the hospital. Later historians have suggested he may have been suffering from the effects of Alzheimer’s disease or syphilis. On July 30, 1865, one of Semmelweis’s colleagues lured him to a Viennese insane asylum, under the pretense that he would be visiting a new medical institute. When Semmelweis surmised what was happening and tried to leave, he was severely beaten by several guards, secured in a straitjacket and confined to a darkened cell. Two weeks later, he died of a wound on his right hand that had become gangrenous.
Semmelweis’s theories about hygiene and infection never won acceptance beyond the walls of his own hospital. It wasn’t until the 1880s that pioneers of germ theory such as Louis Pasteur, Joseph Lister and Robert Koch proved to the world that disease really could be transmitted by microscopic particles, leading to a revolution in sanitary practices. Only then was the crucial importance of handwashing widely accepted and Semmelweis’s contribution acknowledged.
Today, the term “Semmelweis reflex” is used to refer to the knee-jerk tendency to reject new evidence because it contradicts established norms.
As a new pandemic tests the world’s medical systems and its ability to mount a coordinated response, our minds need to remain open to creative solutions that don’t necessarily fit accepted methodologies. Even in 2020, it remains a challenge to convince people that washing their hands is one of the most effective ways to combat Covid-19. If any positive change comes from the pandemic, it may be that hand-washing will at last become as universal as Semmelweis hoped.
-- Dr. Fitzharris is a historian of medicine and the author of “The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine.”
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