Corona Daily 328: Dr Ignaz Semmelweis

It may shock readers to learn our ancestors 200 years ago were not in the habit of washing hands. Neither were the doctors and surgeons.

The handwashing history begins with Ignaz Semmelweis, a bald, mustachioed Hungarian doctor. In the 1840s, many new mothers were dying from childbed fever. Even in the best hospitals, they could fall ill and die shortly after giving birth. Dr Semmelweis, working in Austria’s Vienna General Hospital, was intrigued and decided to find the cause. In the maternity ward staffed by male doctors, the number of new mothers dying was double that in the ward staffed by female midwives. This was a puzzle in itself.

The doctor tested several hypotheses. He even wondered if male doctors examining women was such an embarrassment as to cause fever. After meticulously ruling out various hypotheses, he found a possible culprit: the dead bodies. In the mornings, doctors always helped students perform autopsies. In the afternoons, the doctors and their students visited the maternity wards and delivered babies. Midwives didn’t conduct any autopsies and never left their ward. Semmelweis inferred the doctors were carrying some particles from the cadavers to the new mothers. Doctors didn’t scrub their hands between patient visits as they do today.

In 1847, Semmelweis implemented mandatory handwashing for the male doctors and students. He prescribed a chlorinated lime solution to wash hands and the instruments. The mortality rate in the male doctor ward plummeted.

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In 1850, Semmelweis presented his handwashing findings at the prestigious Vienna medical society. The medical community rejected his logic and science. In those days, the medical science trusted the “Miasma theory” that held all diseases such as cholera and the plague were caused by bad air. The doctors listening to Semmelweis also believed he was blaming them for the patients’ deaths. The heavy criticism resulted in the Vienna hospital abandoning mandatory handwashing.

Semmelweis published a book in 1861 offering evidence of the connection between handwashing and mortality. The book was widely condemned. He suffered acute depression and was admitted to a mental asylum. Shortly thereafter, he died at the age of 47.

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In the 1850s, the Crimean War was fought between Russia on one side and the Ottoman Empire, UK and France on the other. Florence Nightingale, later known as the founder of nursing, served as a manager and trainer of nurses during that war. She was the other handwashing champion. The mandatory handwashing instituted by her during the war reportedly brought down mortality rates from 42% to 2%.

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Dr Semmelweis’s work led to Louis Pasteur developing “the germ theory of disease”. Surgeons began scrubbing in the 1870s. But it took more than 100 years, and a string of food borne outbreaks and infections for the Centers of Disease Control and Prevention (CDCs) to announce hand hygiene as an important way to prevent the spread of infection. The first guidelines were issued in the 1980s. Washing with soap was recommended in 1995. In January 2000, the Medical University of Budapest was renamed the Semmelweis University in honour of the man universally condemned in his time for his handwashing theories.

In August 2008, the Global Handwashing Day was established. It is observed on 15 October each year. 

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(P.s. More on handwashing tomorrow.)

Ravi