Ignaz Semmelweis and washing your hands

Ignaz Semmelweis; Image via Wikipedia

Ignaz Semmelweis (1818-1865) was one of the early contributors to the Germ Theory of Disease, which led to a revolution in the survivability of various medical procedures. He was a Hungarian physician who specialized in obstetrics. Prior to the mid-1800’s, the process of childbirth carried a much more significant risk to the mother, with a major complication known as puerperal fever, or “childbirth fever”. Women who had a moderately uneventful delivery would become sick with this condition, and die with alarmingly high frequency a few days or weeks after delivery. Semmelweis began working in the Vienna General Hospital’s First Obstetric ward, and noticed that the mortality rates for new mothers was three times higher for mothers in the doctors’ wards in comparison to the midwifes’ wards. He considered several possibilities as to what might be causing the striking difference in the two obstetric wards. He eliminated crowding, as the midwifes’ clinic was actually more crowded than the doctors’ clinic, and he also eliminated climate differences, as the two clinics were geographically very close to one another. He was left with the possibility that the medical staff was the cause of the disparity.

An important clue came in 1847 when his good friend Jakob Kolletschka died shortly after being poked by a student’s scalpel during an autopsy. Analysis of Kolletschka’s body during his autopsy indicated that he had died of something similar to what the women dying of puerperal fever were succumbing to, and this suggested that the causes of the disease were similar. Semmelweis then proposed that incidence of puerperal fever was related to examination of cadavers, which was done by doctors but not by midwives. He began to have the doctors’ staff wash their hands with a solution of chlorinated lime (a bleach solution.) This procedure caused the incidence of puerperal fever to drop from 18.3% in April 1847  to  2% and less by June, with no deaths due to the condition during the summer of 1847.

Although this idea seems obvious to us today, it was met with resistance and ridicule at the time. The cause of disease was believed to be unique to the individual, and therefore a common cause for all disease was unheard of. He was dismissed from the Vienna General Hospital for political reasons, and returned to Hungary. He continued to write angry letters to prominent European obstetricians, accusing them of ignoring his finding and being murderers. People close to him (including his wife) felt that he was losing his mind, and he was committed to an asylum in 1865. He died of septicemia only 14 days later, possibly from being beaten by guards. His findings were validated shortly afterwards by the work of Louis Pasteur, Robert Koch, and Joseph Lister during the formalization of the Germ Theory.

BONUS:  We’ve spent a lot of time talking about methods for microbial control. Imagine that you know about the possible methods of transmission, but do not yet know of the need for  handwashing after coming from the autopsy suite. What else might you propose to control the spread of infection in this situation?

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About ycpmicro

My name is David Singleton, and I am an Associate Professor of Microbiology at York College of Pennsylvania. My main course is BIO230, a course taken by allied-health students at YCP. Views on this site are my own.

Posted on March 15, 2011, in A bit 'o history, Bonus!, Lecture, Wash your hands! and tagged , , . Bookmark the permalink. 4 Comments.

  1. Sterilizing the instruments that a doctor may use will help in aiding to keep the infection from spreading. If the instruments are cleaned, then there won’t be any infectious disease still on the same instruments that the doctor may use on someone else and therefore, each time he may operate on someone new, they instruments he may use will be clean. Disinfecting the tabletops and other inantimate objects within the autopsy rooms would help keep infections from spreading as well because no one can accidentally rub up against the object with the infection on it and retrieve it. (Although, most infections are not able to survive for long periods of time on such things like a tabletop.) Possibly even wearing masks would help to control infectious diseases. We know that droplet transmission can occur within up to 1 meter of someoen else, and so if you were masks, this could potentially help in reducing the infection from spreading from person to person. Like said in the reading, washing of the hands is also a very good idea.

  2. Rivers Singleton

    For the history buffs who may follow this blog, the surgeon Sherwin Nuland’s book, The Doctors’ Plague: Germs, Childbed Fever, and the Strange Story of Ignac Semmelweis opens with a truly chilling account of childbed fever. I believe the story is fictional, however Nuland not only describes the basic infection transmission process but does so in a way that illustrates the sociological aspects of diseases. Wealthy, upper class women went to one ward where they received better care than women with lesser financial or social status who were sent to another ward. His biography of Semmelweis that follows is factually correct, I believe, but the writing does not compare to the opening story.

    • There is a translation of Semmelweis’ monograph available on Google Books. Portions are summarized in the Wikipedia link in the posting above, which said that the early 19th century saw a society change in Europe leading to a number of changes. One of which was an attempt to “address the problems of infanticide of illegitimate children,” by creating maternity wards where underprivileged women could receive medical care for free in exchange for allowing their care to be administered by doctors and midwives in training. The clinic in which Semmelweis was receiving his training in (he was the equivalent of today’s “Chief Resident” at the time) served this underprivileged population, and many women begged to go to the other institution where they were cared for by midwives in training instead, hence the significant overcrowding at that institution.

  3. To control the spread of infection you really need to make sure that all areas of the room are clean. Now we know that disinfecting instruments used in surgery and the instruments that are going into the body need to be clean and sanitized before using them and we need to make sure that people in the room are covered and not bringing in any bacteria from outside. Thats why people now that are going to be in the room for surgery have to wear scrubs and protective clothing around each extremity because like we have discussed in class we are a walking petri dish and we can have bacteria that we are immune to but under a surgery environment we may be susceptible to infections if we don’t provide the right amount of prevention. We have also found that to much cleanliness is bad for our bodies because we are over protecting ourselves, so that also boasts the question of when is it ok to not be so clean?

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