Ignaz Semmelweis and washing your hands
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?