In modern times, the idea that healthcare staff have a
particular obligation to keep their hands clean is part of the conventional
medical wisdom. Indeed, the COVID-19 pandemic has landed good hand and
respiratory hygiene right to the forefront of today’s headlines; almost
everyone will tell you that they are paying more attention these days to keeping
their hands clean. Yet, in the mid-19th century, hand washing was considered
to be quite radical.
I recently came across the work of the German-Hungarian physician Ignaz Semmelweis, a young physician who worked with medical students in Vienna at a public maternity ward. At Vienna General Hospital, there were two obstetric clinics: One run by the students and another run by midwives.
(Note: Home birth was the norm for those fortunate enough to have help with labor, delivery, and recovery care.)
In the 1840s, maternity wards were relatively new. They
provided free care for mother and infant, which made them an option for the
economically-disadvantaged. In return, patients would serve as training
subjects for both medical and midwifery students. At this time, hand washing
was not routine in medical care.
Dr. Semmelweis was surprised to find that incoming patients
preferred the midwifery ward to the medical students. So much so, in fact, that
women sometimes begged on their knees to be admitted to the care of the
The belief that no one gets better in a hospital persists
today, but was very common in the 1840s. Women would sometimes purposefully
wait so that they would deliver their baby on the street.
Dr. Semmelweis noted that the outcomes for women delivering
in the midwifery ward were better than in the medical student ward, despite having
identical facilities. Death rates were often three times higher. He further observed
that the women who came out best were those delivering in the street on the way
to the hospital.
Above: Mortality in medical student ward (1st) vs Midwifery ward (2nd)
This was at a time where maternal deaths were part and parcel of childbirth. In addition to hemorrhage, infection (known as “puerperal fever”) caused many fatalities. Most surmised that the medical students caused more casualties due to rough treatment, but Semmelweiz wasn’t so sure.
Then, one day, a physician friend was accidentally cut by a
medical student’s scalpel while performing an autopsy. His wound became
infected and he died some time later. Dr.
Semmelweis noticed that his deterioration was almost exactly the same as that
of women who succumbed to puerperal fever.
He concluded that, since midwives weren’t involved in
performing autopsies (and medical students were), that “cadaverous particles”
carried by the medical students into the maternity ward was responsible for the
worse outcomes in their ward.
Semmelweis placed a basin with chlorinated lime solution
(calcium hypochlorite) at the entrance to the medical student ward and required
all to wash their hands in it before entering. The results were impressive: In April
1847, more than 18 percent of new mothers perished as a result of infection. In
May 1847, only 2% died. Some months, the death rate was zero.
He became a fierce advocate of hand washing, going so far as
to call doctors who failed to do so “murderers”. Not surprisingly, the rigid
medical establishment of the time took offense. When he wrote a book about his
findings, it was roundly criticized and mocked. He lost his position at the
Vienna hospital (maternal deaths rose six-fold as a result) and moved to
Over time, Semmelweis became more and more adamant, to the
point that some felt he had become unhinged. In 1865, a physician “friend” took
him to visit a “new medical institute”. It turned out to be an insane asylum.
When he realized what was happening, he resisted admission and was severely
beaten by guards. Straitjacketed and tossed into a padded cell, he died within
two weeks from, of all things, a gangrenous infection of a hand wound. He was
47 years old.
Although Louis Pasteur began his work on the Germ Theory of Disease around the same time, it was decades before Semmelweis’s beliefs about hand hygiene became accepted by the medical community. In the general population, it took a pandemic in 2020 to convince many that washing their hands often is a good policy to prevent infection.
Ignaz Semmelweis, disgraced and forgotten outside of Hungary, was proven right. Today, his name isn’t familiar even to most physicians. One day, however, he may be recognized for advocating a policy that has saved millions.
Joe Alton MD
If you’re in the market for medical kits and supplies, take a moment to check out Nurse Amy’s entire line at store.doomandbloom.net.