The Man Who Invented Hand Washing

ignaz_semmelweis_1857_with_signatureBefore Louis Pasteur, there was Ignaz Semmelweis (1818-1865), a Hungarian obstetrician who developed a theory that saved lives, but was ridiculed and ultimately rejected for his efforts.

Born July 1, 1818 in Buda, Hungary, Austrian Empire, Ignaz Phillip Semmelweis was the fifth child of a successful grocer. In 1837, he began a degree in law at the University of Vienna, but ultimately switched to medicine, specializing in obstetrics. His generation of medical school graduates was on the cusp of the era of physician as scientist.. These young doctors no longer looked to imbalances produced by bad air or evil spirits as the causes of disease and death. Instead, they looked to the scientific method to develop explanations and Ignaz was keenly interested in data analysis as an investigative tool.

vienna-freyung-with-austria-fountains-rudolf-von-alt

Rudolf von Alt painting of Vienna, Freyung with Austria Fountains

In 1847 at age 29, Semmelweis had risen to become Chief Resident of the First Clinic of the lying-in division of Vienna General Hospital. It was a time when childbirth was still a dangerous affair and one of the leading causes of maternal mortality was puerperal or childbed fever (CBF). While most women still delivered at home, those who had to be hospitalized due to complications, or other factors such as poverty or illegitimacy, faced mortality rates as high as 25-30%. CBF raged through obstetric wards like the plague through Medieval Europe. The problem was so great that hospital obstetric units were sometimes closed down due to the death rates. As a doctor and man of science, Semmelweis found this unacceptable.

In his position, Ignaz began collecting data on maternal death rates in Vienna General’s two maternity clinics. Analysis of the data showed an alarming difference between the two. Vienna General was a teaching hospital for both doctors and midwives. His area, the First Clinic, was staffed by male doctors and medical students. The other, the Second Clinic, was staffed by female midwives. In the First Clinic, the death rate for mothers was five times greater than it was in the Second Clinic. Ignaz was determined to discover the reason for the difference.

He first studied the methods and procedures of both clinics. In the Second Clinic where midwives attended births, women delivered on their sides, whereas they delivered on their backs in the First Clinic. He instituted change with the doctors under his supervision, but this produced no improvement.

Next, he observed that shortly after a death, a priest accompanied by a bell ringer went through the ward. Ignaz theorized that these symbols of death frightened the remaining patients so that they developed fevers and died, as well. He barred the priest from the ward. Still, there was no reduction in the death rate.

Frustrated and in need of a vacation, Semmelweis traveled to Venice in hope that time away and a different environment might stir inspiration. Upon returning to Vienna, he found that a friend had died. The friend was a pathologist. Death was not an uncommon occupational hazard for that branch of the medical profession. The cause was not unusual either- a pricked finger, onset of septicemia, followed by death. What caught Semmelweis’s attention was that the pathologist had pricked his finger while doing an autopsy on a woman who had died of CBF. Ignaz studied the symptoms the pathologist had displayed and discovered they were the same as those of CBF.

Today, a doctor who failed to recognize the dangers of cross contamination would be a good candidate as a defendant in lucrative malpractice suits and for having his/her license to practice revoked. In Semmelweis’s time, however, doctors went from autopsy to surgery to obstetric deliveries with nothing more than wiping the blood from their hands. The fact that a man could die of CBF was a revelation. When Ignaz examined the procedures used by the two clinics, he realized that the only substantive difference between the doctors’ lying-in clinic and that of the midwives was that the doctors and medical students were doing autopsies and the midwives were not. He hypothesized that particles from the corpses remained on the men’s hands after autopsy and were transmitted to the brith canals of women who were being assisted during delivery by them.

He tested his theory by ordering his staff to clean their hands and instruments with chlorine. Although he had no knowledge of germ theory, he knew that chlorine would eliminate the smell of decaying corpse particles. Naturally, the death rate for new mothers declined significantly.

This should have been a discovery lauded by the entire medical profession. Unfortunately, Semmelweis was a better doctor than politician. He alienated his colleagues with very public disagreements and made influential enemies. In addition, his hypothesis made doctors feel that he accused them of causing CBF deaths. Eventually, doctors put ego before patient welfare and refused to use the chlorine washes. As a consequence, Semmelweis lost his job and death rates returned to their previous levels. Hubris prevented his colleagues from admitting the consequences of abandoning the chlorine washes.

In other parts of Europe, Semmelweis continued his crusade for hand washing with little success. Whether he was driven crazy by obsession with his lack of success, the effects of syphilis, or Alzheimer’s, in 1865 at the age of 47, he was committed to an asylum from which he never emerged. It is believed he was beaten by guards, developed sepsis, and died – a sadly ironic fate for the man who discovered how to prevent the spread of infection by the simple act off washing one’s hands.

Related Fiction

Thank you to HI reader Leonide Martin for this recommendation! She read the book some years ago and enjoyed it immensely. It is a fictionalized account of Ignaz Semmelweis’s life!

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Finding historical fiction set in Vienna is not difficult, but fiction featuring Semmelweis or medical practice in 19th century Vienna did not reveal itself in my research. The following novels are set prior to WWI  when Vienna was home to leading  lights in medicine.

 

when neitz wept

 

 

tallis tv

Resources

https://www.georgetakei.com/little-known-historical-figures-who-completely-changed-the-world-2623318348.html

https://www.ncbi.nlm.nih.gov/pubmed/30444981

http://broughttolife.sciencemuseum.org.uk/broughttolife/people/ignazsemmelweis

https://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives