The Origin of Hand Washing

Lack of communication leads to a slow start

t’s 1846, and mothers and practices in his clinics and their infants are dying at a drastically reducing puerperal I staggering pace fever rates, has garnered postpartum–often at a rate of national attention for his 40% in some clinics. The ingenuity and for being cause: childbed fever or what targeted as a social pariah for is now known as puerperal going against his fever. The infection is most contemporaries. Semmelweis often caused by groups A and was the first doctor to causally B Streptococcus and was associate the link between By Raquel Kahler quite a mystery in the medical hand washing and childbed November, 2014 community in the middle of fever. However, puerperal the 19th century. fever has an even deeper history, one that is Important women such as simultaneously astounding Raquel Kahler is a Research and Elizabeth of York, Mary and mortifying. Development Microbiologist Wollstonecraft, the mother of and Technical Support Jean-Jaques Rousseau, and Specialist at Hardy Diagnostics. the English queen Jane She graduated with dual degrees in Microbiology and Seymour died of this disease Molecular Biology from shortly after giving birth. California Polytechnic State University, San Luis Obispo. Though germ theory had its origins as early as the 16th century, the notion that

invisible “seed-like” entities,

HardyDiagnostics.com “poisonous insects,” or “worms” were the cause of the disease was difficult for doctors to believe and was not widely accepted by the Figure 1: Ignaz Semmelweis, a medical community. Hungarian physician practicing at a hospital in Vienna, Austria, Ignaz Semmelweis, the proposed hand washing and physician responsible for chlorine solutions in the OB ward implementing hand washing in 1847. Puerperal fever is considered of cause, 9% due to one pride for doctors to walk a modern disease. Evidence of disease is significant. In around in their coats stiff with this disease is either rare or addition, it’s presumed that blood from the last autopsy or nonexistent before the 17th not all puerperal-related surgery they performed, after century, after which women deaths were accounted for at which they headed straight to started going to hospitals to the time. the maternity ward to do their give birth. In fact, even shift delivering babies. throughout the late 18th Women who showed signs of century and early 19th century, infection and died after being Needless to say, this provided the mortality rate due to released from the maternity ripe opportunity for the childbed fever was relatively ward or who were sent to the transfer of infectious low: generally less than 1%, general hospital for care due organisms from a corpse to a according to data from Vienna to overcrowding were new mother or her infant. The General Hospital. excluded from this data, so idea that the agent of the actual rate is believed to transmission was the doctor be higher. was preposterous and wholly rejected. Semmelweis was part of the golden age of the scientist physician; when doctors began to use symptom-based diagnoses as opposed to homeopathy to solve medical maladies. Autopsies became a large part of physician training into symptom-based

Figure 2: Before Semmelweis diagnosis as doctors began to Figure 3: Streptococcus bacteria is instituted hand washing, the look for internal signs and the main cause of puerperal fever. incidence of puerperal fever among symptoms. Consequently, However Staphylococcus can also women in the obstetrics ward was autopsies were performed be involved. as high as 40%. routinely on the deceased. The emphasis on getting to the Charles Delucena Meigs, a However, the year 1823 root of disease through well-known obstetrician at the marked the beginning of autopsy resulted in a growing time, is quoted as saying, pathological anatomy, or trend in the dirty appearance “Doctors are gentlemen, and autopsies, in Vienna General of many doctors. In addition, gentlemen’s hands are clean.” Hospital. It is also the year because doctors who However, a few doctors saw childbed fever-related deaths performed autopsies were in the dangers of this bravado. began to skyrocket. From this the field determining the point on until Semmelweis cause of sickness, they were Ignaz Semmelweis was not implemented hand washing revered among their the first. In fact, a couple of procedures, the death rate due colleagues and society. years before Semmelweis to puerperal fever varied from published his findings on just over 2% to as high as This led to the belief that the puerperal fever, an American 9.2%. Given today’s US dirtier the doctor, the better doctor named Oliver Wendell maternal death rate of the doctor. It was a point of Holmes published an article in 0.000185% in 2013 regardless the New England Quarterly Journal of Medicine and Hodge and Charles Meigs–yet two weeks later due to a blood Surgery entitled, “The maintained his reputation as a infection likely contracted Contagiousness of Puerperal distinguished professor and during the beatings. Fever.” In this article, Holmes doctor. He went on to publish identifies doctors as the link another text on the topic, Semmelweis was so rejected between successive cases of which became a cornerstone by the medical community at puerperal fever; his theory for the germ theory of disease. the time of his death that he stemmed from seeing was neither honored nor colleagues contract the recognized for his disease after performing contributions. autopsies on the dead. Sadly, it took 20 years after Though Holmes’s publication his death for Semmelweis’s was groundbreaking, it was findings on hand washing and largely ignored and never the spread of disease to begin reached the international to take hold. medical community. Thus, Semmelweis’ research and Louis Pasteur, known as the conclusions are still “father of microbiology,” is considered novel. In addition, famous for developing the Semmelweis theorized that first vaccine and for not only were doctors invalidating the notion of responsible for transmitting Figure 4: Semmelweiss often spontaneous generation. disease between patients, but lashed out against his critics Pasteur connected the germ that washing hands with a denouncing them as irresponsible theory of disease with chlorinated lime solution murderers or ignoramuses. Semmelweis’ data and was reduced transmission. more successful at Semmelweis, on the other disseminating Semmelweis’ While Holmes suggested hand, was ridiculed and information. “purifying” instruments and rejected by his colleagues, burning clothing after a case peers, and even friends and Today, hand washing is of puerperal fever, family. Semmelweis became intricately connected with Semmelweis recognized the obsessed with childbed fever hygiene and is the foundation importance of good hygiene and could do nothing but of modern medical practice. regardless of the previous think or talk about the disease. patient’s disease status. He had little patience for Semmelweis’s story is Semmelweis’ findings those who did not agree with interesting, but it’s also one dramatically reduced the rate his theory and talked worth remembering. Not only of puerperal fever in his clinic vehemently to and about his was he one of the first and saved countless lives. opponents. champions to document the importance of hand washing, Unfortunately, both Holmes Eventually, Semmelweis’s he is also an unfortunate and Semmelweis were obsession became his example of poor objective criticized for their findings. downfall and he was lured to peer review and Holmes came under fire by a mental institution where he communication. Semmelweis two obstetricians–Hugh L. was placed in a dark room and was not sheepish, but he faced severely beaten. He died just a dogged community unable to be objective about their own practices. When his theory was rejected by the medical community, he became angry and obsessed with converting others to his viewpoint. Unfortunately, his anger and ineffective communication style resulted in his being professionally and socially ostracized.

Figure 5: Semmelweis’ work was commemorated with this statue built in 1904 in Hungary.

However, the medical community did not live up to their own Hippocratic Oath. Consequently, because Semmelseis’s findings were not analyzed objectively and readily accepted, more lives were lost to a completely preventable disease.

Raquel Kahler Santa Maria, CA