sign in sign up
<<
Home , Ignaz Semmelweis

How-To-Do-It

Ignaz Semmelweis & the Importanceof Washing Your Hands

Walter E. Brown,Jr. RobertP. Williams

We all know that washing hands is of master of (Robinson an important act of personal 1929). to protect us from with mi- Medical students routinely exam- croorganisms. Is there any published ined patients in the First Clinic in evidence that washing hands does . In the Second Clinic, the mid- wives were trained and held respon- any good? In this articlewe briefly ex- Downloaded from http://online.ucpress.edu/abt/article-pdf/52/5/291/45020/4449112.pdf by guest on 25 September 2021 amine studies by Ignaz Semmelweis sible for patient care. Childbed fever that show its importance.This work is raged in the First Clinic, with a mor- an early contribution to the germ tality rate of about 10 percent-four theory of disease. At the end of the ar- times as great as that of the Second ticle, there is an experiment demon- Clinic. Semmelweis knew the mid- strating the evidence of his wives did not attend autopsies. Nor practice. did they do patient examinations as Until the middle of the 19th cen- frequently as the medical students. It tury, by physicians and was appalling that more women were students was hasty and superficial dying in the attended by phy- (Slaughter 1950). They washed their sicians than those attended by mid- hands with tap water and dried them wives. on their handkerchiefsor waved them One of Semmelweis's teachers died in the air; the surgeons then went di- suddenly from a small wound re- rectly to the wards to examine pa- ceived while performing an autopsy. tients. Semmelweis realized that the patho- Doctors believed in the miasma Figure 1. Ignaz Philipp Semmelweis logic changes in the were iden- theory of disease. This theory blamed (1818-1865).Modified from Dawson, tical to those of women dying of epidemics on some peculiarchange in P.M. (1924). Semmelweis an interpre- childbed fever. During this time Sem- the atmosphere that was produced by tation. Annals of Medical History, 6, melweis, his students and physicians poor sanitary conditions (Dowling 258-279. were examining the birth canals of fe- 1977). Puerperal(pertaining to or con- male patients with unwashed hands nected with ) or childbed after they came directly from the au- fever was believed to be an illness of topsy rooms (Gyorgyey 1968). The miasmatic origin, but no one felt re- obstetricsprofessors all over America. doctors and students were the instru- sponsible for the atmospheric influ- But no one knew the cause of childbed ments of death and carried cadaver ences or capable of coping with them. fever. particles on their unwashed hands Childbed fever was an ancient We now know that the disease from the autopsy room directly to the scourge. The heroine in Tolstoi's usually is due to with the patients (Sinclair 1909). novel Anna Kareninasuffered from the bacteriumStreptococcus pyogenes. It in- In May 1847 Semmelweis began a disease. The illness was described in fects the patient, reproduces rapidly plan to destroy the poison carried general terms, yet was unmistakable and causes a serious, oftentimes fatal, from cadavers and sick patients by (Sigerist 1943). infection in mothers who have just The New YorkHospital had to close given birth (Wilson 1955).Streptococcus in the late Walter E. Brown, Jr. is a life science its obstetric service in 1828 because of pyogeneswas discovered teacherand chairmanof the science depart- the high death rate due to childbed 19th century. The bacteriumStaphylo- ment at Gentry Junior High School, Bay- fever. Eleven years later, a famous coccusareus also has caused the dis- town, TX 77521. He has a B.S. from the New England physician, Oliver Wen- ease. This informationwas unknown University of Houston and a M.Ed. from dell Holmes, stated that childbed until the 1880s and 's Our Lady of the Lake University, San An- fever was probablycarried by doctors statement of the germ theory of dis- tonio, TX. Robert P. Williams is a pro- from ill to healthy expectant mothers. ease. fessor of microbiologyand immunology at He also proposed that the disease was In 1848, a young Hungarian physi- BaylorCollege of Medicine, Texas Medical passed from autopsy to bedside. He cian, Ignaz Philipp Semmelweis, Center, in Houston, TX 77030.He received an A.B. from Dartmouth College and a advised physicians to change their began to practice handwashing as an M.S. and Ph.D. from the University of clothes and wash their hands and fin- antiseptic measure in the Chicago. The author of more than 140 ar- gernails with a solution of calcium clinic of Vienna. Semmelweis (Figure ticles and books, he is a past president of chloride before examining patients 1) received his medical degree from the AmericanSociety for Microbiologyand (Harbert 1980). These new ideas met the in 1844 and a Fellow of the AmericanAcademy of Mi- with a great deal of opposition from shortly after that attained the degree crobiology.

SEMMELWEIS291 having medical students and physi- Semmelweis was encouraged to A year later he was working at a cians wash their hands with a chloride publish his theory and results that hospital in Pest, Hungary, where he of lime solution (DeKruif 1932). The showed partides carriedby physicians reduced the number of due to washing was performed before and from ill patients or cadavers caused childbed fever. Finally, in 1860, Sem- after examining patients. Medicalper- childbed fever, but he did not. Physi- melweis published a book titled The sonnel unacquaintedwith the reasons cians were convinced that the impor- Etiology,the Conceptand Preventionof for such measures protested (Thomp- tance of particles was exaggerated, PuerperalFever which was somewhat son 1954), but the results were as- and the idea was not highly regarded. disorganized and difficult to follow. It tounding. The fell, and In fact, the concept was an expression did not convince his adversaries, and for the first time it was lower in the of the that was mothers continued to die of childbed First Clinic than in the Second. Not a not developed until several years fever. Semmelweis enraged obstetri- single case of childbed fever was re- later. cians by publishing a series of public ported for six months, a fact that was In 1850 Semmelweis consented to letters accusing them of murder. unheard of in all of Europe. Sem- speak on his theory before the Medical At this time, Semmelweis's mental melweis also made observations and Society of Vienna. His theory stood on condition deteriorated. As a result of collected data showing that deaths the verge of acceptance (Nuland memory loss and fits of strange be- were less frequent in the Second 1988). But again he could not be per- havior, he was placed in a sanitarium Clinic where the midwives had not suaded to publish his work. Subse- (Slaughter 1950). Semmelweis was come from the autopsy room. quently, he left Vienna. only 47 years old; two weeks later he

was dead. There is a controversyas to Downloaded from http://online.ucpress.edu/abt/article-pdf/52/5/291/45020/4449112.pdf by guest on 25 September 2021 the cause of his death. Most biogra- phers state that he died of an infection similar to the one he had fought to protect expectant mothers from con- tracting. Semmelweis also may have suffered from the clinical symptoms characteristicof Alzheimer's disease, which would explain his erratic be- havior (Nuland 1988). Semmelweis made an important contributionto obstetricsand . He practiced antiseptic surgery 15 years before Lister and, several years before Pasteur proposed the germ theory, presented a concept that par- ticles (germs) caused infectious dis- ease. The story of Semmelweis is im- portant for students of science be- cause along the path of investigation, observation and examination, he made important discoveries that saved many lives. In the final analysis, Semmelweis failed to gain recognition for his theories because he was too stubbom to publish his findings until several years after their discovery. Ignaz Semmelweis was not a micro- biologist and had little knowledge of the relationship of microbes to dis- ease. But as a result of hard work, and perhaps a touch of genius, his dis- covery became a milestone in the his- tory of medicine. Lord Lister said, "Without Semmelweis my achieve- ments would be nothing. To this great son of Hungary, surgery owes most" (Thompson 1954).

Experiment In this experimentyou will see how Clorox acts as an antiseptic (Figure 2), thus demonstrating Semmelweis's principle of antisepsis. Figure 2. Four culture plates demonstratingresults of the experiment. Plate = Upon completion of the laboratory control;Plate 2 = 5 percent Cloroxsolution; Plate 3 = 10 percent Cloroxsolution; unit, the student will be able to: = variationis due to a deeper level of Plate 4 20 percent Clorox solution. Color 1. identify Semmelweis with child- agar in plates 1 and 3 which does not alter the results. bed fever and antisepsis

292 THE AMERICAN BIOLOGY TEACHER, VOLUME 52, NO. 5, MAY 1990 2. identify the control 3. discuss the variables Table 1. Data sheet for effects of Clorox on bacterialgrowth 4. describe other uses of Colonies % the beneficial effects of ColonyCount Colorof 5. discuss Control Experimental Solution washing hands using an anti- Day Control Experimental septic 0 0 0 none none 5 1 0 0 none none 2 5 1 white cream Materials 3 65 8 yellow, white, cream cream, yellow You will need the following items to 4 65 8 yellow, white, cream cream, yellow successfully complete this exercise: Experimentalcount will vary with the percentageof Clorox solution used. hand soap paper towels Petri dishes Clorox, fresh solutions growth of the microbes and by which microorganismscan be nutrient or Trypticase Soy Agar record data. passed from one person to an- (Agar No. 11774, BBLMicrobiology 5. After48 hours, have the students other. Systems, BectonDickinson and Co., record their observations on a 10. Do you think Clorox could be Cockeysville, MD 21030) data table (see Table 1) and make used to wipe down laboratory Downloaded from http://online.ucpress.edu/abt/article-pdf/52/5/291/45020/4449112.pdf by guest on 25 September 2021 500 ml beakers sketches of the colonies from tables and clean instruments? 100 ml graduatedcylinders both dishes. Daily observations Explain. Name other uses of protective eyeware should include the day and date chlorine in everyday life. Students should be instructed not to of the experiment and the place Clorox on their skin or in their number and color of colonies ob- mouths. served. Discussion Questions A postlaboratorydiscussion allows Procedure students to consolidate their knowl- The teacher should ask questions edge of microbes and the action of Students' hands should not have recalling the facts and follow this up Clorox on them. A review of the been washed one hour prior to the ex- with more analytical questions that above questions will stimulate stu- periment. will urge the students to link facts to- dents' thinking in the laboratory.Stu- gether. Open questions can follow for dents should conclude that microbes 1. students in a Place four group, the purpose of a discus- are on their hands and that an anti- a stimulating assign each group to make cer- sion. septic of proper strength can reduce tain of fresh Clorox so- strength Some examples of questions: the microbialcount; that Semmelweis lution. was an early proponent of using chlo- Group I: 5 percent solution 1. What is an antiseptic?List some ride solutions for antisepsis and that Group II: 10 percent solution used at home, school washing hands is an important hy- Group III:20 percent solution or the hospital. gienic practice. 2. Give each group two Petri dishes 2. What important concept did Clorox contains chlorine which be- containing agar to grow . Ignaz Semmelweis contribute to longs to a group of highly reactiveele- One dish will be labeled control, science? Did he stop believing in ments known as halogens. Halogens the other, the percent of Clorox his idea after he was ridiculedby are oxidizing agents that inhibit mi- solution assigned to them. his fellow physicians? crobial growth. It is used in medical 3. One student from each group 3. What percent of Cloroxkilled the laboratoriesas an antisepticand a dis- raises the lid of the control dish least amount of microbes? The infectant. Weak Clorox solutions can and touches his or her fingers greatest amount? kill viruses. Chlorination of water lightly on the media, closing the 4. How many colonies did you supplies and swimming pools is an dish afterward. These students count from the control? How important measure for the control of wash their dirty fingers in the many from the experimental microorganisms. Chlorine is used in Clorox solution for 15 seconds dish? sewage treatmentplants for the same and let them dry in the air for 5. Describe the colors of the colo- purpose. two minutes. The students then nies observed. touch their washed fingers to a 6. Explain why the experimental second dish of media, closing the dish had a different number of dish afterward. Finally, the stu- colonies than the control dish. References dents wash their hands using 7. List some variablesin the experi- DeKruif,P. (1932).Men againstdeath. New soap to remove the Clorox. ment. York:Harcourt, Brace & World. 4. Incubate the culture dishes at 8. What is the importanceof having Dowling, H.F. (1977). Fighting infection, room temperature (25?C)for 48 a control? Compare your data conquestsof the 20th century.Cambridge: hours. Count the number of col- with other groups and draw con- HarvardUniversity Press. onies on the Petri dishes. This clusions with respect to the rela- Gyorgyey, F. (1968). Puerperal fever number is not quantitative but 1847-1861.Master's thesis, Yale Univer- tionship between the strength of sity Press, 49-121. will give a relative value of the Clorox and number of colonies Harbert,E. (1980). Lifeand lettersof Oliver amount of microbialgrowth. The observed. Wendell Holmes. New York: Chelsea experiment should be conducted 9. Briefly discuss how this experi- House. for four days to allow adequate ment demonstrates one method Nuland, S.B. (1988).Doctors, the biography of

SEMMELWEIS 293 medicine. New York: Alfred A. Knopf. Sigerist,A.E. (1943).Civilization and disease. enant. In The fight for life (pp. 9-141). Robinson, V. (1929).Pathfinders in medicine. Chicago:University of ChicagoPress. New York:Reader's Digest Association. New York: Medical Life Press. Slaughter,F. (1950).Immortal Magyar. Sem- Wilson, G. (1955). Topley& Wilson'sprin- Sindair, S.W. (1909). Semmelweis,his life and melweis,conqueror of childbedfever. New ciplesof bacteriologyand immunity(4th ed., his doctrine. Manchester, England: Uni- York:Henry SchumanPublishing Co. Vol. II). Baltimore:Williams & Wilkins versity Press. Thompson,M. (1954).The cry and the cov- Co.

Answersto PostlaboratoryQuestions 1. An antiseptic is a chemical 3. 5 percent, 10 percent and 20 ison to the experimental dish. used to kill pathogenic micro- percent. The stronger the solution, the organisms on a living object, 4. Answers will vary to both fewer microbial colonies were such as the surface of the questions. observed. human body. Other antiseptics 5. Answer will vary as to the 9. Microbes are found on the used are: Listerine, alcohol, io- color. hands and can be passed to dine and Phisohex soap. 6. Because Clorox solution de- another person. stroyed some of the microbes. 10. Yes, Clorox is also used as a 2. The idea that a disease can be 7. Possible variables include: disinfectant. A disinfectantis a transmittedfrom one person to length of washing time, chemical used to kill patho- Downloaded from http://online.ucpress.edu/abt/article-pdf/52/5/291/45020/4449112.pdf by guest on 25 September 2021 another by way of the hands. amount of microorganismson genic microorganismson a life- He introduced the practice of the fingers, incubationtemper- less object such as a tabletop. antiseptic technique to medi- ature, age of Clorox (Clorox Other uses include chlorina- cine. No, because his data loses strength with time and tion of water supplies, swim- showed that his idea was light exposure). ming pools, washing clothes sound. 8. A control is used as a compar- and sewage treatmentplants.

A3 A A

'lbpmagnification of 1250Xwith the l.25Xbody tube and lOXwide field eyepieces, a 6-volt,20-watt halogen illumi- A m arel nationsystem, rack and pinion focusable substage D D o D , condenser,and fully rotatable binocular body tube. co Five-yearwarranty on the mechanicalparts and Xone-year warrantyon allelectrical parts. ic osco e Asa bonus,a handsomeand rugged 1 / * _ ~~~~~~~~~~~~~canzingcaseis includedFREE. 1/2 price. Orderyour Amarel 61X Microscope Withfull warran ! U. Ztoday!Call 716-223-2370. Withfullwarranty! ~ F * ------Now,you canpurchase one of the Save Even More! fineststudent lab microscopes on the Sendthis couponin withyour order by June markettoday-the Amarel61X-for 15,1990 and receive an additional$50 off only$650. Half of the regularlist price. the alreadylow price of $650for the Amnarel Takeadvantage of this specialoffer while 61XMicroscope. supplylasts.V3 AMAREL Outstandingperfonnance fea- tures you'll receive with your _0 ;. . F7 EjP CISImO Amarel61X include excellent image VS 1NS'R UMENISJ, INC. clarity,four achromat objectives for AAmvl PmWon Instruments,Inc. sharpcontrast and superb resolution, 78 SchuylerBaldwin Drive *4X *lox 40X looX Fairport,NY 14450-9196 I94l AMERIANBIOLOG(716) V 223-2370 FAX(716) 223-3413

294 THEAMERICAN BIOLOGY TEACHER, VOLUME 52, NO. 5, MAY1990