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 midwifery (Robinson an important act of personal hygiene 1929). to protect us from infections with mi- Medical students routinely exam- croorganisms. Is there any published ined patients in the First Clinic in evidence that washing hands does Vienna. 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 antiseptic 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, hand washing by physicians and was appalling that more women were students was hasty and superficial dying in the hospital 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 death 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 childbirth) 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 infection 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 Louis Pasteur'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 obstetrics 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 University of Vienna 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 deaths 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 mortality rate 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 germ theory of disease 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 surgery. 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 chlorine 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.