The Doctor Who Championed Hand-Washing And Briefly Saved Lives
This is the story of a man whose ideas could have saved a lot of lives and spared countless numbers of women and newborns' feverish and agonizing deaths.
You'll notice I said "could have."
The year was 1846, and our would-be hero was a Hungarian doctor named Ignaz Semmelweis.
Semmelweis was a man of his time, according to Justin Lessler, an assistant professor at Johns Hopkins School of Public Health.
Semmelweis considered scientific inquiry part of his mission as a physician.
It was a time Lessler describes as "the start of the golden age of the physician scientist," when physicians were expected to have scientific training.
So doctors like Semmelweis were no longer thinking of illness as an imbalance caused by bad air or evil spirits. They looked instead to anatomy. Autopsies became more common, and doctors got interested in numbers and collecting data.
The young Dr. Semmelweis was no exception. When he showed up for his new job in the maternity clinic at the General Hospital in Vienna, he started collecting some data of his own. Semmelweis wanted to figure out why so many women in maternity wards were dying from puerperal fever — commonly known as childbed fever.
He studied two maternity wards in the hospital. One was staffed by all male doctors and medical students, and the other was staffed by female midwives. And he counted the number of deaths on each ward.
When Semmelweis crunched the numbers, he discovered that women in the clinic staffed by doctors and medical students died at a rate nearly five times higher than women in the midwives' clinic.
But why?
At Vienna General Hospital, women were much more likely to die after childbirth if a male doctor attended, compared to a midwife.
Semmelweis went through the differences between the two wards and started ruling out ideas.
Right away he discovered a big difference between the two clinics.
In the midwives' clinic, women gave birth on their sides. In the doctors' clinic, women gave birth on their backs. So he had women in the doctors' clinic give birth on their sides. The result, Lessler says, was "no effect."
Then Semmelweis noticed that whenever someone on the ward died of childbed fever, a priest would walk slowly through the doctors' clinic, past the women's beds with an attendant ringing a bell. This time Semmelweis theorized that the priest and the bell ringing so terrified the women after birth that they developed a fever, got sick and died.
So Semmelweis had the priest change his route and ditch the bell. Lessler says, "It had no effect."
By now, Semmelweis was frustrated. He took a leave from his hospital duties and traveled to Venice. He hoped the break and a good dose of art would clear his head.
When Semmelweis got back to the hospital, some sad but important news was waiting for him. One of his colleagues, a pathologist, had fallen ill and died. It was a common occurrence, according to Jacalyn Duffin, who teaches the history of medicine at Queen's University in Kingston, Ontario.
"This often happened to the pathologists," Duffin says. "There was nothing new about the way he died. He pricked his finger while doing an autopsy on someone who had died from childbed fever." And then he got very sick himself and died.
Semmelweis studied the pathologist's symptoms and realized the pathologist died from the same thing as the women he had autopsied. This was a revelation: Childbed fever wasn't something only women in childbirth got sick from. It was something other people in the hospital could get sick from as well.
But it still didn't answer Semmelweis' original question: "Why were more women dying from childbed fever in the doctors' clinic than in the midwives' clinic?"
Duffin says the death of the pathologist offered him a clue.
"The big difference between the doctors' ward and the midwives' ward is that the doctors were doing autopsies and the midwives weren't," she says.
So Semmelweis hypothesized that there were cadaverous particles, little pieces of corpse, that students were getting on their hands from the cadavers they dissected. And when they delivered the babies, these particles would get inside the women who would develop the disease and die.
If Semmelweis' hypothesis was correct, getting rid of those cadaverous particles should cut down on the death rate from childbed fever.
So he ordered his medical staff to start cleaning their hands and instruments not just with soap but with a chlorine solution. Chlorine, as we know today, is about the best disinfectant there is. Semmelweis didn't know anything about germs. He chose the chlorine because he thought it would be the best way to get rid of any smell left behind by those little bits of corpse.
And when he imposed this, the rate of childbed fever fell dramatically.
What Semmelweis had discovered is something that still holds true today: Hand-washing is one of the most important tools in public health. It can keep kids from getting the flu, prevent the spread of disease and keep infections at bay.
You'd think everyone would be thrilled. Semmelweis had solved the problem! But they weren't thrilled.
For one thing, doctors were upset because Semmelweis' hypothesis made it look like they were the ones giving childbed fever to the women.
And Semmelweis was not very tactful. He publicly berated people who disagreed with him and made some influential enemies.
Eventually the doctors gave up the chlorine hand-washing, and Semmelweis — he lost his job.
Semmelweis kept trying to convince doctors in other parts of Europe to wash with chlorine, but no one would listen to him.
Even today, convincing health care providers to take hand-washing seriously is a challenge. Hundreds of thousands of hospital patients get infections each year, infections that can be deadly and hard to treat. The Centers for Disease Control and Prevention says hand hygiene is one of the most important ways to prevent these infections.
Over the years, Semmelweis got angrier and eventually even strange. There's been speculation he developed a mental condition brought on by possibly syphilis or even Alzheimer's. And in 1865, when he was only 47 years old, Ignaz Semmelweis was committed to a mental asylum.
The sad end to the story is that Semmelweis was probably beaten in the asylum and eventually died of sepsis, a potentially fatal complication of an infection in the bloodstream — basically, it's the same disease Semmelweis fought so hard to prevent in those women who died from childbed fever.
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Transcript
RENEE MONTAGNE, HOST:
Today in our segment Your Health we're going to hear about one of the most important advances ever in human health - the revolutionary combination of water and soap and hands. You might be rolling your eyes, but really, hand-washing is still considered the number one defense against the spread of germs. Let's hear this morning the story of the physician who realized the importance of clean hands well before anyone knew about germs. NPR's Rebecca Davis has our story.
REBECCA DAVIS, BYLINE: This is the story of a man whose ideas could have saved a lot of lives and spared countless numbers of women and newborns' feverish and agonizing deaths. You'll notice I said could have. The year was 1846 and our would-be hero was a Hungarian doctor named Ignaz Semmelweis. Now, Semmelweis was what you might call a man of his time. Justin Lessler is an assistant professor at Johns Hopkins School of Public Health. He says in those days doctors like Semmelweis were trained to approach medicine scientifically.
JUSTIN LESSLER: This is the start of the golden age of the physician scientist, where physicians were expected to have scientific training and some scientific understanding.
DAVIS: So doctors like Semmelweis were no longer thinking of illness as an imbalance caused by, say, bad air or evil spirits. They looked instead to anatomy. Autopsies became more common and doctors got interested in numbers and collecting data. The young Dr. Semmelweis was no exception. When he showed up for his new job at maternity hospital in Vienna he started collecting some data of his own. Justin Lessler says Semmelweis wanted to figure out why are so many women in maternity wards dying from something called childbed fever. First, he compared two maternity wards in the hospital.
LESSLER: One of the things he did was count up the number of patients and the number of deaths that occurred in the first clinic, which was staffed by almost all male doctors and medical students, and the number of deaths that occurred in the second clinic that was staffed by almost all female midwives.
DAVIS: Semmelweis crunched the numbers and discovered that women in the clinic staffed by doctors and medical students died at a rate nearly five times higher than women in midwives' clinic. But why?
LESSLER: He went through and he, you know, started ruling out ideas.
DAVIS: And right away he discovered a big difference in the two clinics. In the midwives' clinic...
LESSLER: Women gave birth laterally, or on their side. In the doctor's clinic women gave birth laying on their backs, so he had the women in the doctor's clinic give birth laying on their side.
DAVIS: And...
LESSLER: No effect.
DAVIS: Then he noticed that whenever someone in the ward died of childbed fever, a priest would walk slowly through the doctor's clinic, past the women's beds and there'd be an attendant ringing a bell. This time Semmelweis theorized...
LESSLER: That priest and the bell-ringing attendant so terrified the women after birth that it sent them over the edge and they developed some fever and, you know, get sick and die.
DAVIS: So Semmelweis had the priest change his route and ditch the bell, and...
LESSLER: It had no effect.
DAVIS: By now, Semmelweis is frustrated. He takes a leave from his hospital duties and travels to Venice. He hopes the break and a good dose of art would clear his head. Professor Jacklin Duffin teaches history of medicine at Queen's University in Kingston, Ontario. She says when Semmelweis got back to the hospital, some sad but important news was waiting for him. A colleague of his, a pathologist, had fallen ill and died.
JACKLIN DUFFIN: This often happened to pathologists. There was nothing new about the way he died. He pricked his finger while doing an autopsy on someone who had died of childbed fever.
DAVIS: And then he got very sick himself and died. Semmelweis studied the pathologist's symptoms and realized the pathologist died from the same thing as the women he autopsied. This was a revelation - childbed fever wasn't something only women in childbirth could get sick from. It was something other people in the hospital could get sick from as well, but this still didn't answer Semmelweis's original question - why were more women dying from childbed fever in the doctor's clinic than in the midwives' clinic? Jacklin Duffin says the death of the pathologist offered him a clue.
DUFFIN: The big difference between the doctor ward and the midwife ward was the fact that the doctors were doing autopsies and the midwives weren't.
LESSLER: So he hypothesized that there were cadaverous particles.
DUFFIN: Little pieces of corpse, basically.
LESSLER: That doctors and medical students were getting on their hands from the cadavers that they dissected, and when they delivered the babies, they would get the particles inside the women who would eventually develop the disease and die.
DAVIS: If Semmelweis's hypothesis was correct, getting rid of those cadaverous particles should cut down on the death rate from childbed fever. So he ordered his medical staff to start cleaning their hands and instruments, not just with soap, but with a chlorine solution. Chlorine, as we know today, is about the best disinfectant there is. Semmelweis didn't know anything about germs. He chose the chlorine because he thought it would be the best way to get rid of any smell left behind by those little bits of corpse.
DUFFIN: When he imposed this rule in his ward the rate of childbed fever fell dramatically.
DAVIS: And you'd think everyone would be thrilled. Semmelweis had solved the problem. But they weren't thrilled. For one thing, doctors were upset because Semmelweis's hypothesis made it look like they were the ones giving childbed fever to the women, and Semmelweis was not very tactful. He publicly berated people who disagreed with him and he made some influential enemies. Eventually, the doctors gave up the chlorine hand-washing and Semmelweis lost his job. Even so, he kept trying to convince doctors in other parts of Europe to wash with chlorine, but no one would listen to him. Over the years Semmelweis got angrier and, eventually, even strange. There's been speculation he developed a mental condition brought on by possibly syphilis or even Alzheimer's. In 1865...
LESSLER: He was only 47 years old.
DAVIS: Ignaz Semmelweis was committed to a mental asylum.
LESSLER: The story goes that he was probably beaten. Regardless, in the end he died of sepsis a little while after being committed.
DAVIS: And sepsis, as it turns out, is basically the same disease Semmelweis fought so hard to prevent in all those women who died from childbed fever. Rebecca Davis, NPR News.
MONTAGNE: And now, hearing all that, let's remember that flu season is upon us. Proper hand-washing is more important than ever. So a good time to remember the basics - just use regular soap - just regular old soap and water, warm or cold water, suds up, don't forget the back of your hands, in between fingers and under the nails. Scrub for 20 seconds and voila. You're set. Transcript provided by NPR, Copyright NPR.
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