Frontiers for Young Minds takes you down on a dive into the depths of the historical scientific archives and introduces you to scientists you may have not heard about, but you should! This time, we tell you the story of the invaluable contribution of Ignaz Semmelweis to the field of antiseptic policy by his discovery in infectious disease prevention – or, why you among others should wash your hands.
The Covid pandemic has reminded us more than ever of the importance of washing our hands to stop spreading infections, but the idea that germs cause disease was widely ignored before the second half of the 19th century.
Decades before the champions of the germ theory formalized the relationship between germs and diseases, an unappreciated Hungarian physician, Ignaz Semmelweis, showed the importance of correct hand hygiene in medical practice, using the example of the deadly puerperal fever after childbirth.
A man with a mission
Ignaz Semmelweis was born in a wealthy family of Budapest in 1818, the fifth of 10 children. He moved to Vienna to study law but soon realized he was more interested in the study of the human body. In 1844 he received his medical degree and started working in an obstetric clinic in Vienna.
At the time, giving birth could be a dangerous experience and the infamous puerperal fever accounted for the death of 20-25% of all women giving birth. Where outbreaks happened, they were documented by the local physicians, but considered unpreventable, and women were likely to die if they contracted it.
Now we know that puerperal fever is caused by bacterial infection, mainly Streptococci, but at the time the physicians ignored the concept of germs, despite the insights of medical men such as Alexander Gordon, who identified in 1795 that puerperal fever could be transmitted from woman to woman by the birth attendant, or indeed to the birth attendant if they had a wound.
Semmelweis was skeptical of the prevailing theories and wanted to figure out why outbreaks happened, to properly understand the transmission of this dreadful disease.
Crunching the numbers
Semmelweis started his investigation by comparing the mortality rates due to puerperal fever in the two obstetric divisions of the hospital. He noticed that the first division, where women were visited by physicians and medical students, had a much higher death rate than the second division, which was run by midwives.
Semmelweis went through all the differences between the clinics, including religious practice! But nothing seemed to explain the huge difference in the numbers.
A sad, but inspirational event
In 1847, Semmelweis’ friend and fellow doctor Jakob Kolletschka was pocked with a scalpel during an autopsy of a woman who died of puerperal fever. Few days later he died, victim of the same horrible symptoms.
Semmelweis immediately saw the missing piece of the puzzle he was looking for.
Physicians and medical students that worked in the first obstetric division often visited women and delivered babies after having performed autopsies (in fact, treatises of the time encouraged surgeons acting as midwives to be involved in autopsies, to get familiar with the pathology of fever deaths), while the midwives in the second division were not qualified to perform autopsies and had no contact with corpses.
A simple solution
If the cause of the puerperal fever was some sort of “cadaverous particles” carried by the doctors from the corpse, the solution was to get rid of them before visiting patients.
Semmelweis experimented with different cleaning agents and concluded chloride solution could do the trick, as it worked well to eliminate the smell of the dead body from the hands.
He initiated a mandatory hand wash policy for physicians and medical students after they engaged with corpses and the mortality rate in the first obstetric division finally fell down to the same level as in the midwives’ division. And the number went even lower when they started using the chlorine solution to clean the medical instruments.
Defeated by the establishment
Despite the endorsement of Semmelweis’ theory by the reduction of the women’s death rate, the senior staff of the hospital did not accept his conclusions and got offended that he suggested they were the cause of puerperal fever.
In his attempt to convince his colleagues of the legitimacy of his practice, Semmelweis got very angry and made some influential enemies. He was forced to leave Vienna and went back to Hungary.
Appointed head of obstetrics at St Rochus Hospital in Budapest, he enforced his hand-washing protocol and once again he succeeded in reduced women’s mortality.
In 1861 he published his findings in a book that was not well received and was largely ignored by the scientific community. Semmelweis’ attitude towards his colleagues probably contributed to his downfall. His contemporaries described him as arrogant and bitter, prone to publicly humiliate his opponents. He also wrote open and angry letters to high-ranking European physicians, accusing them of being careless murderers. People around him began to feel he was going mad, and in 1865, he was committed to a mental asylum, where he died shortly after at the age of 47.
Despite his breakthrough discovery in the field of infectious disease prevention, Semmelweis’ results lacked scientific explanation, and his contribution was not given credit until more famous scientists, Pasteur, Koch, and Lister, provided more evidence for the germ theory of disease, and the value of hand washing became more clear.
Today, the unfortunate Ignaz Semmelweis is recognized as a pioneer of antiseptic policy. To honor his legacy, the medical school where he taught in Budapest is now named after him, and Austria issued a postage stamp for 100th anniversary of his death by issuing a postage stamp. He even got his own Google Doodle!
Let’s all do our part in keeping Semmelweis’ memory and teachings alive, by washing our hands!
Want to know more about hospital-acquired infections? Read this Frontiers for Young Minds article on preventing bacteria from forming biofilms.