The First Clean Hands

When Dr. Ignaz Semmelweis, a 19th century medical doctor, published his research on the cause of high death rates in the maternity ward of a Vienna hospital it was rejected by his peers.

For decades the most knowledgeable men of medicine had held the belief that disease, when it broke out beyond normal boundaries into epidemic and pandemic proportions, was airborne.

Their belief seemed well-founded. Sewage disposal wasn’t even a dream of the future and garbage dumps were anywhere in a village or growing city. Anywhere close at hand – including residential streets.

In the mid-1800s in Victoria, BC – now a city of gardens and scenic beauties – septic tanks drained body waste away from stately homes and into open ditches where it hopefully seeped away; and the main garbage dump was in the now picturesque Inner Harbour where the stately Empress Hotel stands today.

The combined odours were so evilly toxic that nearby church services were sometimes abbreviated or cancelled.

Vienna – and anywhere else in the world where populations were growing faster than people could handle change – the belief was firm in the minds of the men of medicine that any air that smelled so bad must be the cause of annual waves of infection that swept away thousands. 

So, when Dr. Semmelweis announced his findings that the 13 to 18 per cent death rate among new mothers and their newborn babies was caused by physicians who, having recently performed post-mortems on infected cadavers, had carried the deadly germs to mother and child, he was ridiculed, not believed.

His proposed solution that starting immediately all doctors wash their hands and scrub them clean before going near a mother and newborn baby were thought to be a scare tactic and ridiculous.

So, the good doctors of central Europe didn’t listen. Not for a while anyway. It was some months after his first warnings and appeals for cleanliness that it was grudgingly noted the maternal mortality rate had dropped to one or two per cent from an 18 per cent high. Grudgingly, the medical fraternity was at least, and at last, paying attention.

Unfortunately, Semmelweis was dead before he could savour his triumph. He was beset with ill health in his final years, some say created by critical pressure when he first advanced his findings. Others say it was public pressure with a touch of racism because of his Jewish lineage that brought on a mental breakdown that resulted in him being declared insane and confined to an asylum in 1865 and where he died at 47.

Years later, after his theories about the spread of germs and the use of antiseptics were implemented as required health care practice, he was revered in the world of medicine.

Last week, I brought readers part of the story of Dr. John Snow – another maternity specialist of basically the same era as Dr. Semmelweis – who experienced a similar rejection of his findings that a killer cholera plague in London could be traced to a single source – “the Broad Street pump” in Soho.

He, too, was derided and attacked from the pulpit by the Reverend Henry Whitehead who challenged Snow’s claim that the Broad Street pump was the sole source of the cholera scourge. “Not so,” shouted Whitehead, “the outbreak was caused not by tainted water, but by God’s intervention.”

To his credit, he did admit later that maybe Snow got it right on cholera as did Semmelweis on the mystery of “childbed fever” half a world away.

Both deserve their posthumous honours and deserved remembrance.And thank you to readers who jogged my memory on Dr.Semmelweis

4 comments

  1. Dear Jim,

    In 2019 I was in Budapest and visited the Semmelweis museum. Thanks for retelling this story. This is what I wrote in a Blog at that time.

    Ignaz Semmelweis

    Ignaz Philipp Semmelweis was born into a Catholic German family in Hungary in July 1st 1818. There is an excellent museum in Budapest called HNM Semmelweis Museum, Library and Archives of the History of Medicine. It was walking distance from my hotel.

    Semmelweis is considered to be one of the first physicians to have identified that puerperal fever and mortality (women dying of septicemia after childbirth) was due to an infectious agent and that it could be prevented by hygienic measures. He carried out a case control study observing that women whose babies were delivered by a doctor after he had carried out an autopsy (with no hand washing etc) had a much higher mortality rate than those delivered by midwives who were not involved in carrying out autopsies and therefore exposed to possible infectious agents. This was in 1847.

    His findings were not published in a journal until 1861. He stated that he had used “chlorina liquida” in May 1847 but then he used the less expensive “chlorinated lime”. This resulted in of the 1,841 maternity patients cared for only 56 died (3.04 per cent).

    Semmelweis’s views were criticized by such names as Virchow (1821-1902). It was not until the experiments and demonstrations of Louis Pasteur (1822-1896) and the postulates developed by Robert Koch (1843-1910) was medical thinking able to formulate a theoretical concept of the pathogens and infections agents that could be responsible for causing diseases. Joseph Lister (1827-1912) from Scotland introduced carbolic acid solutions for irrigating wounds in August 1865.

    By this time Semmelweis was dying in Vienna either of sepsis or perhaps from tertiary syphilis. Lister said at a Congress in Budapest in 1894 “Without Semmelweis my work would be in vain. New surgery owes most to the great son of Hungary”

    The museum to-day has some marvelous old instruments and apparatus on display. I am glad I found it!

  2. I will add the name of another medical pioneer in this struggle, Oliver Wendell Holmes, Sr., an American.

    In 1843 he, too, advocated handwashing to prevent childbed fever; his ideas were also greeted with disdain by many physicians. One of them said, “Doctors are gentlemen, and gentlemen’s hands are clean.”

    And in case you’re wondering, Oliver Wendell Holmes, Sr. was the father of the U.S. Supreme Court Judge of the same name. The father was the author of The Autocrat of the Breakfast Table.

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