Clean Hands, Clean Conscience

“When I look back upon the past, I can only dispel the sadness which falls upon me by gazing into that happy future when the infection will be banished.”

You are lying in a maternity ward bed in the throes of labor. Your doctor walks in. Blood is smeared on his smock. His hands? Filthy. 

“Where have you been?” you moan.

His reply: “Performing an autopsy.”

That might have been a typical conversation between a pregnant woman and her doctor at the Vienna General Hospital’s First Obstetrical Clinic in 1847.

Doctors in those times did not routinely wash their hands. It took too much time. Sinks and faucets were not in every room. Everyone knew disease spread via mysterious miasmas (“ill winds” in the air) or by a person’s “humoural imbalances.”

What’s more, doctors thought of themselves as sacred figures imbued with special healing powers. It would be inconceivable if they were causing illness, not curing it. How preposterous. To suggest otherwise—particularly for a doctor to do so—would have been an unspeakable insult.

That’s exactly what Dr. Ignaz Semmelweis did. He isolated the cause of hospital infection, and he confronted his peers, often insulting them so severely that most refused to listen to him.

Semmelweis was the chief resident in his hospital's obstetrics department. Obstetrics was then regarded as a lesser medical specialty. Most doctors aspired to be surgeons. It’s possible that because Semmelweis was Hungarian and Jewish, prejudice blocked his entry into that field.

Begged on their knees

His hospital had two maternity wards. Midwives ran one and doctors the other. Semmelweis noticed the mortality rate among mothers in his clinic was 10 percent and less than four percent in the midwives’ ward.

Viennese women knew which ward was safer, too. Admittance to each clinic was random, as they each admitted new patients on alternating days. Semmelweis knew of instances when women had begged on their knees on the street to be admitted to the safer clinic. He also knew  death rates were lower among women who gave birth at home than in his own ward.

            “What protected those who delivered outside the clinic from these destructive unknown endemic influences?” he asked himself.

Death following childbirth was ugly. Known then as puerperal fever, today it is called sepsis, a bacterial blood infection. Death was typically accompanied by a high fever, pus, and abscesses and occurred within 24 hours of birth.

            Semmelweis rigourously examined each clinic to try to figure out what could be causing the different death rates.

            He ruled out many things. He determined that religious beliefs had nothing to do with the death rate. In his doctor-run clinic, women gave birth lying on their backs; in the midwives’ clinic, they did so lying on their sides. Perhaps that was the reason. Semmelweis had women in his clinic delivery babies on their sides. The death rate remained unaffected.

            When a new mother died in the doctors’ clinic, a priest walked through the ward ringing a bell. Maybe it so frightened the women, the tolling of the bell killed them. He told the priest not to ring a bell and to walk elsewhere. This made no difference either.

            After returning from a vacation, he learned that his colleague Dr. Jakob Kolletschka had died after autopsying a woman who had died of the fever. During the procedure, he cut his finger.

            Semmelweis rightly concluded that doctors were unwittingly transporting germs or what he called “cadaverous particles” to patients. A "morbid poison" he called it.

            He immediately ordered all doctors to wash their hands in a chlorinated lime solution. Today we would call it a dis-infectant, something that stops infections. He also insisted that all medical instruments be washed in the solution, too.       
          The result? The death rate fell to two percent in two months. 

            Peers urged Semmelweis to publish his findings. For unknown reasons, he declined to do so, and a friendly colleague published a paper summarizing his findings. It ultimately took Semmelweiss 13 years to publish the results of his research.

            As insightful and courageous as he was, he was also equally lacking in insight about human relations. He bull-headed insistence on improved hygiene insulted other physicians. Worse, he offended the head of his hospital. As a result, Semmelweis was passed over for promotion. 

A medical Nero

            An angry Semmelweis returned to his native Budapest where he became head of obstetrics at a hospital there. History repeated itself, and he harangued its doctors and nurses, too.

            To one colleague he said, you have been “a partner in this massacre.” A second doctor got this tongue-lashing: "Should you…without having disproved my doctrine, continue to train your pupils [in ways contradicting my principles], I declare before God and the world that you are a murderer and the ‘History of Childbed Fever’ would not be unjust to you if it memorialized you as a medical Nero.”

             By 1861 Semmelweis had started behaving even more strangely. He drowned himself in liquor and consorted with prostitutes, further degrading his professional reputation.

            His family and medical associates tricked him into visiting an asylum under the guise of learning more about its new approaches. After arriving, however, he realized the danger he was in and tried to escape. He was forced into a straitjacked and tossed into a dark cell. He may also have been beaten by cruel guards.

            Fourteen days later he died at the age of 47. The cause? Gangrene, possibly due to the assault he suffered. He died of sepsis, the disease he worked to prevent.

            “When I look back upon the past, I can only dispel the sadness which falls upon me by gazing into that happy future when the infection will be banished," he once said, "The conviction that such a time must inevitably sooner or later arrive will cheer my dying hour.”

            Today Semmelweis is renowned by doctors around the globe as "the father of infection control" and "the savior of mothers."

            The same year that Semmelweis died, Scottish surgeon Joseph Lister conducted his first experiments regarding antiseptic surgery. He ordered surgeons who reported to him to glove their hands and wash them in a disinfecting solution before and after surgery. “Without Semmelweis, my achievements would be nothing," Lister once said.

            The truth is both men were latecomers to germ theory. As early the 16th century B.C., the ancient Israelites knew, as it is written in the Book of Numbers, that "He that toucheth the dead body of any man shall be unclean seven days….Whosoever toucheth the dead body of any man that is dead, and purifieth not himself, defileth the tabernacle of the Lord."

MORAL: Don't defile yourself.

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