The "Madman" Who Advocated Hand-washing

Ignaz Semmelweis is not a household name. But the Hungarian doctor may be one of the history’s greatest and most consequential medical pioneers. As the man who proposed the now-universally accepted importance of handwashing for healthy, now is as good a time as any to commemorate him.

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Especially since he died broken and ostracized in an insane asylum for daring to devise what we now take for granted. An unfitting fate for a man called the “savior of mothers”.

Semmelweis was a man of his time. The 19th century was the “golden age of the physician scientist”, when doctors were expected to have scientific training and perspective. Gone were the days when illness was an imbalance of “humors” or caused by “bad air” or divine will. Autopsies, once taboo, were more common. Anatomy was taking off, as we began to connect ailments with actual physical causes in the body. Doctors—like the young Dr. Semmelweis—were driven to collect data, crunch numbers, and find evidence to inform their practice.

When he began his new job in the maternity clinic at the General Hospital in Vienna (then the capital of the Austro-Hungarian Empire) he immediately started gathering data on something that troubled him: Why so many women in maternity wards were dying from “puerperal fever”, commonly known as childbed fever, a horrible and painful illness.

Dr. Semmelweis wasted no time. He studied two maternity wards in the hospital—one staffed by all male doctors and medical students, the other by female midwives—and counted the number of deaths on each ward.

After crunching the numbers, he discovered that the clinic staffed by male doctors and medical students had a death rate nearly five times higher than the midwives’ clinic.

Semmelweis was appalled. It “made me so miserable that life seemed worthless”, he remarked. The reputation of the first clinic was so bad that women literally begged not to go there, with some reportedly preferring to give birth on the streets. He had to get to the bottom of it.

Semmelweis carefully assessed the data and tried to find empirical evidence. He ruled out various hypotheses—overcrowding, climate, etc.—and discovered one key difference: The male doctors and medical students did autopsies; the midwives did not. The germ theory of disease was not yet widely accepted, so the doctor proposed that it was “cadaverous materials” that were causing the infections.

The solution was simple: He decreed that doctors needed to wash their hands after autopsies, not just with water, but with a chlorine based chemical solution he devised.

The result was dramatic: The mortality rate in the first clinic dropped an astonishing 90 percent. After hand washing was instituted in mid-May of 1847, death rates continued dropping precipitously: 2.2 percent in June, 1.2 percent in July, and—for the first time ever—zero in two months in the year following this discovery.

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Semmelweis wasted no time getting the word out to doctors and hospitals everywhere. Yet despite his evidence, the idea that all that mattered was cleanliness was considered extreme at the time. How could this one factor be the cause? The doctor was largely ignored, rejected, or even ridiculed.

In fact, he was ultimately dismissed from the hospital for political reasons and was so horribly harassed by the medical community in Vienna that he was forced to move to Budapest.

Semmelweis was outraged. He began writing open and increasingly angry letters to prominent European obstetricians, sometimes denouncing them as irresponsible murderers. His colleagues, including his own wife, believed he was losing his mind. In 1865, 1865, nearly twenty years after his breakthrough, he was committed to an insane asylum. Ironically, he died there of septic shock—similar to the infectious deaths he had worked to prevent—just two weeks later, possibly from being severely beaten by guards.

It was ignoble and cruelly ironic end to a man whose findings are now the bedrock of public health and sanitation worldwide. Semmelweis was ridiculed, marginalized, and ultimately forgotten because his observations conflicted with the established scientific and medical opinions of the time; indeed, many doctors took offense at the idea that they should wash their hands — at the cost of their patients’ lives.

It was only two decades after his sad death that Semmelweis’s recommendations gained widespread acceptance: Louis Pasteur’s confirmation of the germ theory of disease, followed by Joseph Lister’s use of hygienic methods during surgery both validated the Hungarian doctor, who lacked the scientific means to explain his findings.

But given his selfless and righteous dedication to the well-being of patients, I like to imagine Semmelweis would be pleased to see his ideas become conventional wisdom. He might also be amused that his name is used for the eponymous “Semmelweis reflex” or “Semmelweis effect”, which describes a tendency for new evidence or knowledge to be viscerally rejected because it contradicts established norms, beliefs, or paradigms.

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