How the grandfather of hand hygiene became an outcast of the medical community

It is a tragic bit of irony that the man known as the grandfather of hand hygiene died as the result of an infection. Dr. Ignaz Semmelweis, a Hungarian physician, passed away at the age of 47 from a wound on his hand that he sustained after being beaten by the guards of an insane asylum. It was 1865 in Vienna, and Dr. Semmelweis had been committed to the asylum by his medical colleagues. They said he suffered a nervous breakdown after he had become increasingly outspoken about what would become one of the most consequential scientific discoveries in history. He was met with ridicule and derision from the medical profession.

Dr. Semmelweis’ career began at the Vienna General Hospital. The hospital had two maternity clinics that admitted mothers on alternating days, but there was a key difference between the two. The “first clinic,” as it was known, had a maternal mortality rate of 10% — one in ten mothers who gave birth there did not survive. The “second clinic” averaged well under 4%. The reputation of the first clinic was so bad that mothers even begged to be admitted to the second, preferring in many cases to give birth in the streets. Even these women who refused admission, Dr. Semmelweis noticed, were less likely to come down with the fever that was so common in the first clinic.

He began to investigate. It couldn’t be overcrowding because the second clinic was regularly more crowded. He ruled out “the climate” because the two clinics were virtually the same. He even entertained the idea that priests giving last rites in the first clinic were frightening women so severely that they were developing the fever.

The most notable difference between the two clinics was the people delivering the care. In the second clinic, it was midwives, but the first was a teaching clinic.

Dr. Semmelweis’ breakthrough came following the death of his good friend, Jakob Kolletschka. He died of a fever after being accidentally cut by a scalpel during a post mortem exam of one of the cadavers — the same ones used to teach the students. His autopsy showed a pathology similar to the women in the first maternity clinic. Dr. Semmelweis had discovered a connection. The women, he proposed were being poisoned by “cadaverous material” and suggested that the students use a solution of chlorinated lime to cleanse their hands after an autopsy. The solution, Dr. Semmelweis noted, worked well to remove the putrid smell of the cadavers.

The results were astounding. Within a month of creating a new hand washing protocol, mortality rates dropped to 2.2% in the first clinic, then 1.2% a month later. By the next year — for the first time since the clinic opened — the mortality rate dropped to zero.

The significance of the discovery was obvious to Dr. Semmelweis but it wasn’t met with the same receptiveness from his colleagues. His publications received mixed and occasionally confused feedback. The clinical understanding of disease in that era — that suggested it arose out of a uniquely personal imbalance of the four humours — simply didn’t align with his claim that it had just one cause: a lack of cleanliness. His findings lacked a scientific framework to prop it up. Germ theory, which could provide such a framework, wouldn’t be developed for another decade and would take years after to gain traction across the European continent.

There was also a cultural dimension to this. Doctors were gentlemen, and the idea that their hands could be unclean was a subtle challenge with their professional identity. Many were offended by the very suggestion that they ought to cleanse their hands.

Understandably, Dr. Semmelweis was frustrated by all of this. For some 20 years he raged against his colleagues. He lashed out at critics going so far as to call them “ignoramuses” and “irresponsible murderers.” He became bitter, despondent. He was referred to the asylum by a fellow doctor and lured there under the pretence that he would be visiting one of the country’s famous new institutes.

It would take years, and the work of his diligent students, before Dr. Semmelweis was recognized for his pioneering contributions to healthcare.

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