Fun Fact: Handwashing Was Not Accepted in Hospitals Until the Late 19th Century

In 19th century Europe, puerperal fever, also known as childbed fever, was a significant clinical health problem that resulted in high rates of maternal mortality. Physicians at the time hypothesized the causes were miasma (ie, unpleasant air), epidemicity, or God’s divine providence.

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Hungarian obstetrician Ignaz Semmelweis was perplexed by the high occurrence of puerperal fever among new mothers. After graduating from Vienna Medical School in 1844, he went on to specialize in obstetrics and work at Vienna General Hospital. He began to care for women suffering from puerperal fever and, upon their death, would conduct autopsies to understand more about the cause of the illness.

At the hospital where Semmelweis worked, there were 2 maternity clinics: one in which the deliveries were conducted by physicians and medical students (who were solely men at the time), and one where deliveries were conducted by midwives (who were only women). What Semmelweis found odd was that the rate of maternal mortality was significantly higher in the first clinic (16%) than the second (7%). Semmelweis investigated this discrepancy in hopes it would help to clarify the underlying cause.

In the first clinic, physicians and medical students would start their day by doing autopsies on the women who had died the night before. Because surgical gloves were not invented yet, this meant they handled the cadavers with their bare hands. Following these morning activities, they would deliver newborns without washing their hands. Semmelweis wondered whether there was a correlation.

The doctor thought a potential method of reducing transmission of the so-called death particles could be through handwashing, so he implemented a handwashing policy. Before staff could enter the labor room, Semmelweis required them to brush under their fingernails and wash their hands in chlorinated water until their skin was dry and the smell of cadavers was no longer present. After a year of this practice, the maternal mortality rate in the first clinic dropped from 16% to 2.4%.

For much of the rest of his career, he committed himself to studying puerperal fever, ultimately culminating in the publication of his book, The Etiology, Concept, and Prophylaxis of Childbed Fever in 1861. However, the release of his book did not garner him praise or positive feelings from the medical community. Criticized for its poor language and unprofessional writing style, Semmelweis’ book was not well received, and he began to suffer bouts of depression, rage, paranoia, and forgetfulness. Due to the crippling nature of his mental state, he was institutionalized to treat his mental health and died in 1865.

Following the publication of Louis Pasteur’s germ theory of disease and Joseph Lister’s concept of antisepsis approximately 20 years later, Semmelweis’ work and ideas experienced a resurgence with a greater receptivity than he had experienced in his lifetime. He was hailed as the father of hand hygiene, the father of infection control, and the savior of mothers by the medical community and the public alike, and his efforts live on in the washed hands of innumerable medical professionals, likely preventing the deaths of millions.

REFERENCE

Tyagi U, Barwal KC. Ignac Semmelweis—father of hand hygiene. Indian J Surg. 2020;82(3):276–277. doi:10.1007/s12262-020-02386-6