We Shouldn't Forget Ignaz Semmelweis

Hi! 

Yesterday, I sent you a story about why doctors typically wear blue (or green) scrubs in the operating room. In it, I mention handwashing, and how consumers (if that's the right word) for cleanliness among health professionals ushered in the expectation that doctors, etc. wash their hands before performing operations. That's true, but it's incomplete. A lot of you wrote in to tell me about Ignaz Semmelweis.

I've never written about Semmelweis before for the simple reason that I never got around to it, and normally, I'd not share his story in a Weekender -- he definitely warrants a regular Now I Know. But enough of you mentioned him that I think now's the time. 

Semmelweis was a physician in Vienna in the 1840s. At the time, something called puerperal fever or "childbed fever" was killing newborn babies at an alarming rate. Semmelweis investigated the matter and found some interesting data. There were two maternity clinics at his hospital, but one of the clinics had roughly twice the infant mortality rate as the other. Semmelweis looked for a cause -- was there something about the clinics that were different and could cause such a discrepancy? And he came up with a very strange one: the staff. At the clinic with the higher mortality rate, medical students (and sometimes, doctors) were delivering the babies. At the one with the lower mortality rate, midwives were doing the deliveries. 

That was strange, so Semmelweis investigated further. He noticed that most midwives had the mothers lie on their sides when giving birth but the med students and doctors weren't, so he suggested that they do that -- but, per NPR, the results didn't improve. Beyond that, there were no other obvious differences. He was about to give up when a friend of his -- an adult -- died with similar symptoms as the babies with puerperal fever. And in this case, Semmelweis knew how his friend had gotten sick: as NPR notes, his friend "pricked his finger while doing an autopsy on someone who had died from childbed fever." 

Semmelweis postulated that if doctors could get the disease from the bodies they were autopsying, the same doctors could transmit the disease back to the babies they were delivering. He wasn't quite thinking about modern germ theory, but he was close enough -- as NPR summarizes, "Semmelweis hypothesized that there were cadaverous particles, little pieces of corpse, that students were getting on their hands from the cadavers they dissected. And when they delivered the babies, these particles would get inside the women who would develop the disease and die." And even if you don't understand germ theory, it's not hard to come up with an easy solution to get rid of "little pieces of corpse" (gross): you should wash your hands.

So Semmelweis suggested exactly that. In 1846, he started telling doctors to wash up, using a chlorine solution that was a common disinfectant at the time. And it worked! Infant mortality fell significantly in his hospital.

But the victory was short-lived. Many of the doctors in Semmelweis's hospital didn't want to wash their hands, and didn't take kindly to the accusation that they were not only dirty people but also, somehow killing their patients. Semmelweis, by most reports, was less-than-diplomatic with the anti-washers and made more friends than enemies. He was ultimately fired from his job and, without him to enforce handwashing rules, the practice waned and infant mortality rates started to climb again. Worse, because Semmelweis wasn't able to make handwashing stick at his own hospital, he was unable to get other hospitals on board with a handwashing program. A great discovery in public health failed to take root, and wouldn't for about another century.

As for Semmelweis himself, the rest of his life was both tragic and short. He wrote a book to try to get adoption of his handwashing idea, but it wasn't well-received and he lashed out publicly against his critics. His mental health decayed rapidly and he went into a downward spiral; by his early 40s, his doctor committed him to an asylum. When he tried to leave the asylum, the guards roughed him up a good deal, likely giving him an infection in the process. He died two weeks later on August 13, 1865, at age 47. 

The Now I Know Week in Review

Monday: The Walls (and Book) That Can Kill You. Congrats to the two people who caught (and told me they caught) the Harry Potter reference. 

Tuesday: Foul Tip. The world's best and worst baseball card.

Wednesday: The $64,000 Fake New York City Tourist. Except for the getting beaten up part, I really want to try this.

Thursday: Why Doctors Wear Green (or Blue) Scrubs. See above. 

And some other things you should check out: