handwashing prevents death--11/13/24

13 Nov 2024

handwashing prevents death--11/13/24

0 COMMENTS

Today's selection--from To Boldly Go Where No Book Has Gone Before by Luke O'Neill. Ignaz Semmelweis uncovers the role of microbes in infection:

“In the 1840s, a Hungarian doctor, Ignaz Semmelweis, described the importance of handwashing and the sterilization of surgical instruments. Semmelweis worked in obstetrics at the Vienna General Hospital, in a maternity unit that had been set up to address the issue of infanticide — a common practice among underprivileged mothers at that time, mainly because of poverty. The unit took in pregnant women for free, in return for the women being subjects for the training of doctors and midwives. There were two maternity clinics in the hospital, and Semmelweis noticed that in the first clinic there was a maternal mortality rate of 7–15 per cent due to something called puerperal fever, while in the second clinic it was less than 2-7 per cent. This was well known outside the hospital and Semmelweis wrote about desperate women on their knees begging to be allowed into the second clinic. Some of the women gave birth in the streets and were then admitted to the hospital, and he noticed that puerperal fever was rare in these so-called street births.

“Semmelweis became deeply troubled by the death rate in the first clinic, saying: 'It made me so miserable that life seemed worthless.' He began examining for differences between the clinics and realized that the only major difference was the people who worked in the clinics. The first clinic was used to instruct medical students while the second was for midwives. This is good science, because it involves careful observation that gives rise to an hypothesis.

Semmelweis, aged 42 in 1860, photograph by Borsos and Doctor

“In 1847, he figured out what was going on. A friend of his, Jakob Kolletschka, had been accidentally poked with a student's scalpel during an autopsy and died. Semmelweis noticed that Kolletschka had died of puerperal fever, just like the women in the first clinic. He realized that the cause of death was contamination from cadavers — the medical students often carried out dissections and would then work in the first clinic. Semmelweis proposed that the medical students carried 'cadaverous particles' on their hands from their dissections, and so he started a policy of handwashing with chlorinated lime. He chose this because it was best at removing the putrid smell from infected bodies during autopsies. The results were remarkable. A drop of 99 per cent in mortality. He was called the 'saviour of mothers'.

“Despite the results, it took time for doctors to accept his instructions. One reason was he couldn't explain why handwashing worked. Many still believed that disease was caused by an imbalance in the four humours and some doctors were annoyed at being accused of having dirty hands when they appeared to be clean.

“Semmelweis was critical of these colleagues. He caused such a stir that he was forced to leave Vienna and went to work in Budapest. In 1861 he developed severe depression. He reportedly turned every conversation to the topic of puerperal fever. Criticism of his findings continued, and at one point he wrote a letter to 'all obstetricians' in Europe, criticizing them all. He began drinking heavily and was admitted to an asylum because of his increasingly erratic behaviour, which may have been caused by early onset Alzheimer's disease or even syphilis, which obstetricians sometimes caught from the fluids they picked up from patients. He was beaten by the guards when he tried to escape and died of his wounds — which, ironically, had become infected. He was 47.

“The term 'Semmelweis reflex' describes a reflex-like rejection of new knowledge because it contradicts entrenched norms or beliefs. Eminent doctors at the time said: 'Doctors are Gentlemen, and Gentlemen's hands are clean.' Sir Frederick Treves, who was famous for his friendship with Joseph Merrick (also known as the Elephant Man) said: 'There was no object in being clean ... Indeed, cleanliness was out of place. It was considered to be finicking and affected. An executioner might as well manicure his nails before chopping off a head.' We saw something similar during the COVID-19 pandemic, when it took a while for it to be accepted that it was an airborne disease rather than one that was mainly caught from droplets on contaminated surfaces.

“The work of Semmelweis is a great example of how systematic scientific observation can be used to find a solution to a problem. What Semmelweis had uncovered was the role of microbes in infection.”