Image: Elke R. Steiner

Your hands contain millions of microbes, most of which are harmless, but some can easily provoke colds, flu, diarrhea and, most recently, COVID-19.

Especially during these times of pandemic, doctors are careful to remind us at all times that we should wash our hands regularly. However, can you imagine a world where doctors themselves don’t wash their hands? In Hospitals?

Only 150 years ago, this was the norm or, more accurately, there was no norm at all as far as handwashing is concerned.

A doctor who fiddled with the intestines of some unfortunate patient might deliver a baby only an hour later, washing his hand in between as he pleased. That is, if the previous operation left his hands a bit too dirty.

During those times the only problem with dirty hands was the smell — it literally annoyed the doctors. If it didn’t stink, it was safe to sink or so the old saying goes (Ok, I just made that up).

It wasn’t until 1846, a couple of years before Louis Pasteur showed there was a direct connection between germs and diseases, that the benefits of hand-washing were explored and plainly proven. Sadly this only lasted briefly until an iconic physician came along.

This is the inspirational, yet unfortunate story of Ignaz Semmelweis, a Hungarian doctor who saved countless lives by being the first to introduce mandatory hand washing for physicians.

Medicine, just coming out of the dark ages

Image: National Library of Medicine

The mid 19th century were still troubled times for medicine, although the field had evolved past borderline witchcraft. Evidence-based medicine, the kind that’s assisted by the scientific method was slowly but surely becoming the way to go in the western world thanks to consistent results. For one, autopsies became very common — something that would prove very important for a number of reasons, as we shall learn — and the importance of keeping records was suddenly evident to everyone. Dr. Semmelweis was no exception.

At the time, he was employed in the maternity clinic at the General Hospital in Vienna. There, Semmelweis wrapped his head around a most peculiar occurrence. A lot of women were dying of puerperal fever or childbed fever, but this itself was nothing out of the ordinary. What was strange was that women in the clinic staffed by doctors and medical students died at a rate nearly five times higher than women in the midwives’ clinic.

When faced with such a dilemma, the most obvious thing to do is determine the differences between the two outcomes to eventually find a cause-effect mechanism. So, the good doctor took it one step at a time. Was this a matter of gender? This prove to make no difference. Then, he noticed in the midwives’ clinic, women gave birth on their sides, while in the doctors’ clinic, women gave birth on their backs. He immediately ordered all women deliver babies on their backs, yet to no effect.

Later, Semmelweis noticed that whenever someone on the ward died of childbed fever, a priest would walk slowly through the doctors’ clinic, past the women’s beds with an attendant ringing a bell. He came up with the idea that the annoying bell ringing was traumatizing the women giving birth to such an extent that it caused a reaction eventually causing them to die. So Semmelweis had the priest change his route and ditch the bell. This, too, had no effect.

Cadaverous particles

After a myriad of failed attempts, Semmelweis grew weary and was just about to give up. He decided to go on vacation to Venice to freshen up and maybe find some much needed inspiration.

On his return, he was greeted by the sad news that one of his colleagues, a pathologist, had fallen ill and died. After investigating, he found the pathologist had died of the same illness as the women had — childbed fever.

The fact that men could get the disease too was revolutionary for Semmelweis. The doctor soon understood that because the pathologist had performed autopsies on diseased women, he must have gotten ill because of the close contact.

Semmelweis hypothesized that there were “cadaverous particles”, small 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. Remember, people knew very little about microbes back then, let alone their connection with diseases.

Doctor Semmelweis . Image: De Agostini Picture Library.

So, to get rid of those pesky “cadaverous particles”, Semmelweis ordered the doctors and students to wash their hands before delivering each baby — not with soap, but chlorine.

Aha! Semmelweis had come through and understood the whole cause and effect chain — not so fast!

He just thought chlorine was better because it covered the putrid stench left over the doctors’ hands after each autopsy better. It’s pretty funny when you think about it, but it did the job – chlorine may actually be the best disinfectant there is.

Not knowing chlorine is a disinfectant does little to affect its properties. It goes without saying that the rate of childbed fever fell dramatically. A fantastic example of a wrong assumption rendering the desired outcome — a naive illusion for the greater good.

Not everybody was happy though. Doctors’ reputation was affected because they were made to look sloppy and Semmelweis himself didn’t help that much by constantly fueling the flame, feverishly commenting against his detractors.

He was fired and humiliated. Worst of all, doctors gave up the chlorine hand-washing. Eventually, Semmelweis went mad by all accounts and in 1865, when he was only 47 years old, he was committed to a mental asylum.

Eventually, he ironically died of sepsis – an infection in the bloodstream very similar to childbed fever.

Semmelweis’ doctrine was subsequently accepted by medical science after patients began dying in droves again in the absence of rigorous hand washing. His influence on the development of knowledge and control of infection was hailed by Joseph Lister, the father of modern antisepsis: “I think with the greatest admiration of him and his achievement and it fills me with joy that at last he is given the respect due to him.”

How to wash your hands properly

In honor of Semmelweis, here’s a guide on how to properly wash your hands:

• Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
• Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.
• Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
• Rinse your hands well under clean, running water.
• Dry your hands using a clean towel or air dry them.

It’s worth mentioning that antibacterial soap has been found to pose no added benefit over regular soap. In fact, using antibacterial soap does more harm than good because it builds tolerance to the common ingredient triclosan, thus hampering treatment when you actually need it.