5 December 2020 02:07 AM

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SHOMA A.CHATTERJI | 21 APRIL, 2020

The History and Mystery of Hand Washing

Semmelweis's hypothesis


The first principle of prevention of and protection against a Corona Virus infection after the wearing of masks is the repeated washing of hands. If you do not wash your hands before and after eating, while preparing and serving food even in normal times, you are likely to cause infection as bodily fluids need to be washed away often to keep infection and sickness at bay and also for personal hygiene.

You wash your hands before touching or picking a baby. You wash your hands after coming home. It is so organic and natural that you are not even aware of it.

But the talented young scientist who discovered the link between infection and unwashed hands had to die at the young age of 47 in a mental home in Budapest. His body was filled with gangrene resulting from physical torture by the mental home staff, his mind a wreck from persistent depression resulting from humiliation, insults, torture and the collective refusal of medical scientists to accept his theory. He was dismissed from the hospital for political reasons and harassed by the medical community in Vienna, was eventually forced to move to Budapest where a worse fate awaited him and his findings.

The real-life story of Semmelweis reminds one of the protagonist in Norwegian playwright Henrik Ibsen’s The Enemy of the People (1882) that tells the story of a man who dares to speak an unpalatable truth, and is punished for it. Semmelweis was a Hungarian doctor who first invented the theory that it was necessary to wash hands before treating a patient after having done a post mortem. In those days, around 1846, doctors freely moved in hospitals between the morgue and the delivery room. Washing of hands was totally unknown at the time. Neither did they wear gloves or protective face masks. Semmelweis is known as one of the earliest pioneers of antiseptic procedures. Joseph Lister, noted British surgeon and pioneer in antiseptic surgery, acting on Louis Pasteur’s research, practised and operated using hygienic methods, with great success.

Semmelweis is today referred to as an early pioneer of antiseptic procedures. He is defined as the “saviour of mothers.” He had found that between two gynaecological wards with expectant mothers at the Vienna General Hospital’s First Obstetrical Clinic where he worked as assistant to the head professor, that there was a discrepancy in the mortality rate of new mothers between two wards.

One ward was taken care of by junior doctors while the other one was looked after by trained nurses. Interestingly, deaths of new mothers from puerperal fever or childbed fever was much higher in the ward supervised by junior doctors than in the ward managed by matrons and trained nurses.

His research led him to discover that the junior doctors attended to the new mothers in the ward reporting directly after a post mortem without washing their hands. He even proved that the mortality rate in the affected ward could be cut down to zero if the doctors washed their hands with chlorinated lime solutions before attending to the new mothers.

He found that this chlorinated solution worked best to remove the putrid smell of infected autopsy tissue, and thus perhaps destroyed the causal "poisonous" or contaminating "cadaveric" agent hypothetically being transmitted by this material.

Semmelweis insisted that if doctors attended to a patient after having dissected a dead body without having washed their hands, this could easily transfer cadaverous particles the doctor may have caught from the carcass and would therefore be prone to transfer the same to the patient in the maternity ward. The nurses and matrons were not involved in autopsies so the incidence of death of puerperal fever was much lesser than in the other ward.

The idea hit him strongly when his friend and colleague Jakob Kolletschka died of what turned up on his post mortem, of symptoms similar to puerperal fever. He also learnt that while Jakob was conducting a post mortem on a new mother who had died of puerperal fever, he was accidentally poked with a student’s scalpel. Semmelweis immediately proposed the link between cadaveric contamination and puerperal fever.

The mortality rate in April 1847 was 18.3%. in the ward supervised by the junior doctors. After washing of hands was instituted in mid-May, the rates in June were 2.2%, July 1.2%, August 1.9% and, for the first time since the introduction of anatomical orientation, the death rate was zero in two months in the year following this discovery. Yet, his seniors and colleagues not only turned a deaf ear to his appeals, but also felt he was going crazy.

Puerperal Fever was quite common in the mid-19th century in maternity hospitals and it could also be fatal. He urged his juniors to follow the practice and some of them agreed soon cutting down on the mortality rate in their ward. But his seniors not only disagreed but treated his observation like a joke, went on to insult him and even threw him out of the hospital. He published his findings in Etiology, Concept and Prophylaxis of Childbed Fever. But no one paid attention and the story goes that at one point, even his wife went against him.

Semmelweis's hypothesis, that all that mattered was cleanliness, was extreme at the time, and was largely ignored, rejected, or ridiculed. His observations were in conflict with the established scientific and medical opinions of the time. Semmelweis died on 13th August 1865. A year after his tragic death, it was left to Louis Pasteur’s “germ theory” that went on to prove through research and experiment that Ignaz Philipp Semmelweis was right.

He is today considered a pioneer in introducing hand disinfection standards in gynaecological and obstetrical clinics in 1847. Today, a university for medicine and health-related disciplines (located in Budapest, in Hungary) is named after Semmelweis. At least seven short films have been made on Semmelweis. Looking back on his life and his discovery, it would not be wrong to state that he perhaps deserved the Nobel Prize but he is just one among those who deserved it but did not get it

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