Meet the hygiene pioneer who discovered that handwashing saves lives
But the irony of the remarkable doctor’s work is that he died from an infection, after being tricked into entering an insane asylum.
In 1847, Semmelweis was working in a hospital in Vienna, Austria, and overseeing two maternity wards. He noticed that the second clinic had a low rate of infection with a mortality rate of less than 4%, while the first clinic had 17% of patients succumbing to “puerperal fever”, known at the time as “childbed fever”.
It was common in hospitals and was often fatal. The two clinics took admissions on alternate days. With the poor reputation of the first clinic known among expectant mothers, some would give birth on the street rather than give birth in the first clinic. Semmelweis described women on their knees, begging not to be admitted to the first clinic.
“To me, it appeared logical that patients who experienced street births would become ill at least as frequently as those who delivered in the clinic... what protected those who delivered outside the clinic from those destructive unknown endemic influences?”
At the time, it was believed that “miasma”, poisonous gases in the air, were the cause of infection. But Semmelweis noted that the first clinic, where patients were more likely to die, was staffed by doctors and medical students and was next to the post-mortem room where autopsies were carried out.
The second clinic was staffed with midwives who never went into the post-mortem room and did not handle dead bodies. As the two wards were close together, Semmelweis discounted the air could be the cause of infection and believed the differences between the two clinics held the solution to the fatalities.
He also excluded overcrowding because the clinic with fewer fatalities was always far more crowded. He looked at the techniques in each clinic, but they were the same and he started eliminating possible differences, even looking at religious practices. Described as “severely troubled” by the difference in mortality rates, Semmelweis said “it made me so miserable that life seemed worthless”.
Then in 1847 a breakthrough for the doctor came, even though it brought grief ; his good friend and doctor, Jakob Kolletschka, was cut by a student’s scalpel during a post-mortem examination. Kolletschka developed blood poisoning and died.
Semmelweis attended the autopsy and noticed the lesions on his friend’s body matched those of the cadaver from the post-mortem examination. He deduced that infection was nothing to do with the air, but that “cadaverous particles” on the medical students’ hands were the cause. He concluded that an unknown “cadaverous material” was the cause behind childbed fever.
From then on, he insisted that all staff scrub their hands with calcium chloride before touching any patients. Within two years the mortality rate in both clinics had dropped to practically nothing, with a zero death rate even being recorded for two months.
In 1848, he widened the scope of his work to washing of medical instruments as well.
Yet “germ theory” had not yet been accepted by the Viennese medical community and when Semmelweis presented his findings and hypothesis on the importance of extreme cleanliness, instead of being celebrated, he was ridiculed and mocked. Semmelweis was fired.
He moved to another hospital in Budapest where he continued to insist on staff washing their hands and stressing the importance of antiseptic procedures.
But the medical fraternity firmly stuck to their old belief of “miasma” and Semmelweis was met with open hostility and vicious mockery.
The medical community held that he had no acceptable scientific explanation for his amazing results in reducing mortality to less than 1%.
Facing the hostility of the scientific and medical community took its toll on Semmelweis mental health. His public behaviour was described as erratic and he wrote increasingly angry letters to some of Europe’s most prominent obstetricians, labelling the medical fraternity as “ignorant murderers”.
Early onset dementia has also been mentioned in history records as a possibility for Semmelweis’ behaviour.
In 1865, Semmelweis was “invited” to tour new facilities in an insane asylum, but it was, in fact, a trick to have him admitted. Even his wife believed he was losing his mind. When he realised what was happening, Semmelweis started to struggle, sustaining a wound to his hand.
He was badly beaten and thrown into a cell. His “treatment” included being doused in icy water and force-fed laxatives. The wound on his hand developed gangrene and he died two weeks later, aged 47.
The fact that Semmelweis’ hypothesis relating his empirical observations of extreme cleanliness were ridiculed by his peers, points to “belief perseverance” by those same peers - which is a psychological tendency to cling to discredited beliefs.
Additionally, many doctors of the time, who would have held gentleman status, were outraged with the notion that their hands could be unclean. Some science historians have put forward that resistance from established medical opinion to groundbreaking contributions from an unknown scientist has been common in history and “constitutes the single most formidable block to scientific advances”.
Almost two decades later, with advances in germ theory by the likes of Louis Pasteur and Joseph Lister, Semmelweis’ practice of washing hands was finally accepted.The Independent on Saturday