#FEMSmicroBlog: Handwashing, a symbol of resistance

12-03-2021

Handwashing is one of the most essential public health tools at our disposal. In the 1840s Ignaz Semmelweis (considered today as the father of hand hygiene) first proposed that such a simple activity can save lives, but no one believed him. He fought a long battle against the established medical system, which ended up in his tragic death. This is the story of the origins of handwashing as told by Vanesa Ayala for the #FEMSmicroBlog. #HistoryOfMicrobiology

Handwashing is such a common activity, especially during a pandemic. Yet as trivial as it might seem, handwashing is a relatively new concept. Up until the mid-19th century, handwashing was regarded as completely unnecessary. Medical doctors did not wash their hands, even after dissecting a corpse. And when someone told them that hand hygiene helps in preventing the spread of diseases, they found the idea outrageous.

That someone was Ignaz Semmelweis (1818-1865), a Hungarian doctor who worked at the Vienna General Hospital.

 

Save lives: wash your hands

It is undisputed that washing your hands prevents transmission of infectious diseases like cholera, polio, influenza, COVID-19, among many others. Because it is cost-effective, convenient, and simple, it is considered as one of the best public health practices to control infection spread. In 2009, the World Health Organization (WHO) launched a global initiative called “Save lives: clean your hands”.

You must be thinking: Sure, obviously hand washing is important. Everybody knows that. Yet, handwashing as a technique to prevent the spread of infectious diseases was proposed only in the 1840s. Back then, the notion of disease spreading by hand was not known. Indeed, the concept of germs (microorganisms as cause of a disease) was yet to be described.

 

Cadaverous particles

For example, today we know that puerperal fever is caused by the bacterium Streptococcus pyogenes. In the mid-19th century, the accepted causes included miasma (an outdated term for bad smells in the air) or uncleanliness of the bowels. For patients diagnosed with the latter, the treatment was extensive purging.

Medical trainees spent their mornings dissecting cadavers before going to the maternity clinic […]. They did not wash their hands in-between.

When working in the maternity wards at the Vienna General Hospital, Ignaz Semmelweis noticed that considerably more women died of puerperal childbed fever at the doctor-led maternity clinic than at the midwife-led clinic. He started to investigate what the difference between those two places was, and set himself to find the culprit.

Ignaz Semmelweis, 1860 (from Wikipedia)

Semmelweis had a scientific and curious mind, and looked for a convincing explanation. When he learned that a colleague had accidentally cut himself while dissecting a corpse, and then died from what looked like puerperal fever, he found what he was looking for: medical trainees spent their mornings dissecting cadavers before going to the maternity clinic, while the midwives running the other clinic did not.

The students did not wash their hands in between activities.

Semmelweis used the term “cadaverous particles” to describe what is left on a doctor’s hands after working with corpses. He postulated that these particles could be transferred by touch. To test his hypothesis, he made medical students wash their hands and instruments with a solution of calcium hypochlorite before working with patients. The mortality rate dropped significantly in just a few months (from 18% to under 1%).

 

A fatal battle against the system

In 1847-48, Semmelweis presented his findings in several publications and at medical conferences throughout Europe. The concept was not well received, widely resisted, and even mocked.

Despite the clear evidence, surgeons were not convinced of washing their hands before surgery. Handwashing as a tool to prevent disease? Ridiculous! Was he suggesting that doctors were not clean, and that it was their fault that patients died? Insulting even!

Brochure from Semmelweis Museum in Budapest (© Semmelweis Museum)

Semmelweis’ struggle against the established hierarchical medical system in hospitals and the constant rejection by his peers put him in great mental and emotional stress. After a long battle, he was admitted to a psychiatric hospital, where he died at 47 from an infection after being harshly beaten by the guards.

A couple of decades later, after Pasteur’s and Koch’s theories saw the light, the work of Ignaz Semmelweis was proven right. He is now recognized as the father of hand hygiene. Nowadays, the term Semmelweis reflex is used to describe the tendency to reject new ideas despite adequate evidence, especially if they contradict preexisting beliefs.

If one day you are in the beautiful city of Budapest, you can visit the house where Ignaz Semmelweis was born and which now hosts the Semmelweis Museum of Medical History (Semmelweis Orvostörténeti Múzeum). It is worth it. The legacy Semmelweis left behind cannot be more relevant today.

Illustrations for the #FEMSmicroBlog by Eliza Wolfson (@eliza_coli) ( FEMS and Eliza Wolfson, CC-BY-SA-NC 4.0)

About the author of this blog

Vanesa Ayala-Nunez has more than ten years of experience as research scientist in the field of infectious diseases. Working at the interface of Virology, Immunology, and Cell Biology, she has dealt with several scary human pathogens. She did her PhD at the University of Groningen in The Netherlands and a Postdoc at IRIM in France. Vanesa is now a Scientific Editor, working in France and Germany. She collaborates on different SciComm projects and is a volunteer for the FEMS Volunteers’ Translation Team.

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