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Wash Your Hands, Doctor

True story · 3 min read

In 1846, a young Hungarian doctor named Ignaz Semmelweis had a problem he could not stop looking at.

He worked in the maternity wards of the Vienna General Hospital, one of the largest in Europe. It had two delivery clinics, and women were admitted to one or the other on alternate days. The First Clinic was staffed by doctors and medical students. The Second was staffed by midwives. In every other way the two wards looked alike.

And yet mothers in the First Clinic were dying of childbed fever at a terrible rate, often two to four times higher than in the Second. In some years, roughly one woman in ten who gave birth in the First Clinic did not go home. Women out in the streets knew it. They begged not to be taken there, and some chose to give birth on the road to avoid it.

Semmelweis went through explanations one at a time, like a man trying keys. Was it overcrowding? The Second Clinic was just as crowded. Bad air? Both wards shared the same air. Was it the position the women lay in, or the way the priest walked in to give last rites? He changed the position; he changed the priest's route. Nothing happened.

Then, in March 1847, a friend and colleague, the forensic-medicine professor Jakob Kolletschka, died. During an autopsy a student had nicked Kolletschka's finger with a scalpel. He sickened, and when Semmelweis read the autopsy report he saw that Kolletschka's body showed the same changes as the dead mothers.

Something clicked. The doctors and students of the First Clinic went straight from the autopsy room, where they dissected the bodies of women who had died of the fever, to the delivery room, where they examined living ones. They never washed properly in between; a rinse left the smell of the dead room on their hands. The midwives never touched the dead. Whatever the doctors were carrying, Semmelweis decided, they were carrying it on their hands.

In May he issued an order. Everyone entering the clinic had to wash first in a solution of chlorinated lime, the one thing he found that took away the smell, and scrub until the smell was gone.

The numbers fell, and they fell fast. In the months that followed, mortality in the First Clinic dropped to about the level of the Second, and in some months to between one and two in a hundred.

There was very little applause. Many senior doctors were insulted by the idea that gentlemen's hands could carry death. Semmelweis also had a weakness: he could show that washing worked but not why. Nobody yet knew about germs, and his talk of "cadaverous particles" was a guess. His manner did not help; he could be blunt, and he later wrote angry letters accusing critics of murder. His post lapsed in 1849 and was not renewed. The politics of the revolutionary year and his powerful enemies both played a part, and he left Vienna.

Within two decades, Louis Pasteur's work and then Joseph Lister's antiseptic surgery would supply the missing explanation. Semmelweis did not live to see it settled. In 1865, after a breakdown that alarmed his colleagues, he was committed to an asylum in Vienna. He died there two weeks later, aged forty-seven, of blood poisoning from an infected wound.

Semmelweis had the numbers but not the mechanism, and a temper that made enemies. Even so, the numbers were on his side, and it took medicine another generation to look at them.

Words in this story: clinic, autopsy, antiseptic, mechanism, mortality