Every day is Ignaz Semmelweis day

January 16, 2023

Chances are you haven’t heard of Semmelweis Ignác Fülöp, also known as Dr. Ignaz Philipp Semmelweis. A Hungarian physician who made one of the most foundational contributions to modern public health: handwashing. This is a rendition of the futile story of Dr. Semmelweis and the Vienna Medical Society at Allgemeine Krankenhaus der Stadt Wien (Vienna General Hospital).

Vienna General

Childbirth has always been difficult. Nature does not prioritize the comfort or safety of the adult over the birth of the child. In the early 1840s, only about 5 in 1,000 women died in childbirth done by home birth or midwife. Many chose this method over exposure to “The Doctors’ Plague” in a hospital, where deaths from puerperal fever (also known as Childbed fever) were 1 in 6.

In 1846, Dr. Semmelweis was applying for a position at Vienna General, but there were two problems: he was Hungarian and Jewish. Surgery was reserved for the elite doctors, who had the right pedigrees and prayed to the right gods. He was hired, but not as a surgeon – he was to run the obstetrics division of the hospital.

After Jenő Doby's engravig, Public domain, via Wikimedia Commons

Every day he struggled with screams from terrified women when he approached them. Determined to stop the deaths of more mothers, he listened to them. Dr. Semmelweis, like Alexander Gordon and Oliver Wendell Holmes, discovered that patients caught puerperal fever when doctors moved from dissecting corpses in the autopsy suite to childbirth in the delivery room. Unlike Gordon and Holmes, Ignaz was going to do something about it.

Dr. Semmelweis ordered his medical students and doctors to wash their hands with a chlorinated lime solution to disinfect after performing autopsies and before delivery. Deaths from Childbed fever plummeted within months.

An obvious victory? Not all were so easily convinced. This simple recommendation kickstarted a decade plus battle with Semmelweis’s superiors.

That germs cause disease was barely a fringe theory in Europe. No, the model of disease in medicine was miasma theory. Putrid stenches in the air causing disease. This “bad air” that came from rotting organic matter was where everything from the plague to cholera came from. Why were corpse-free delivery rooms, literally where new life was yielded, causing deaths? There was no miasma to be had, and yet until Semmelweis instituted handwashing procedures, deaths were rampant.

The higher ups at Vienna General did not take to Ignaz’s recommendations. Semmelweis was met with ridicule, derision, and outright hostility. The staid halls of medical academia could not be upended by the ravings of a lower-class physician.

However, Semmelweis was not one to take these slights lightly. For over a decade he became more outspoken, more angry, filled with righteous indignation over the injustice of easily preventable deaths. However, his stubbornness also worked against him. He was reluctant to perform studies on animals and frequently refused to publish his results in medical journals. Despite the leadership unwilling to listen, Semmelweis failed to articulate his beliefs and recommendations.

After abruptly leaving Vienna General and returning to Budapest, Semmelweis published “Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers” (“The Etiology, the Concept, and the Prophylaxis of Childbed Fever”), a tome that articulated his hypothesis and provided recommendations for delivery doctors.

The end of Semmelweis’s life devolved into despair. With failing health and increasingly erratic and hostile behavior, Dr. Ignaz Semmelweis was committed to Landes-Irren-Anstalt in der Lazarettgasse, an insane asylum in Wien. There he was beaten by guards, imprisoned in a straight jacket, and died of blood poisoning two weeks after admission.

Takeaways

Dirty hands spread billions of bacteria, and unchecked spread drives high medical system costs and mortality rates. When properly implemented, twenty seconds of handwashing curbs disease extremely effectively. What seems like common knowledge now was revolutionary 200 years ago.

Leadership

The story of Dr. Semmelweis highlights two cases of failed leadership: one from the medical community, and one from Dr. Semmelweis. The medical community failed to logically consider evidence that countered their intuition, despite championing the process of science. Dr. Semmelweis failed to publish transparently and quickly, and fell prey to emotional outbursts and ad hominem attacks, later calling dissenting surgeons murderers. As such, handwashing opposition remained in the medical community for years after Semmelweis’s death.

Globalization

In places without clean water, effective handwashing is impossible, leading to increased health disparities. Globally, over 10% of people are without clean water, and as climate change worsens, that number will grow. In Ghana, improper leadership for infrastructure has impacted clean water availability for handwashing, potentially leading to worse COVID-19 outcomes. Thus, disease will continue to worsen.

The pandemic has taught us the power globalization has over us: global health is local health. Disease in one place affects us all.

Hierarchies

In broader context, Dr. Semmelweis’s case is similar to Dr. John Snow’s as an intervention failing due to dogma. Both doctors faced ridicule from established norms of the time. It was only after a paradigm-shift occurred that their interventions were accepted. It is relatively recent that evidence-based medicine has become as accepted as it has, and it still faces pushback from physicians when it goes against intuition. This is the struggle of being human, on some level. But it also demonstrates the importance of mechanisms for challenging the status quo.

Rare are actions so simple yet so effective at preventing disease transmission. Handwashing (properly) is still the best public health measure we can all take to reduce disease.

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