The surprising History of Handwashing (PAU June 2022) script

Interviewer: We take it for granted now that washing our hands is a tool to fight disease. But somebody had to discover that, and most of the credit goes to a Hungarian doctor named Ignaz Semmelweis. How did he come to realize that handwashing was so important for our health? To answer that, we’ve invited Dr. Diana Tulane, a professor of the history of medicine at Purdue University in Indiana who has studied Ignaz Semmelweis, to our program.
Welcome and good morning, Prof. Tulane.

Prof. Tulane: Good morning, and thank you for inviting me.

Interviewer: My pleasure. How did you become interested in Ignaz? Is he famous?
Prof. Tulane: Actually, I was interested in medicine as practiced in the 19th century, and Ignaz Semmelweis became an important name in medicine from that period.

Interviewer: I’m assuming he had something to do with handwashing.

Prof. Tulane: Yes, that’s right. The history of handwashing is actually complicated, and it’s pretty amazing that someone discovered the importance of handwashing at a time when most people thought disease was caused by something like bad air.

Interviewer: How can the history of handwashing be complicated? It seems like a pretty basic thing to do.

Prof. Tulane: Now it seems basic, but that wasn’t always so. The story begins in 1844 in Vienna, Austria, where Ignaz worked in Vienna General hospital, which was the largest maternity hospital in the world. As you can imagine, hospitals at that time were very different from what we know today. They didn’t know about germs, and hospitals were so crowded that it wasn’t really that rare for there to be more than one patient in a single bed. Conditions for healing were very poor. Not surprisingly, the mortality rate in hospitals of the time was extremely high.

Interviewer: I can imagine.

Prof. Tulane: One disease that was particularly deadly at this time was child bed fever, which was responsible for the death of many, many women. Women would notice symptoms just a few days after giving birth. Child bed fever was a particularly dramatic disease because it occurred at a time when people were supposed to be very happy, as their child had just been born, but things could go very bad for the mother in a very short period of time. She would start screaming because of the pain and go delirious, and die a horrible death.

Interviewer: How terrible. What caused this disease?

Prof. Tulane: We know now that this disease is caused by a bacterial infection, but that wasn’t known at the time. Remember, they didn’t know about germs.

Interviewer: So what happened at the hospital in Vienna?

Prof. Tulane: The conditions at Vienna General hospital were so crowded that they had to divide the maternity ward into two clinics, one that was served by doctors, and the other that was served by midwives. Soon it became apparent that many more women were getting child bed fever and dying in the doctors’ clinic than in the midwives’ clinic. This was very puzzling to everyone, because doctors had more training than midwives, so everyone expected that doctors would be able to provide better care. No one understood why more women in the doctors’ clinic were dying.

Interviewer: I bet it was Ignaz who solved the puzzle. And how did he do it?

Prof. Tulane: Well, first he analyzed some of the explanations that people had already suggested. Many people thought that child bed fever was caused by overcrowded conditions, but he knew that that could not be the only factor because both the clinic served by doctors and the one served by midwives were equally crowded, so there was no difference there that would explain the difference in mortality. But he did observe some other differences between the two clinics.

Interviewer: Really? How did he do this?

Prof. Tulane: He did what any good scientist would do: he set up controlled experiments. He had the women in one clinic give birth while lying on their sides, while those in the other clinic gave birth while lying on their backs. He then switched the positions for each group, but this had no effect. More of the doctors’ patients were still dying. Then, he noticed that in the doctors’ clinic, a priest was walking down the aisles ringing a bell. He thought that maybe psychological terror played a role because the women in the doctors’ clinic knew that they were dying once they saw the priest and heard the bell, but that he couldn’t proof that, either.

Interviewer: It sounds like this process took a long time.

Prof. Tulane: Oh yes, it took him several years. Then, in 1847, his best friend Robert, a doctor, was accidentally cut while doing an autopsy and died soon afterwards. Ignaz noticed that his dying friend shared a lot of characteristics with the women dying from child bed fever, so he hypothesized that they all had the same disease, and it obviously wasn’t only related to giving birth. He then observed that the doctors would do autopsies and afterward go directly to the maternity ward to deliver babies. He realized that the disease might be caused by the contact with dead bodies.

Interviewer: So, in effect, the doctors were spreading the disease from cadavers to mothers who had just given birth.

Prof. Tulane: Exactly. To test his hypothesis, Ignaz had the doctors wash their hands with a disinfectant after they performed an autopsy and before they entered the maternity ward. Once the doctors started doing this, the mortality rate of women in their clinic decreased to the same level as that in the midwives’ clinic.

Interviewer: So, did Ignaz become a hero? It sounds like he saved a lot of women’s lives.

Prof. Tulane: Well, yes and no. At first, the medical community was skeptical. Most of the doctors agreed to his idea of handwashing, but Ignaz was not an easy person to work with. For example, he insisted that all cases of child bed fever were caused by contamination from autopsies, even when that really wasn’t possible. In the end, he was taken to a psychiatric hospital and died alone.

Interviewer: How sad! But his realization that handwashing could prevent the spread of disease turned out to be very important.

Prof. Tulane: Yes. At about the same time as his death, scientists discovered that germs cause disease, and that would not have happened without the work of people like Ignaz Semmelweis.

Interviewer: That’s all we have time for today. Thank you, Dr. Tulane, for this very interesting history of handwashing.

Prof. Tulane. Thank you.