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Did You Wash Your Hands?

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by lisby1

Article by John Turano

I often hear that science is hard, especially from my own students,.

When questioned about what it is that makes science hard, I usually get answers that relate to having to remember a whole bunch of facts. You know, all that “stuff” and all those “things” with the funny sounding names.

I used to think it was the kids. They made it hard because they didn’t care enough to understand. And while that may be true to a degree, I think what makes science “hard” in today’s science classroom, isn’t so much the kids, but the way the content is presented. We often present scientific discoveries, principles, and concepts without considering the historical context that these discoveries were made. In many cases, these discoveries were made by ordinary people who led ordinary lives. And on the way, they made their contributions to science.

Here’s an example of what I’m talking about.

Wash your hands. How many times have we heard this growing up? Today we seem to be obsessed with keeping our hands and all the surfaces in our homes and work places germ-free. We’re bombarded with advertisements for all sorts of products that promise us a relatively germ-free environment. If it’s not 99.9% germ free we’re in mortal danger? It’s amazing that humans have survived for so long without all these hand sanitizers and toilet bowl cleaners! I keep my perspective in all this by picturing those brave American pioneers crossing the Great Plains with little bottles of hand sanitizers hanging from their belts. After all, you don’t know where those pesky prairie dogs have really been, do you?

In the not too distant past, before medicine understood the connection between disease and germs, before they understood that surgery required the doctor to actually wash their hands, the death rate to disease and infections was understandably high. This was especially true on the battlefield where most deaths came from not from getting shot, stabbed, or clonked on the head, but from the resulting infectious diseases that were spread by the doctors themselves.

One of the primary causes of death during childbirth in the 19th century was not the absence of a doctor. Mid-wives, and the practice of midwifery, had been around for thousands of years. And humans have been giving birth for many millions of years without doctors or mid-wives. No, what caused the death of women in childbirth was a little understood condition called childbed fever.

For many doctors in 19th-century, this was an accepted fact-of-life. Women died during childbirth. And given the attitudes towards women in general, why would this condition need to be researched or explained? It was an accepted part of life that some women died after childbirth.

The study of diseases and the spread of diseases was of great interest to the medical community in Europe during the 1800’s. Epidemics like smallpox, typhus, and syphilis were still ravaging European populations, but until medicine understood what caused disease, treatments and cures would have to wait. Until that happened, people were going to die.

One of the great medical research centers in Europe was Vienna, Austria. This was not the Austria that we think of today. This was the heart of the great Austro-Hungarian Empire. The Austro-Hungarian Empire was a major political, economic, and social force in Europe, and had been for centuries.

So the place to learn medicine, especially if you’re from the Empire, was Vienna. In 1837 a young Hungarian student at the University of Vienna decides to switch his studies from law to medicine. He is from the Hungarian city of Pest, which is now Budapest, and is far from home. Ignaz Semmelweis is an outsider in aristocratic, German-speaking Vienna and is treated as such. He’s ridiculed for his dress, his speech and his humble origins. Despite these obstacles, he completes his studies and at age 28 gets a position as assistant to the director of the obstetrics clinic at Vienna’s General Hospital, the most prestigious teaching hospital in Europe.

One of the shocking statistics young Semmelweis discovers was the very high death rate among women giving birth. At times it got as high as 30%, but it averaged around 13% a year. This was not uncommon across Europe, so Semmelweis’ hospital was not out of the ordinary. And in all cases the cause of death was childbed fever. Childbed fever, known as puerperal fever, is a raging infection that spreads rapidly in the body and kills in a few days. The disease was investigated, but causes of the fever were not found.

What was more intriguing to Semmelweis, though, was where in this prestigious hospital the deaths were coming from.

The hospital’s obstetrics clinic was separated into two divisions. The First Division was the teaching section for the medical students. For the most part these students were all males and among their other duties, they were responsible for conducting their own post-mortem examinations. The Second Division was used for the teaching of midwives. These women had no medical or surgical duties.

What Semmelweis discovered was that the death rate in the Second Division, the section with the midwives, was only about 2%. Of course this was known in the Viennese community and pregnant women would beg to be admitted to the Second Division. Afterall it doesn’t take, pardon the pun, a brain surgeon to understand where the best chance of survival was.

Semmelweis also noted that even though the hospital opened in 1794, the increase in deaths did not start until 1822, when medical students were required to do their own post-mortem examinations.

In 1847 Semmelweis lost a close friend who was a professor of forensic science at the university. His friend died from an infection he received after he cut his finger during an autopsy. What was revealing to Semmelweis was that the physical conditions inside his friend’s body were the same as the conditions found in the bodies of the women who died from childbed fever.

Semmelweis reasoned that it must be the lack of cleanliness in the clinics that caused the deaths. And he had a body of research to back up his suspicion.

References to hand washing and cleanliness can be found not only in the Bible, but in Indian, Babylonian and Persian literature. In the 18th-century, the physician-general of the British army advocated the washing of hands for doctors. And in the United States, Oliver Wendall Holmes strongly suggested that there is a connection between cleanliness and childbed fever.

All of this suggested that the hands of the medical students, who may have just been called from surgery or an autopsy, did not wash their hands before they delivered a baby. As they assisted in the birth of the child, they infected the women with disease causing pathogens. So in the Spring of 1847 Semmelweis required that not only did the medical students need to wash their hands with soap and water, but that they should also scrub under their fingernails with a brush and finally wash their hands again in a chlorine solution.

Within a month the mortality rate at the hospital dropped to 2%. Semmelweis’ thesis was quickly accepted by the hospital and you would think that he was on the road to stardom. But that wasn’t the case.

Instead of enjoying the fame that you might expect would come after such a momentous discovery, Semmelweis’ life began to slowly spiral downward.

One mistake Semmelweis made was his refusal to publish his findings in medical journals. This would have lent his thesis credibility and solidify his position at the universiity. Speculation as to the reasons for not publishing seem to center around his lack of self-confidence. He was a Hungarian in Vienna; an outsider who did not know the customs nor speak and write the language well. He had been shunned and ridiculed for years. That can be understandable. It’s not uncommon in the history of science to see this kind of treatment to outsiders occur. But what Semmelweis did next was probably the most damaging.

So taken by guilt over his discovery that he could have been responsible for the deaths of hundreds of women, Semmelweis began to write letters to his peers about how they must accept responsibility for the deaths of their patients from childbed fever. He wanted them to acknowledge their moral culpibility. Not only had Semmelweis gone against accepted medical practice with his new technique, and we know how “popular” that is even today, he takes a moral stand suggesting that the medical community must accept responsibility for their mistakes.

The reaction to this, of course, was ostracism. Here was an outsider, a Hungarian from a very humble background no less, telling the aristocratic medical experts in Vienna, the epicenter of the Austro-Hungarian Empire, what they needed to do and feel. Not good.

In 1848 a wave of revolt overtakes Europe. The people want a more liberal form of government. Hungary revolts and try to break away from the Austrian Empire, but fails. By 1849 order is restored and life goes back to normal, for most.

There is no evidence that Semmelweis participated in these revolts, but the powerful medical leaders didn’t forget his insult.

In March of 1849 his position at the hospital came up for renewal and was turned down. Big surprise there. He then applied for a position as an independent physician with hospital privileges and private students. After a year of his application being “reviewed” it was approved, but with a number of “conditions”. One condition was that he could not demonstrate any procedure on a cadaver, which was the normal practice at the time. He had to use a dummy.

He got another chance to re-build his career in 1850 by being invited to give a lecture to the Vienna Medical Society, which he did. But again he refused to write a paper about his talk for publication.

Concluding that his career in Vienna wasn’t going anywhere, a very bitter and disillusioned Semmelweis returns to his native Hungary where he obtains a position teaching obstetrics at a hospital in Pest. Teaching his technique, he saw the same results in Pest as he did in Vienna; a dramatic decrease in death rates after childbirth.

His life improved somewhat afterwards. He married and began writing about his ideas in a more formal manner. But the establishment still had not forgiven him. So deep were the criticisms of his work that even the founder of cell pathology, Rudolph Virchow, came out against Semmelweis’ thesis. Virchow was a key figure in the establishment of the germ theory of disease and here he is discrediting a person who had already made a link between germs and the spread of disease.

Finally in 1861 Semmelweis publishes his work, but it doesn’t have the effect that he intended. Rather the opposite happens. Instead of just leaving his scientific work to be scrutinized by his peers, Semmelweis attacks all his critics, some of whom are very powerful people of the European medical community. His book is met with great criticism and this pushes Semmelweis into a deep depression.

His mental state deteriorates rapidly, his family life unravels and in July of 1865 he’s committed to a mental hospital where he dies, at 47, a month later. His funeral is attended by a few of his peers, but no one from his family is there, not even his wife. It was reported that she was “sick” that day.

Such a tragic ending to a life that could have turned out so differently had the choices he made been different. He was so overcome by his guilt at being responsible for the deaths of women that he may have very well lost all his objectivity. Here’s a man who found the cause of a devastating fatal disease, made the connection between germs and the spread of disease, and developed an effective method of prevention. But, he went against the Establishment and lost because of politics, jealousy, and, as some believe, discrimination.

Later in the 1800’s, Louis Pasteur, Robert Koch, and, yes, Rudolf Virchow proved Semmelweis correct; that diseases are caused by germs and can be transmitted without proper cleanliness. Unfortunately those pronouncements were made long after Semmelweis was dead and probably forgotten about.

So the next time you reach for that hand sanitizer to prevent the spread of disease in your house, car, and workplace, thank the pioneers of science and medicine, like Ignaz Semmelweis, who made many sacrifices to understand the world around us.

About the Author

John Turano is an award winning twenty-year veteran teacher of high school science who also creates online home-schooling science courses for middle and high school students. You can sign up for his free video course on the life and contributions of Louis Pasteur here: http://teachyourkidscience.com.

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