Please wash your hands, doctor!
Medicine first began to understand that lives could be saved by doctors washing their hands in 1846, in Vienna, Austria.1 Ignaz Semmelweis, a cranky and compulsive obstetrician, counted deaths from what was then called childbed fever, which mothers contracted shortly after giving birth. He noticed that at one clinic, as many as three in ten mothers were dying, but at another, hardly any did. The deliveries at the clinic with the high death rate were all done by physicians, while the clinic with few deaths was run by midwives.
Semmelweis observed that the doctors attending the more prosperous mothers in the (not coincidentally named) First Clinic would arrive in the obstetric unit directly from the autopsy suite, and even though they washed their hands with soap and water, their hands still carried a foul odor. He thought “cadaverous particles” were carried on the doctors’ hands.
Semmelweis insisted that all the physicians and medical students wash their hands with a chlorine solution between every patient. The deaths of mothers quickly plummeted.
But the idea that doctors needed to wash their hands offended many of his colleagues, who saw themselves as gentlemen in no need of special hygienic practices.
Moreover, the impressive statistics from Semmelweis could not withstand the then current medical received wisdom, which held, with the ancient Greeks, that the body’s four humors caused all disease, not some microscopic particles that no one had ever seen.
Semmelweis was ridiculed, rejected, and removed from the faculty of his hospital.
He died in an insane asylum a few weeks after his forty-seventh birthday, in 1865. Within twenty years, the work of Louis Pasteur, Joseph Lister, and Robert Koch produced the germ theory of disease, and Semmelweis was belatedly recognized as a visionary.
Now, one hundred and sixty-odd years after Dr. Semmelweis proved that washing hands in the hospital saves lives, life-threatening hospital infections remain rampant. And while we now have better medications to fight bacteria than doctors in the 1840s, when Semmelweis worked, we now face super bugs that resist antibiotics. So the issue remains a deadly threat to patients.
But the main solution is the same as it was in the 19th century: Compulsive and regular hand washing by everyone who touches the patient.
The same cultural forces at work back then still exist today. An apt quote comes from Dr. Oliver Wendell Holmes (father of the Supreme Court justice):
“In my own family, I had rather that those I esteemed the most should be delivered unaided, in a stable, by the mangerside, than that they should receive the best help, in the fairest apartment, but exposed to the vapors of this pitiless disease.”
Holmes was ridiculed just like Semmelweis was in Europe.
Charles Meigs, a well-known obstetrician, sniffed: “Doctors are gentlemen, and gentlemen’s hands are clean.”
Except when they’re not.
Which is anytime you don’t see the doctor or nurse wash up and put on fresh gloves in your presence.
1 This material is adapted from Patrick Malone’s book, The Life You Save: Nine Steps to Finding the Best Medical Care — and Avoiding the Worst (Da Capo Lifelong 2009).
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