Clean Hands Save Lives

Lessons from a 19th -century medical crusade still resonates

by: Leyla Sani

In a famous drawing by Leonardo Da Vinci of sexual congress, a narrow duct winds its way upward from the top of a woman’s uterus to the tip of her nipple. The drawing helped perpetuate the notion that mother’s milk arose from transmuted menstrual blood—a popular misconception that remained largely un-challenged long after da Vinci’s death in 1519.

daVinci (70K)

So when early-l9th-century doctors in Europe discovered a milky white pus in the abdomens of women who had died of childbed fever, they traced the cause of their deaths to “clotted milk” that had backed up and clung to their intestines. This was only one of the bizarre theories put forward to explain a scourge that was then killing up to one-third of women who delivered their babies in hospitals. Another hypothesis was that an indefinable aura hung over the wards.

The pall of death might have continued to hover had it not been for an indefatigable Hungarian obstetrician named lgnác Semmelweis. Two decades before Louis Pasteur discovered that bacteria could cause disease, Semmelweis found that doctors could stop the spread of childbed fever if they washed their hands in chloride of lime between patients. In this captivating biography, Sherwin Nuland, a surgeon at Yale and winner of the National Book Award for How We Die, chronicles Semmelweis’s battle to win recognition for his discovery. Semmelweis’s lonely campaign began in 1846, when he noted that the death rate among women whose babies were delivered by doctors at the Allgemeine Kranken-

haus hospital in Vienna averaged about 24 percent and sometimes rose as high as 30 percent. Among women in wards attended by midwives, the death rate was a mere 2.4 percent, as it was among women who delivered at home. He also observed that the doctors frequently performed internal examinations after spending their mornings dissecting corpses in the morgue. He concluded that the doctors were carrying some sort of particle directly from the dead bodies to the mothers, then transferring it from one woman to another. (The disease is now known to be caused by a strain of streptococcal bacteria.) By 1848, after he had ordered doctors to wash their hands in chloride solution before entering the wards, the death rate had dropped dramatically, to about 1 percent.

Despite making a discovery that would later save the lives of millions, Semmelweis was largely ignored by a hostile medical establishment. Nuland reveals that Semmelweis was partly to blame for his lack of acceptance. Not only did he fail to reproduce his findings in laboratory animals, but he also neglected to write up his results in an accessible manner in medical journals. More than a decade later, Semmelweis did write a book—a 543-page tome that Nuland describes as logorrheic, repetitious, hectoring, accusatory, self-glorifying..... . . in sum, virtually unreadable.”

Many of his detractors failed to grasp the fundamental principle of his work, and when they questioned his conclusions, he responded with personal insults, denoun-cing one professor of obstetrics as a murderer. Sadly, Semmelweis later succumbed to symptoms of Alzheimer’s. In 1865 he was consigned to a mental asylum, where he was probably beaten to death by the staff within hours of arriving.

It is tempting to dismiss this piece of history as an artifact of a dark age, and yet the struggle of Semmelweis is eerily prescient. In 1856 he berated a hospital manager for sending sheets to a laundry that returned them in the same filthy state. Last June, a century and a half later, the London Times reported that 68 percent of nurses surveyed in Britain had no laundry facilities for uniforms in their hospitals, forcing them to wash them in non-sterile conditions at home. That practice has been implicated in the spread of hospital infections. Simple disinfectant use has been shown to reduce rates of infection by antibiotic-resistant bacteria, and yet hospitals in many countries, including the United States, often neglect such basic measures. Ignorance and slovenliness may be the demons in Semmelweis’s story, but they are no strangers to the sophisticated 21st century, either.

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