By Minoli Ekanayake
Ignaz Philipp Semmelweis
Father of Infection Control
Nature had us dive in blind into the tides of a pandemic we stood unprepared to tackle. Without any definitive treatment yet available, we exceedingly rely on precautionary measures such as social distancing, and handwashing regimes. While this seems like a sensible approach now, surprisingly little is known about the man who originally hypothesised the necessity for handwashing protocols; The father of infection control itself, Dr. Ignaz Philipp Semmelweis.
Dr. Semmelweis gained his MD Vienna in 1844, following which he worked an assistant in obstetrics for the first division of maternity service at the Allgemeine Krankenhaus teaching hospital (Vienna, Austria). He observed that mothers who delivered in medical student/doctor-run maternity ward had a 13–18% mortality following childbirth due to puerperal (childbed) fever. In contrast, this value was only 2% in the adjacent midwife-run maternity ward.
Upon further investigation in 1846, he recorded that doctors and medical students often visited the maternity ward immediately after performing autopsies; which were aimed at finding a tangible reason for the deaths of said mothers. He speculated the likelihood of ‘cadaverous particles’ on the hands of medics which were transferred from the morgue to the maternity ward. Considering midwives did not conduct surgeries or autopsies, they would not have come in contact with said particles.
This practice may seem horrifying especially when comparing how aseptic (aiming at the complete exclusion of harmful microorganisms) techniques are deemed gospel by medics today. Nonetheless, during the Victorian era, miasma (night fever) - an archaic medical theory, dictated that the foul air from disintegrating organic matter facilitated the spread of diseases. The notion of pathogenic microscopic organisms was a mystery yet to be discovered. Therefore back then, it was not a crime to switch back and forth from dissecting corpses in the morgue to delivering babies in the maternity ward - even if it meant not washing their hands in between.
One of Semmelweis' colleague, a pathologist, fell ill and died after pricking his finger whilst dissecting a corpse that had died from childbed fever. At the time, this was nothing out of the ordinary among pathologists. Upon studying the pathologist's symptoms, Semmelweis realised his colleague died from the same cause as the women who died of childbed fever, an illness deemed to be limited to women in labour. He conjectured that anyone at the hospital can contract it as well.
To investigate his hypothesis, he asked doctors to wash their hands and instruments in a chlorine solution before delivering a baby; A substance he believed would dispatch the inevitable smell of cadaverous particles. The rate of mortality amongst mothers plummeted to nearly 1%, even lower than the midwife-run ward. This was evidence of the impact handwashing has in preventing infections.
However, handwashing was not popular among everyone. At the time, doctors hailed from middle or upper-class families, who considered themselves as ‘cleaner’ than the working-class. It was viewed as an insult that their dirty hands caused the death of new mothers. They stopped washing their hands, in support of the general notion back then that water was the potential cause of disease. One of his senior colleagues suggested the new hospital ventilation system helped reduce the deaths, backing the miasma theory.
He lost his job and was believed to have had a breakdown. It is speculated that he developed a mental-health condition probably due to syphilis or Alzheimer's which admitted a 47-year-old, Semmelweis into a mental asylum in 1865. He was probably beaten and eventually died of sepsis; a potentially fatal complication of an infection in the bloodstream - in other words, the same condition he strived to prevent among new mothers who died of childbed fever.
About the author
Minoli Ekanayke Minoli is a final year medical student at the General Sir John Kotelawala Defence University (Sri Lanka). She was prepared to dive into her commitments as a final year medical student, but now finds herself working towards her degree in her dorm.
Reference
Best, M., & Neuhauser, D. (2004). Ignaz Semmelweis and the birth of infection control. Quality And Safety In Health Care, 13(3), 233-234. doi: 10.1136/qshc.2004.010918
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