#10- Dr Ignaz Philipp Semmelweis: Celebrating World Hand-Washing Day

The reason you wash your hands and remain alive to this day is because of this Hungarian dude!

Triggers: Deaths, dying mothers, blood, corpses

Hello everyone! 😄 It has been a while since I posted here. I have been keeping myself busy with some learning on Inkscape so I could expand my skill set and not simply be a person who can only work in the lab. Although there is a lot for me to explore and learn, I am back once again to share some knowledge on microbiology, as simple as always, and everyone is free to leave a comment on my work as long it is constructive feedback, words of appreciation, or if you just want to talk microbiology to me 😊

On this very day, October 15th is known as World Hand-Washing Day where I will mention a notable man named Dr Ignaz Philipp Semmelweis, the guy who suggested proper hygiene practices. I felt this is important to talk about since some people like to take it for granted or consider it silly to rub their own hands under running water with some soap.

So buckle up and join me as we explore the brilliant yet sad life of this great person.

Introducing Ignaz Semmelweis!

A black and white engraved portrait of Ignaz Philipp Semmelweis, with a mustache covering his upper lip, and balding head. Source in caption.
Figure 1- The portrait of Ignaz Philipp Semmelweis. Source- By Jenő Doby — Benedek, István (1983) Ignaz Phillip Semmelweis 1818–1865, Gyomaendrőd, Hungary: Corvina Kiadó ISBN: 9631314596. plate 15, Public Domain, https://commons.wikimedia.org/w/index.php?curid=4550652

On 1st July 1818, a boy was born in Buda, Hungary (now part of Budapest), to a well-to-do family who owned a successful grocery shop. He was the fifth oldest of ten and his name was Ignaz Semmelweis.

Despite being born to Germanic parents, he and his siblings were considered Hungarian and spoke the language fluently.

The Semmelweis family house, the place where they lived and worked, still stands to this day at Apród Street in Tabán as a little museum showcasing some of Ignaz’s belongings and works, so make sure to have a peek someday! (See Figure 2) 👀

Few hints and excerpts of his personality are only known. One is from a diary, now lost, described as “of a happy disposition, truthful and open-minded, extremely popular with friends and colleagues.” Few years after his passing, a Viennese colleague (in an obituary notice for a different physician) referred him as “the genial Semmelweis”. Lastly, from observing Semmelweis’s work, it is said that he was an energetic, impulsive, sensitive, and thorough individual who disliked controversy. Overall, he was a good man at heart who cared a lot for the people.

Ignaz Semmelweis’s childhood home now standing as Semmelweis Museum of Modern Medicine and his final resting place. It is an angled shot of a late Baroque-style house. It is painted white and has a dark brown roof. Source in caption.
Figure 2- Ignaz Semmelweis’s childhood home now standing as Semmelweis Museum of Modern Medicine and his final resting place. Source- By Biusante — Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=50268916

He completed his school education and went to the University of Vienna to pursue law in the autumn of 1837, but the following year he decided to do medicine, hence receiving his M.D. in 1844. It is still not sure why he made a sudden change.

Ignaz wanted to join as an assistant in internal medicine at Dr Josef Skoda’s clinic, but another physician took that position. So, he chose obstetrics by completing a two-month course taught by Johannes Klein’s son-in-law, Baptist Johann Chiari at the first section of the Vienna General Hospital’s maternity ward. He was later awarded a master’s in midwifery upon completion.

In the year 1846, he became an assistant to Klein in the first section a.k.a. the First Clinic of the Viennese maternity ward. His duties included maintaining records, making rounds to check patients in the mornings and afternoons, assisting in the delivery of babies, and taught obstetrical students by conducting demonstrative autopsies at the morgue. All seemed well when he joined until he had to face the real horrors in his section.

Working at Vienna’s House of Death

When I say expecting mothers begged to be put in the Second Clinic in the maternity ward, I mean it, so much so Semmelweis himself said these words — “witness moving scenes in which patients, kneeling and wringing their hands, beg to be released in order to seek admission to the second section.” It was common knowledge that the people outside the hospital knew a lot of the deaths that occurred in First Clinic.

The main entrance of present-day Vienna General Hospital in Vienna, Austria. It is a very large and clean hospital with some cars parked in the front and hospital staff moving some stretchers outside on the pavement. Right in front of the building is lush green grass and some trees. Source in caption.
Figure 3- The main entrance of present-day Vienna General Hospital in Vienna, Austria. Source- By Thomas Ledl — Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=71212004

During my time in university, I learned how severe the situation was in the Viennese hospital when my lecturer told all of us, women in labour would intentionally wander and deliver their babies literally on the streets because they feared entering the hospital. Thankfully, both mothers and their children were safe and healthy despite taking such desperate measures. Also, some even induced miscarriages to avoid birthing at the hospital!

The mortality rate was quite high in the First Clinic compared to the Second Clinic due to the illness known as childbed fever or puerperal fever. The disease took hold of mothers in almost every charity maternity clinic and other places in Europe, and the Vienna General Hospital was one of them. Several dying and dead mothers in his section and the constant ringing of the bell to indicate the arrival of a priest to do the final rites troubled Ignaz a lot that he said it “made me so miserable that life seemed worthless”.

The graph depicts the yearly death rates of women in the two sections of a maternity ward in Vienna General Hospital It clearly indicates that the First Clinic had the highest mortality than the Second Clinic caused by puerperal fever. Source in caption.
Graph 1- The graph depicts the yearly death rates of women in the two sections of a maternity ward in Vienna General Hospital It indicates that the First Clinic had the highest mortality than the Second Clinic caused by puerperal fever. Source- By Power.corrupts — Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=4765159

The Search for Truth

This whole scenario happened in the 19th century where people believed in things like miasma theory, humoral theory, and other silly non-scientific things. The germ theory was still not proposed, unfortunately.

According to the biography I referenced in this post, it stated that majority of the staff at the hospital and the science-y society people strongly believed that the miasmas from dead bodies were causing childbed fever and not their unhygienic practice. They would just fiddle around with dead bodies in the morgue, and come straight out of there to check on a woman at the maternity ward with blood and decaying infected tissue all over their hands. I know that this is super gross but that’s how things rolled in 19th century Europe.

Ok, now back to Ignaz being traumatised by dying mothers and his need to take a break from all of this. So he and two of his buddies went to Venice, Italy, to admire the beauty of some Venetian art and find some peace. He returned to work only to find that his close friend, Prof Jakob Kolletschka, died while he was away. The cause of his death was a student who pricked his finger with the same knife used for carrying out an autopsy at the morgue. Now imagine this, they were going in with bare hands, all over the dead body, while doing an autopsy which is icky and a serious health hazard by today’s standards.

A micrograph showing Streptococcus pyogenes bacteria, the actual cause behind puerperal fever, stained using Pappenheim’s stain. The bacteria is in the form of red beads on a chain, hence the name streptococcus.  Source in caption.
Figure 4- A micrograph showing Streptococcus pyogenes bacteria, the actual cause behind puerperal fever, was stained using Pappenheim’s stain. Source- By Photo Credit:Content Providers(s): — This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #2110.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.العربية | Deutsch | English | македонски | slovenščina | +/−modified by de:Benutzer:Kookaburra, Public Domain, https://commons.wikimedia.org/w/index.php?curid=146411

But, the death of Prof Jakob was not in vain as it proved to be a turning point for Semmelweis’s understanding of how childbed fever became a massive problem. He observed and compared the features seen in his dead friend and the maternity patients and these were — pleurisy, pericarditis, peritonitis, and meningitis. The symptoms seen in Jakob were very much identical to childbed fever. Deep down Ignaz knew he was on the right track and concluded that it was caused by something far more than just miasma, cold air, and other illogical opinions. It was the strict hygiene that was lacking in the hospital.

Semmelweis compared the differences between the First and Second Clinics to find what exactly is killing these women in such a horrific way. He diligently worked on cadavers every morning and eliminating possible causes, even the most harmless options like clothing, diet and humidity. Although, he did spot one important clue — the proximity of the morgue to the First Clinic. Due to this setup, professors, assistants, and students would come to work on the cadavers. Also, regular handwashing with soap was not cutting it because dead-body smell still lingered on their hands, indicating that it did not completely remove the filth. He wanted something strong enough to clean the hands perfectly. And one more point to add, the Second Clinic had midwives attending them, and they were the only ones not allowed to go into the morgue, hence the reduced mortality.

The graph shows the monthly mortality rates of women dying from puerperal fever during the years 1841–1849. The red line indicates the event of introducing chlorine hand wash by Dr Ignaz Semmelweis in May 1847. A significant decline in deaths is quite noticeable from May 1847 onwards. Source in caption.
Graph 2- Monthly mortality rates of women dying from puerperal fever during the years 1841–1849. The red line indicates the event of introducing chlorine hand wash by Dr Ignaz Semmelweis in May 1847. A significant decline in deaths is quite noticeable from May 1847 onwards. Source- By Power.corrupts — Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=4765094

You can see this was like a eureka moment for Ignaz and he took Klein’s permission to introduce chlorinated lime washes for everyone to disinfect their hands before assisting women in their delivery. According to him, it was the best candidate as the agent can effectively clean and was pretty cheap. Almost at the end of May 1847, he got everyone in his section to wash their hands with the disinfectant before tending to their patients. The results were remarkable! There was an immediate drop in mortality and it stayed low until new recruits came in August (See Graph 2). Some new students neglected the disinfection of their hands and caused a spike in deaths. This caught Ignaz’s attention to adopt stricter measures by assigning one male obstetrician and one midwife per woman in labour and their names were publicly displayed so he could catch anyone being a slob red-handed. Once again, the mortality rate dropped.

Scholars with Bloody Hands

Remember when I mentioned earlier that he did not like controversy? He did land up making a big controversy when people in the science community heard what he did to reduce deaths in the maternity ward easily. Instead of praising him as a hero, they told him he was being delusional. From what I have read in the biography, the science big wigs were pretty stubborn and arrogant in giving up their belief in miasmas from dead bodies causing the illness. Semmelweis knew that it was not miasma but something else from the decaying matter.

Additionally, some of them misinterpreted Ignaz’s results to support their beloved miasma theory when he clearly wanted proper hygiene practices to be followed everywhere, from disinfecting the hands, to changing the bedding and cleaning all obstetrical equipment before use. Not to forget that Hungary was under the Austrian Habsburg rule and they were revolting against them for independence and things got quite dicey. He only managed to give a single lecture about his findings in Vienna in 1850. However, he did not publish the results of his work.

Other than the Viennese hospital, he did take an insignificant position as director at St. Rochus Hospital and eventually worked at the University of Pest, where he applied his idea which presented amazing results, as always. Yet again, the others were blind and did not accept his simple answer to a deadly problem.

He faced a great amount of ridicule, rejection, and hatred from many in the scientific community that he spiralled into a rage. In today’s modern terminology, our mans was really going through it. He published some essays, and one book on his work hoping that it will save many mothers but it was ignored with such irresponsibility that he wrote open letters calling them out on their shameless ignorance by literally accusing them of murder. Instead of accepting their mistake, they decided to waste their time in shaming him while several mothers pass away under their “care”.

As he became more deranged and people came to know of this unusual change in behaviour, János Balassa, professor of practical surgery at the University of Pest wrote a referral to send Semmelweis to an insane asylum on 29 July 1865. Ignaz’s friend and former colleague, Ferdinand Hebra lured him into the asylum in Lazarettgasse, a rather large institution and the least pleasant in Vienna. When he realised he was being fooled, it was too late. Many guards beat him up to a pulp, put him in a straitjacket, and left him in a dark cell. They would douse him with cold water and feed him castor oil. After 14 days of suffering from the day he was ambushed, he died on 13 August 1865. It was from a wound on his right middle finger that became gangrenous, leading to pyemia, according to an autopsy report at the Vienna General Hospital’s morgue where he once worked.

After his death, the obstetricians were still in massive denial and continued with their obstetrical work without washing their hands in chlorinated lime and never questioned each other’s actions, while bodies of mothers continued to pile.

It was a sad end for him as he died from the very thing he swore to protect many mothers from.

Conclusion

A Google Doodle guide on how to wash your hands properly with a proud Dr Ignaz Semmelweis on 20th March 2020. The steps are as follows: wet your hands, take enough soap to wash both hands, rub palms to get it nice and soapy, rub top of hands with fingers interlaced, interlace fingers to rub palms, backs of fingers against palms and interlaced, rotational rubbing of both thumbs, scrub palms with closed fingers, and wash hands. Source in caption.
Figure 5- A Google Doodle guide on how to wash your hands properly with a proud Dr Ignaz Semmelweis on 20th March 2020. Source- Google Doodle Archive

As you can see, you and your mothers are still alive today and rarely die from puerperal fever because all doctors wash their hands thoroughly and everything is kept absolutely clean to avoid the risk of infection. Also, one should wash their hands with soap after using the bathroom. Like really, this man did not die and get nicknamed as the ‘saviour of mothers’ just so you can give some lame excuse 🔪🔪🔪 Lastly, pandemic or not, wash and sanitise those hands 😊🔪

That is the end of this long, interesting post! It was fun and emotional to write because researchers, doctors, and healthcare workers everywhere risk their lives on a daily basis to save everyone when facing deadly pathogens. I, as a person who studied at a university, can assure you that there are still some arrogant lab folks who don’t show respect and are not open to new ideas. I encourage you to please stand up for what is right, even if you can change one person’s mind or their life like how Dr Ignaz Semmelweis did with scientifically concrete evidence and most importantly, empathy.

Thank you for reading! Do clap, and subscribe/follow me for more weekly inspirational and simplified microbiology 😄🙌

Glossary

Mortality rate- Death rate; a measure of the number of people who died in a population per unit of time

Miasma theory- An obsolete theory where diseases were caused by a ‘bad form’ or ‘noxious form’ of air from decaying organic matter

Humoral theory- An obsolete theory to understand the inner workings of the human body and it includes blood, yellow bile, black bile, and phlegm

Streptococcus pyogenes- Streptococcus: chain of round/coccus-shaped bacteria, pyogenes: pus-forming

Pleurisy- Inflammation of the membrane that surrounds the lungs and lines the chest cavity

Pericarditis- Inflammation of the heart’s pericardium membrane

Peritonitis- Inflammation of the peritoneum membrane that lines the inner abdomen wall and holds abdominal organs

Meningitis- Inflammation of the membranes, collectively called the meninges, that cover the brain and spinal cord

Pyemia- Circulation of pyogenic bacteria in the blood; ‘emia’ means presence in blood

Sources

  • Me remembering stuff from my university lecture in 1st year of my degree
  • Childbed Fever. A Scientific Biography of Ignaz Semmelweis. By K. Codell Carter and Barbara R. Carter, Revised Edition.

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Treveni Mukherjee

Treveni Mukherjee

A University of Leeds alumna with an Integrated Masters degree in Microbiology excited to simplify the subject for the curious and also for students ✌😄