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The Legacy And Death Of The Tragic Hero Of Handwashing

14/12/2015 8:20 AM IST | Updated 15/07/2016 8:25 AM IST
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Caucasian woman washing her hands

On the evening of 13 August 1865, at a mental asylum in Lazarettgasse in Vienna, Dr Ignaz Fülöp Semmelweis was pronounced dead. His body was brought back to his hometown of Pest (now Budapest) in Hungary and at his burial on the 15th of August, not a single member of his family was present. Semmelweis died as he had perhaps lived. Unloved and uncared for.

The death of a Hungarian obstetrician 150 years ago, however tragic, would perhaps elicit little interest today. But what Semmelweis discovered saved millions of lives - in fact, it is probable that many of us reading this piece are alive because of him.

He had discovered that washing hands saved lives.

What Semmelweis discovered saved millions of lives - in fact, it is probable that many of us reading this piece are alive because of him.

Sitting pretty in 2015, where handwashing is such a taken-for-granted activity, one would wonder why such common sense had to be a scientific discovery in the first place. But 150 odd years ago, the very thought that dirty hands could transfer germs was medically unacceptable. Disease either spread through air or through the exchange of bodily fluids. Resultantly, personal hygiene and handwashing were a low priority, especially for doctors. The cost of such ignorance was significant not only in terms of the number of patients who lost their lives, but how some of them, had they lived, would have made a significant impact on human history. The most well known case is that of the death of United States President James Garfield in 1881. Only four months into his Presidency, he was shot at twice by his assassin. Strangely, he did not succumb to his bullet injuries but to septic poisoning of wounds. A group of 12 doctors, led ironically by a certain Dr Bliss, probed and prodded his bullet wound with their unwashed and unclean fingers, spreading the infection, which finally took his life. Had he been left alone, he probably would have survived his non-fatal bullet injury.

Exactly 35 years before the death of James Garfield, Semmelweis was grappling with a paradox that eluded medical sense of the times. As an obstetrician in the Vienna General Hospital, he was puzzled by the fact that pregnant women were desperate to get midwives to assist childbirth rather than certified medical practitioners. The data from the medical wards revealed that the maternal mortality rate in the First Clinic managed by trained physicians was significantly higher than the Second Clinic where midwives assisted childbirth. In fact, desperation to avoid the First Clinic was so acute, women preferred giving birth on the streets of Vienna. Evidence of unclean streets and uneducated midwives being safer agents of childbirth than reputed hospitals and licensed physicians vexed Semmelweis. Through several attempts at eliminating possible causes, he finally deduced why this was happening.

His work was rejected, ignored and ridiculed. The very idea that doctors could infect patients they examined rubbed the medical establishment the wrong way.

He correctly guessed that in the First Clinic, which was also a medical college, as doctors moved between dissecting rooms to examining women in labour, they were carrying something with them that was infecting patients. Though he was unable to articulate what exactly the agent was, he instituted a process that would revolutionise medical science. He insisted that all doctors stepping out of the dissection room had to wash their hands with chlorinated lime before examining patients. Within days, maternal mortality from childbed/puerperal fever had dropped in the First Clinic by 90 %. A few more months later, it had dropped to zero. Semmelweis had eliminated maternal mortality caused by child bed/puerperal fever by instituting handwashing.

Such an incredible success would generally call for accolades, but strangely Semmelweis was greeted with an eponymous paradox. His work was rejected, ignored and ridiculed. The very idea that doctors could infect patients they examined rubbed the medical establishment the wrong way. Though Semmelweis hadn't published any medical and academic papers on his work for a relatively long period of time, he did maintain extensive time series data of how puerperal fever had disappeared from the maternity wards post handwashing. However, that was not considered as "scientific" evidence. When he finally published his book titled The Etiology, Concept and Prophylaxis of Childbed Fever in 1861, almost 10 years after his success in Vienna, it received unfavourable reviews. Embittered by the politics and arrogance of the medical establishment, Semmelweis grew distant from his friends and family.

The story of a brilliant but embittered doctor finally ending up in a mental asylum and dying there would have been tragic enough. But the real story behind the death of Semmelweis, meticulously reconstructed by researchers a hundred years after his death, is far more tragic. Semmelweis had been tricked into getting admitted into the asylum. When he realised what was happening and tried to escape, asylum guards subjected him to horrific beatings, which included tying him down and trampling him underfoot. He finally died of pyemia, a form of infection that spread from those very injuries, which were left untreated.

His search for a solution to maternal mortality was not only driven by his concern as a doctor, but because he couldn't tolerate his staff in the First Clinic being ridiculed

Almost 150 years later, since 2008, 15 October is celebrated across the world as Global Handwashing Day. More significantly, the word "hygiene" has entered the global agenda for the first time under the new set of Sustainable Development Goals. It is now recognised that washing hands reduces the risk of child mortality from diarrhoea and pneumonia. From celebrity endorsements to UN and corporate sponsorships, handwashing is now a mainstream development issue. It is also popular on social media as #iwashmyhands tends to trend on twitter on Global Handwashing Day.

The fact that Semmelweis's legacy is still mentioned only in passing, if at all, is a reminder that the international sanitation and hygiene sector has never really searched for heroes to motivate its practitioners. Establishing handwashing in children is definitely a challenge. Keeping community mobilisers, teachers, trainers inspired year after year, in a branch of work that has little money and glamour is quite another. As much as children, adults too need heroes and stories of their success, struggle and sacrifice to get inspired. And here's something that we can learn from Semmelweis. His search for a solution to maternal mortality was not only driven by his concern as a doctor, but because he couldn't tolerate his staff in the First Clinic being ridiculed for their perceived incompetence. He wanted to find a solution which would re-inspire respect and confidence in his staff.

That is the kind of leadership hygiene practice needs today.

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