Hand Washing

The story of Semmel Weis and the introduction of hand washing to save maternal lives

Despite the evidence that handwashing prior to patient examinations had contributed to a dramatic reduction in puerperal fever, Semmelweis encountered vehement resistance from the medical establishment, where many practitioners were reluctant to accept their role in disease transmission and recoiled at the suggestion of handwashing.

He was eventually dismissed from his position at the Vienna General Hospital in 1849. This dismissal came as a significant blow to his career and reputation. 

Following his dismissal, Semmelweis faced severe mental health challenges, possibly from a syphilis infection he acquired during his research into infectious disease. He struggled with depression and was committed to a mental institution in Vienna. ~ Circlesofmamas

This pubmed article from 2022 confirms the history of handwashing and the reality that this simple step is still often one missed in clinical settings:

Handwashing is a simple method for preventing the spread of pathogens. It is now common practice, but this was not always the case. Advocating for it often costed a doctor his career in the 1840s. Hospitals in the early 1800s had little idea of the significance of hygiene; thus, they were often mocked as disease-producing incubators or as "houses of death." Many of the ill and dying were kept on wards with no ventilation or access to clean water; hospitals were found to offer only the most basic care. The mortality rate for patients admitted to hospital was three to five times greater than that for individuals cared for at home. Doctors did not routinely wash their hands until the mid-1800s, and they would proceed straight from dissecting a corpse to delivering a baby, providing the basis for the spread of puerperal fever. Despite advances in modern medicine, healthcare providers still face the issue of infection outbreaks caused by patient care. While the body of scientific data supporting hand hygiene as the key strategy to prevent the spread of pathogens is substantial, we highlight that achieving this crucial, long-awaited breakthrough was a hard task through history.

It turns out, that despite the idea of medicine being based on rational thought, this study concluded doctors aren’t rational after all. In this study concluded logic and reasoning alone don’t change a physicians behavior:

Conclusions: Hand hygiene is more experiential than rational. Findings suggest that certain promotional strategies appealing to the experiential thinking mode may improve compliance, and that traditional approaches based on logic and reasoning alone probably will not work.

What issues in healthcare might be guided more by habit, emotion, or establishment head-in-the-sandness that is not evidence based? Whether it’s access, attitudes toward people of color or feelings and/or policies around masking and other health initiatives, I can name quite a few I have observed secondhand as a physician’s wife.

Let’s return to the history of handwashing for a moment and consult PBS:

According to PBS,

Historians are quick to remind that Semmelweis was not the first physician to make this clinical connection, one that many expectant mothers of the era called “the doctors’ plague.” For example, the obstetrician Alexander Gordon of Aberdeen, Scotland, suggested in his 1795 Treatise on the Epidemic of Puerperal Fever that midwives and doctors who had recently treated women for puerperal fever spread the malady to other women. More famously, in 1843 Oliver Wendell Holmes, the Harvard anatomist and self-proclaimed “autocrat of the breakfast table,” published “The Contagiousness of Puerperal Fever,” in which he discerned that the disease was spread by physicians and recommended that actively practicing obstetricians abstain from performing autopsies on women who died of puerperal fever as one of their “paramount obligations to society.”

What is interesting is that PBS notes the accuracy of the expectant mothers who called it out for what it was, yet in the same sentence, give credit to obstetrician Alexander Gordon of Aberdeen. Why not simply give credit to the expectant mothers who had common sense, yet were not board certified in not washing your hands, which contributed to the unnecessary deaths of many women? Why is it so hard to admit that young, middle age and old wives tales are often closer to the truth than establishment norms, however stubbornly held they may be?

Yet although Igor Semmelweis at least has had his voice restored to him post mortem, the women who were onto the truth from common sense and intuition remain silenced today, except for as a footnote in a PBS article.

How many times to patients - whether women, men or children - have a better clue than the establishment what might be causing their symptoms/side effects, but there is a strong bias to dismiss their concerns if they fall in certain categories where such correlations have already been dismissed or minimized or even gaslighted to the extreme in order to shutdown the conversation? Correlation isn’t causation. But sometimes common sense tells a clearer story than a study that has been manipulated to hide certain unwanted results. Always look at studies closely. Look for structure. Look for who funded the study. Look for how long it was run with double blinding, if double blinding was done at all. Was a pseudo virus or a live virus used, if a virus was involved? What were the endpoints and were they clinically relevant and/or reliable as indicators of safety and effectiveness? Were the amount of participants removed due to protocol deviations is the same for control and treatment groups? Is the raw study data material available? Has the study been repeated and is it repeatable by a third, independent party?

Once I met a pair of grad students tending the arboretum where I live. I asked what experiments the university is involved with conducting in this space.The grad student pair told me that mostly they are testing different chemicals to use to combat invasive species. They told me The Gates fund a lot of this work and they bias the results.

This happens in healthcare too! Ethics requires that we use our hearts in service to our souls, so that our bodies can thrive in service to our hearts and souls!