Semmelweis’s struggle for a hand-wash

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Washing hands is a simple, low cost, and an obvious health-promoting measure. Yet, we need not one, but two days in a year to reinforce its need. 5th May every year is a World hand hygiene day, and 15th October, a global hand-washing day. In mid-19th century, a doctor named Semmelweis struggled to introduce hand-wash in hospitals. This was a struggle for a change, and women’s health replete with contempt and ridicule.

Hand-wash was a simple, yet a difficult to introduce practice. Semmelweis, a Hungarian physician-obstetrician, who vehemently promoted it, died a tragic unrecognised death. We resurrected him years later, and continue to remember him every time, we medics wash our hands.

The back story

Born in Hungary in 1818, Semmelweis initially enrolled in a law school. He switched to medicine, and graduated in 1840 from Vienna. He was a resident in an obstetrics hospital, when he made some keen observations. In previous five years, about 10% women who gave birth in the first unit died, while in second unit the figure was much lower, about 4%. Most deaths in women who had given birth were due to “child-bed fever” (known as puerperal sepsis today). Surprisingly death was rare if it was an unsupervised childbirth. For comparison, today about 0.2% mothers die after giving birth.

Innovation

Semmelweis figured out that doctors conducted deliveries in the first unit births. Doctors also conducted postmortems in the same facility. In the second unit, midwives exclusively conducted deliveries. He proposed “cadaveric contamination”, and introduced hand-washing with bleach (chlorinated water) in both facilities in 1846. Within a year, deaths dropped to almost zero. It was cleanliness that mattered. His students drew graphs, tables and illustrations and presented these at medical conferences. While his discoveries were pathbreaking, response of medical community was lukewarm.

Backlash

We often cling on to our beliefs, and resist change. In 1850s we had still not discovered microbes. “Bad-air” was a common explanation for infections, and “blood-letting” its treatment. Sanitation movement had begun in 1840s, but its basis was to get rid of “bad air” or miasma. While, microbes were yet to be discovered, many physicians felt that contagion (or contamination) can cause disease.

Around the same time, in 1854 John Snow had managed to control Cholera epidemics in London by suggesting a change in water-pump handles. On the other hand, Semmelweis struggled to convince medical community how chlorine hand-wash helps. He was met with ridicule and rejection. When even Rudolf Virchow disagreed in a medical conference, Semmelweis was distraught. Over the years, Semmelweis became angry, frustrated, and erratic. In 1865 his wife and friends lured him and got him admitted to a mental asylum in Vienna. He died in the asylum two weeks later, beaten, restrained, unsung and un-celebrated.

Recognition

In 1853-56 Florence Nightingale, a pioneer of nursing introduced hand-wash in nursing profession. She wrote in her diary in 1860 “Every nurse ought to be careful to wash her hands very frequently during the day. If her face, too, so much the better“.

In 1865, Lister introduced antisepsis in operation theatres. This was our next step of introducing hygiene in health-care. It was only twenty years later in 1885, Pasteur proved that germs cause disease. Semmelweis was indeed right. Chlorine hand-wash works.

Towards end of 19th century we had our first gloves. Today we practice hand-wash religiously in operation theatres, labor rooms, before and after performing any hospital procedures.

Global hand-washing day

About 150 years after first successful outcomes of hand washing, in 2008 we established 15th October as a Global hand washing day. This day is celebrated to renew our pledge to wash our hands, not only in the hospitals, but also in communities. Today, hand washing is most important tool to prevent sepsis, diarrheas, skin diseases, and even respiratory infections, such as H1N1 and COVID-19.

Swachh Bharat (Clean India)

Sanitation movement started in Europe in mid-19th century. In later years concepts changed from miasma to a contagion. Many infectious diseases declined in this period, even before we had our first antibiotics. Many countries in the world had their cleanliness drives in post-war years. We have two first day covers and postage stamps on such national drives. One is from Japan (1983), and another from Israel (1987).

India adopted its cleanliness drive in a mission mode in 2014. This is “swachh bharat” (or clean-India) campaign. In last few years, India has issued various postal stamps and special covers on this theme.

Hand-wash and toilets

About 2.4 million people world-wide do not have access to toilets. India tops this list. In absence of a toilet, defecation is done in open. Open defecation leads to loss of privacy, contaminates soil, and does not provide for post-defecation hand-wash. Since 2012, UN celebrates world toilet day on 19th November every year. We are on a path towards sanitation for all by the year 2030.

Today, Semmelweis must feel contented. We promote hand-wash in communities as well as hospitals. We recognise it as a simple and most effective intervention to fight epidemics. Hopefully we will learn from history, and will not relegate any other Semmelweis to ridicule and contempt.