Thread by @vagina_museum

Hand washing has been a hot topic recently due to coronavirus so we thought we'd share the story of the obstetrician who pioneered hand washing...

And how it eventually lead to his descent into madness....

Ignatz Semmelweis was a Hungarian doctor appointed to Vienna General Hospital in 1846. He worked in an obstetric clinic specifically built to be free of charge so that in exchange the women agreed to have students learn from them.

There were two clinics - one for training doctors and one for training midwives. The clinics admitted patients on alternate days.

There was a problem though. The maternal mortality rate in the doctors' clinic was 3 times higher than the midwives' one. And the women knew this.

They did everything they could to be admitted to the midwives and avoid the doctors' clinic, even going as far as giving birth on the street rather than seeing the doctor.

The major killer was puerperal fever, also known as childbed fever, and the women who gave birth on the street got it *less* than the women giving birth in the doctor's clinic, that's how bad the doctors' clinic was.

The huge difference in mortality between the clinics distressed Semmelweis. He absolutely had to get to the bottom of this.

He ruled out as many causes as he could, and came to the conclusion that there was really only one major difference. One was used for training doctors and one was for training midwives. 🤷‍♀️

The breakthrough happened when a friend and colleague, Jakob Kolletschka, was accidentally cut during an autopsy by a student's errant scalpel...

An autopsy of Kolletschka was done and it showed that he died of...

Puerperal fever.

A man, who had never come anywhere near giving birth, died of childbed fever.

The cogs whirred into place in the mind of Semmelweis. This was before germ theory (the idea that disease is spread by microorganisms) had really taken off, so he had to make a theory of his own.

He concluded that something was being transferred between the bodies of the women who'd died and the doctors doing their autopsies, and then that disease-causing thing was being transferred to the women on the ward.

This was why there was the difference in death rates between the clinics.

Midwives didn't do autopsies.

Semmelweis started a strict regime of doctors washing their hands with chlorinated lime between autopsies and seeing patients.

It lead to a reduction of deaths from 18% to 2% 😮

In 1848, there were at least two calendar months where there wasn't a single death.

Semmelweis became extremely severe when it came to cleanliness, and extended the washing to the instruments too, which further halved the death rate.

When Semmelweis moved to a hospital in Hungary (he was dismissed in Austria, probably for political and xenophobic reasons. Google it, there's only so long this thread can be) he even managed to replicate his results reducing the maternal mortality rate to less than 1%.

But the doctors didn't like it one bit.

The medical establishment was extremely reluctant to accept his new theory, even though the evidence was undeniable.

They still didn't believe his theories when he left the hospital in Hungary, and the death rate increased by 600%, probably because they stopped washing their hands.

Why didn't they believe it? Many factors probably. Firstly, people find it hard to accept a new theory that contradicts what they already believe, especially one that requires you to change your behaviour.

At the time, it was thought disease was caused by bad smells, or imbalanced humours, not tiny particles that live on dead bodies.

Also, Semmelweis didn't really understand why hand washing worked, he just knew it did. This lack of explanation rubbed some doctors the wrong way.

They also didn't like the idea that their hands were unclean. Doctors tended to be middle class gentlemen, and it's likely the posh Austrian men didn't like this Hungarian coming in and telling them they were dirty.

Semmelweis eventually became obsessed with cleanliness. It is easy to see why - perhaps the death of his friend could have been prevented if he only knew about hand washing before?

He would write angry and rude letters to obstetricians across Europe, even accusing them of being murderers, because they would not accept his theory.

His behaviour changed over the years, he was filled with vitrole and became an alcoholic, all while still fighting for his hygiene theory to be accepted. His obsession and behaviour became so alarming to his loved ones that they agreed something had to be done.

Historians are unsure of what lead to this change in behaviour. It may have been stress and grief, but might also have been late stage syphillis or dementia.

In 1865, his friend tricked him into going to a mental institution. When Semmelweis realised what was happening, he tried to run. The guards beat him into submission and admitted him.

Two weeks later, Ignatz Semmelweis died.

Rather ironically, of an infection.

He sustained many wounds from the guard's beating, and it's likely they would not have been cleaned.

It was only years later, when germ theory had become established, that people started to realise why Semmelweis was so pioneering.

So there you have it. Hand washing is perhaps one of the greatest medical advancements in recent history and now you know who to thank - Ignatz Semmelweis and the pregnant women of Vienna.

Now go forth and wash those hands!