The Washington PostDemocracy Dies in Darkness

The man who discovered that unwashed hands could kill -- and was ridiculed for it

Ignaz Philipp Semmelweis, a Hungarian doctor, discovered means against childbed fever. (AP) (Associated Press/ASSOCIATED PRESS)

Over the weekend, an image of a mustachioed man with beady eyes and a bald head and wearing an old-timey suit appeared on the homepage of Google pleading with us to wash our hands.

It was a doodle of Ignaz Semmelweis, a 19th-century Hungarian doctor who was known as the pioneer of hand-washing. He discovered the wonders of the now-basic hygienic practice as a way to stop the spread of infection in 1847, during an experiment in a Vienna hospital’s maternity ward.

But if Semmelweis were alive today, he probably would be amazed to find that billions were now hearing his pleas amid a devastating pandemic.

That’s because in his day, not even doctors cared to wash their hands. Many didn’t care to heed Semmelweis’s warnings, either.

Now, as “wash your hands” is screamed at us from the mouths of public officials, on highway billboards and from doctors around the world, the story of Semmelweis’s antiseptics breakthrough has found deeper resonance. He has been described as a martyr in life and a hero much later. His advice was finally put to good use only after he died.

As Google put it in its tribute, Semmelweis has informed "generations beyond his own that handwashing is one of the most effective ways to prevent the spread of diseases.”

“It’s unfortunate it takes a situation like the one we’re experiencing now for him to get his due,” Jordan H. Perlow, a Phoenix-based obstetrician who teaches at the University of Arizona College of Medicine, told The Washington Post. “It’s the kind of thing where, from the perspective of the year 2020, you look back and think, ‘How could something as fundamental and basic and primitive as washing one’s hands be looked at in such a negative way?’ ”

Semmelweis, born in Hungary in 1818, started working at Vienna General Hospital’s maternity clinic in 1846 after graduating from medical school. Before long, he became deeply unsettled by the extraordinarily high maternal mortality rate in one of the wards.

In the ward that was staffed by physicians and medical students, 13 to 18 percent of new mothers were dying of a mysterious illness known as the childbed fever, or puerperal fever, according to a BMJ article summarizing his research. By comparison, in the ward staffed by midwives, about 2 percent of women died of the fever. No one knew what explained the extreme discrepancy.

So Semmelweis started digging. He scrutinized everything from the climate to the crowds at each maternity clinic, trying to pinpoint factors that might cause a spike in fever cases at one. But the only obvious difference was the midwives.

What were the doctors doing to the women that midwives weren’t?

“Everything was in question; everything seemed inexplicable; everything was doubtful,” he wrote in his book in 1861, “The Etiology, Concept and Prophylaxis of Childbed Fever.” “Only the large number of deaths was an unquestionable reality.”

Finally, he made a startling realization. A fellow doctor died of what appeared to be a case of childbed fever after cutting himself with a scalpel that had been used during an autopsy of one of the women.

The physicians, Semmelweis realized, had been dissecting infected cadavers with their bare hands. Then, with those same contaminated hands, they were delivering babies.

“They were inoculating their patients with bacteria,” Perlow said. “They were basically immersed in pus for hours.”

The science of bacteria was not yet understood. But Semmelweis was getting close to his answer. He believed the autopsy physicians must be carrying around invisible particles of “decaying animal-organic matter” on their fingers. So he required anyone examining a woman in the labor room to wash their hands in a chlorinated lime solution before entering, especially those who had just touched dead bodies.

Within months, the results of this simple hygienic change were apparent and astounding. The maternal mortality rate dropped to 1 to 2 percent, matching that of the women in the midwives’ ward.

Could the simple act of washing hands really be responsible for saving all those lives?

To some of Semmelweis’s colleagues in the medical community, it sounded crazy.

Dana Tulodziecki, a philosophy of science professor at Purdue University, told The Post that it sounded radical to some because of the prevailing ideas about how diseases spread. Back then, she said, people believed in the “miasma theory,” that wafting toxic odors were largely responsible for spreading diseases through the air. If people cared about washing their hands in earlier decades, she said, it was because they were trying to get rid of the smell, not the particles.

Now Semmelweis was claiming that those invisible particles on doctors’ hands were to blame.

“Nobody was pleased to think that doctors were responsible for killing all these women,” Tulodziecki said. "Nobody liked that. Especially because the ward with the midwives had a lower mortality rate, but of course the doctors were supposed to know much more than them.”

Still, Tulodziecki stressed that Semmelweis was not alone, or first, in identifying the possible link between childbed fever and unsanitary practices by physicians. Most notably, Oliver Wendell Holmes Sr. wrote a paper suggesting that the link in 1843, and James Young Simpson in Britain also independently studied it around the same time as Semmelweis, Tulodziecki said. But in the broader medical community, Semmelweis had a messaging problem. He couldn’t seem to communicate why hand-washing solved the problem.

Perlow said he did not speak German well, so he largely shied away from speaking about his findings at medical conferences or writing about them in medical journals. He left spreading the hand-washing gospel to his colleagues at the hospital who saw its benefits firsthand. But his superiors despised and ridiculed him, writing off his research altogether as they clung to the miasma theory, and in 1849, he was let go.

As the BMJ article noted in 2004, it didn’t help that Semmelweis went around insulting those with differing viewpoints and “accusing superiors of causing the deaths of mothers.” He did not publish his findings at length until 1861,14 years after his experiments, a book that critics including Tulodziecki have described as unfocused and lacking in rigorous scientific reasoning.

By 1865, after suffering a mental breakdown, Semmelweis was admitted to an asylum. He died of sepsis shortly thereafter at age 47, after a wound on his hand became infected. Theories of what happened to the doctor toward the end of his life have varied, ranging from beliefs that the rejection he experienced within medical circles may have contributed to his mental decline, or that he suffered from early-onset dementia.

Years after his death, after the development of the germ theory of disease, and after more advances in the field of antiseptics, Semmelweis’s research was finally accepted.