Doctor Curmudgeon® Just Wash Both Hands!

By Diane Batshaw Eisman, M.D. FAAP Doctor Eisman, is in Family Practice in Aventura, Florida with her partner, Dr. Eugene Eisman, an internist/cardiologist

When I was young and a tad less cranky, I played the piano. I would rush to my piano, only to be stopped by my mother. “Have you washed your hands?” Sometimes I would actually answer ‘yes.’ However, like most children, my hands were frequently grimy and this reminder was not unwelcome to me.

Unlike my response to my mother’s gentle admonition, Dr. Ignaz Semmelweiss did not find the same acceptance of his own ideas. I simply washed my grubby hands. Scientists of his day initially refused to accept his exhortations.

Ignaz Semmelweis was a Hungarian physician. He graduated with a medical degree from the University of Vienna in 1844. At that time, women were dying in childbirth in vast numbers. The mortality rate was almost thirty percent.

Childbed Fever (Puerperal fever) was a bacterial infection of the reproductive tract and could occur up to ten days after delivery.

Dr. Semmelweiss observed that the maternal death rate was far greater in maternity clinics staffed by doctors than in women who gave birth at home. Home births were attended by midwives

Many theories of Childbed Fever were proposed but the cause remained a puzzle.

It was in 1847 that Semmelweiss read the postmortem report of the death of a friend of his. His colleague was Dr. Jakob Kolletschka who had died of ‘blood poisoning” after he cut himself while performing an autopsy. Semmelweiss came to the realization that many of his friend’s symptoms were identical to those of women who had died from Childbed Fever. In those days, it was not uncommon for doctors to go from performing postmortem exams immediately to attend women in labor.

He made the connection that women who gave birth at home with midwives had a far lower mortality rate. This was an important clue for Dr. Semmelweiss. He realized that Doctors in maternity clinics did autopsies and midwives did not.

He then instituted handwashing with a solution of chlorinated lime before examining pregnant women. This simple procedure resulted in a dramatic decline in mortality rates.

But his method of antiseptic hand washing was in conflict with the medical theories of the day and not well accepted. And because he was so irritatingly insistent about handwashing, he lost his post in Vienna where he practiced at that time. Physicians at the hospital could not believe that doctors were the cause of this horrible infection. The current belief was that something called miasmas were spread through the air and caused significant mortality. There were those who faulted Semmelweiss himself for his colleagues’ lack of acceptance of his theory; a theory, which was quite obvious to Semmelweiss. He was outspoken and other physicians were offended that he should continue to admonish them to just wash their dirty hands.

Unfortunately, it was many years later before his method achieved widespread acceptance. It was not until Luis Pasteur confirmed the germ theory of disease and Joseph Lister began to operate using Semmelweiss’s techniques of hygienic handwashing that hand sterilization became commonplace.

As Dr. Semmelweiss said, “My doctrines exist to rid maternity hospitals of their horror to preserve the wife for her husband and the mother for her child.”

Many lives would have been saved if Semmelweiss’ superior at the hospital in Vienna would have listened to him as I listened to my mother. “Wash your hands.”

Dr. Curmudgeon suggests “Bitter Medicine”, Dr. Eugene Eisman’s story of his experiences–from the humorous to the intense—as a young army doctor serving in the Vietnam War.

Bitter Medicine by Eugene H. Eisman, M.D. –on Amazon

Doctor Curmudgeon® is Diane Batshaw Eisman, M.D., a physician-satirist. This column originally appeared on SERMO, the leading global social network for doctors.

SERMO www.sermo.com “talk real world medicine”

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