Why did doctors refuse to wash their hands until almost the 20th century?

Today it seems obvious to us, a matter of common sense. And with the arrival of the coronavirus, much more, to the point that it has become a ritual that we perform about twenty times a day at home. The media lately at all hours: “Washing your hands is more effective than restricting travel to stop the epidemic”, “The technique to wash your hands correctly and prevent them from drying out”, “Coronavirus: 30 seconds that save your life” or “Google remembers how you have to wash your hands in the middle of the coronavirus crisis.”

It wasn’t until the second half of the 19th century, however, that doctors in the United States and Europe began to wash and disinfect their hands carefully before examining their patients or going into the operating room. And at that time they were still an exception. We had to wait until a few years before the 20th century arrived for this routine – one of the best ways to prevent the spread of all kinds of infections and viruses – to become an obligation for all members of the health staff.

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One of the first advocates of the need to wash their hands was Ignaz Semmelweis, a Hungarian doctor born in 1818 in Buda (now Budapest), who, after finishing his studies, specialized in maternity and ended up practicing at the Vienna General Hospital between 1844 and 1848. At that time it was one of the largest centers in the world when it comes to teaching, with such a large department dedicated to its specialty that it was divided into two rooms: one for doctors and their students and another for midwives and their students.

The “infant fever”
Their stay in the Austrian capital coincided with the appearance of a mysterious and little-known infection, which they called “childhood fever.” A disease that began to significantly increase the deaths of first-time mothers in maternity wards across Europe. At that time, all the doctors in the world, including Semmelweis, were not in the habit of washing their hands during the interventions, as they considered it an irrelevant protocol and without consequences for the sick.

According to an article by Irvine Loudon published in “Journal of the Royal Society of Medicine”, in 2013, the maternal mortality rate in that midwife ward was, between 1840 and 1846, 36.2 per 1,000 births, while in the doctors’ room reached 98.4. Semmelweis realized this and began to look for differences between the two wards, to find out why this streptococcal infection affected more patients in one plant than those in the other.

One of the first differences he observed was that a priest regularly went to the doctors’ room to ring a bell as the last sacrament for dying women, recalls Dana Tulodziecki in her article “Destroying the Semmelweis Myth” (2013) published in the magazine “Philosophy of Science”. This professor of philosophy at Purdue University, in Indiana, says that Semmelweis wondered if the women died “from the psychological terror caused by hearing that bell, even if they were not really dying, since it reminded them all the time that they could be next ». So the doctor sent the priest to the other room to fulfill his mission, but the rates obviously did not change.

Semmelweis had his light bulb turned on in 1847, when one of his colleagues at the Vienna Hospital, Jakob Kolletschka, died after he cut his finger with the scalpel of a student with whom he was performing an autopsy. He died several days after an agony during which he showed the same symptoms as the victims of “infant fever”. Then he wondered if the doctors’ room could be affected by an infection similar to the one that had killed his partner.

He then found that, unlike midwives, doctors sometimes examined their patients after performing autopsies without washing their hands or doing it in a very superficial way, without the right product. “Although the role of microorganisms in this type of infection had not yet been discovered at that time, Semmelweis understood that the“ cadaveric matter ”that the student’s scalpel had introduced into Kolletschka’s bloodstream had been the cause of the fatal outcome. And the similarities between the course of Kolletschka’s ailment and the women in his clinic led him to the conclusion that his patients had died from blood poisoning of the same type: he, his colleagues, and medical students had been the carriers of the infectious matter, because he and his team used to come to the wards immediately after performing dissections in the autopsy room, and often retained a characteristic smell of dirt ”, defends Elías Mejía in his work“ Metodología de la scientific research »(Universidad de San Marcos, 2005).

Semmelweis tested his theory on the belief that fever could be prevented by chemically destroying infectious material attached to hands. He then ordered all the students to wash them with a chlorinated lime solution before recognizing any sick. Just then, mortality began to decrease and, in 1848, it fell to 1.27% in the first room and 1.33% in the second. This, in addition, demonstrated that the mortality in the department of the midwives was lower, since they did not dissect corpses.

Routine washing
To expand their hypothesis, Semmelweis and her collaborators examined a woman in labor with ulcerated cervical cancer after carefully disinfecting her hands. And then they proceeded to examine 12 other women in the same room without disinfecting them again. Result: 11 of them died of “childhood fever”. The Hungarian doctor concluded that this disease could be caused not only by “cadaveric matter”, but also by “putrid matter from living organisms”.

When he released the results of his research in the 1960s, most hospitals refused to adopt his policies on hand washing and proper disinfection. And the controversy it generated was not small. According to Tulodziecki, the story is much more complex. “The doctors were not very happy with the fact that Semmelweis pointed them out as responsible for killing all these women. And when he finally published “The etiology, concept and prophylaxis of puerperal fever” in 1860, the truth is that it was not very well written and seemed to ramble on various aspects[…]. In general, it could have improved his arguments, “he writes in his article.

For example, the one who said that “infant fever” was also caused by the decomposing bodies of animals, which made no sense. This infection had arisen many years before in homes, where women used to give birth, and reproduced in the Hospital of Vienna, but in neither place there was, obviously, any cadaveric animal matter or decomposing meat. Semmelweis, too, was a very stubborn, very dogmatic person, and he vehemently insisted that the only way to reduce childhood fever was to make sure that doctors wash their hands after autopsies. Something not all of his colleagues agreed on.

Florence Nightingale
In any case, Semmelweis was not alone in the battle. In the mid-19th century, there were other toilets who realized that the hygiene of professionals could have some effect on their patients. In 1843, the American physician Oliver Wendell Holmes published an article arguing that doctors could transmit “infant fever” to their patients if they were treated with dirty hands. And British nurse Florence Nightingale, considered the founder of modern nursing, wrote in her book “Notes on nursing: what is and what is not” (1859) that “every nurse should be careful to wash their hands frequently during the day ».

Despite the almost solitary effort of these toilets, the importance of handwashing was not fully understood by doctors and nurses until Louis Pasteur released his “Germ Theory of Infectious Diseases.” That is, the one that revealed that certain diseases and infections are caused by microorganisms so small that they cannot even be seen with the naked eye. He himself suggested in 1871 to the doctors of the military hospitals that the surgical instruments and the bandages be boiled before using them. In most, these hygienic precautions were still not followed.

One of the surgeons who followed his recommendations was the British Joseph Lister, who died in 1912, who developed Pasteur’s ideas and is now considered the father of modern antisepsis. He made radical changes in operations, forcing doctors to wash their hands and use gloves and sterile surgical instruments, as well as to clean the wounds with carbolic acid solutions to kill the microorganisms. Before, going through the operating room was almost a sentence of gangrene and death.

Today, healthcare professionals consider hand washing to be a critical hygienic practice for both themselves and their patients. Guidelines are even provided in hospitals on how to do it properly. There is even an International Hand Washing Day (October 15) established by the UN, which warns that more than 200 diseases can be spread through the hands. In addition to respiratory infections and diarrhea, other feco-orally transmitted diseases, such as cholera, hepatitis, dysentery, or giardiasis; and viral infections, such as rashes, conjunctivitis, and mouth and throat infections, among many others. .

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