|Winter Sunshine, Halkidiki, Greece. Photo by the author|
Ever since Pontius Pilate, the Roman governor of Judea, washed his hands before condemning Jesus Christ to death by crucifixion, this simple act of personal sanitation has been used as the figurative icon of a disclaimer, the denial of responsibility. Today, in the climate of the current COVID-19 pandemic, handwashing is not just symbolic but rather an essential part of every individual’s contribution to the collective fight against an invisible adversary. The benefit of handwashing is considered self-evident today, but it was not always so. The current pandemic brings to mind people and events that made a real change in patient outcomes.1
The place of honor in this history has to be given to the Hungarian surgeon Ignaz Semmelweis, who worked in Vienna in the 1840s. In those days childbed fever, a severe streptococcal infection immediately after childbirth, was a prime cause of mortality among newly delivered mothers. Semmelweis noticed a marked difference in mortality between the hospital wing where deliveries were handled by midwives and the one where doctors delivered their patients, the latter being the worse for outcomes. He racked his brains to figure a reason behind this phenomenon, and ended up with an idea. Doctors often moved between the morgue, where they performed post-mortem examinations, to the delivery room without washing their hands between procedures. One young doctor cut himself with a scalpel during an autopsy, subsequently developed the dreaded fever, and died. Semmelweis suspected that a miasma (meaning a dangerous vapor, and a term used before the germ theory) from the cadaveric tissues was responsible for those infections. To test this hypothesis he asked doctors to wash their hands and instruments in a chlorine solution between procedures. The efficacy of this measure was immediate and dramatic, with postnatal mortality dropping from eighteen percent down to just one percent.
Despite this obvious and spectacular success, the suggestion of Semmelweis for general handwashing caused skepticism and even ire among his contemporary colleagues. Essentially he was saying to them: “Women die because your hands are dirty.” Such a perceived insult was not easily accepted by doctors, who generally belonged to the upper social class and considered themselves clean. Semmelweis lost his hospital job, developed depression, and died in a mental asylum at the age of forty-seven. His practice finally gained acceptance years after his death with the establishment of the microbial cause of infections.
The discovery of bacteria and viruses and the role of disinfection, the widespread application of aseptic techniques in medicine and surgery, and the introduction of antibiotics and vaccines have not eclipsed the value and significance of regular handwashing as a first line of defense against the spread of infections. If we have minimized it or considered it a sign of neurotic obsession, we now must reintroduce it in our daily lives in earnest. In this way we light a tiny candle in the memory of Ignaz Semmelweis. Thousands of patients owe him their lives.
- Fleming A. Keep it clean: the surprising 130-year history of handwashing. The Guardian, March 18, 2020. https://www.theguardian.com/world/2020/mar/18/keep-it-clean-the-surprising-130-year-history-of-handwashing
ANTHONY PAPAGIANNIS, MD, MRCP(UK), DipPallMed, FCCP, is a practicing pulmonologist in Thessaloniki, Greece. He graduated from the Aristotle University of Thessaloniki Medical School. He trained in Internal Medicine in Greece and subsequently in the United Kingdom, and specialized in Pulmonary Medicine. He also holds a postgraduate Diploma in Palliative Medicine from the University of Cardiff, Wales, United Kingdom. He is a postgraduate instructor in palliative medicine in the University of Thessaly, Larissa, Greece. He also edits the journal of the Thessaloniki Medical Association, and blogs regularly.