Public Health · 1847
Hand washing prevents childbed fever
Ignaz Semmelweis
In the 1840s, puerperal fever killed women on maternity wards at rates that physicians accepted as more or less inevitable. Vienna General Hospital had two adjacent maternity divisions: the First, staffed by medical students and physicians who also performed autopsies, and the Second, staffed by midwives who had no contact with the morgue. The mortality disparity between them was well known and generated considerable anxiety among pregnant Viennese women, many of whom begged to deliver in the midwife ward or feigned labor pains to avoid the doctors' division. The First Division's mortality from puerperal fever ran between 10 and 18 percent; the Second's ran below 4 percent.
Ignaz Semmelweis, a Hungarian-born obstetrician working as an assistant in the First Division, was struck by the death in 1847 of his colleague and friend Jakob Kolletschka. Kolletschka died of an overwhelming septic illness after a student's scalpel nicked his finger during an autopsy. The pathological findings at Kolletschka's autopsy were, Semmelweis noticed, essentially identical to those of women who died of puerperal fever. He concluded that physicians were carrying lethal cadaverous particles from the autopsy table to the delivery room on their hands.
Starting in May 1847, Semmelweis required all staff on the First Division to wash their hands in a chlorinated lime solution before examining any patient. The effect was rapid: mortality on his ward fell from roughly 10 percent at the start of the intervention to well under 2 percent by the end of the year. The adjacent midwife ward, where no change was made, continued at its baseline rate. The intervention worked despite the fact that Semmelweis had no germ theory to explain it; he could only describe the contamination in vague terms of "cadaverous particles."
The lack of a mechanistic explanation contributed heavily to the rejection he encountered. Several senior Viennese colleagues dismissed the theory, and when Semmelweis left Vienna in 1850 for a post in Budapest, adoption of the protocol stalled. He published his complete data and arguments in "Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers" in 1861, a work that was largely ignored by the European medical establishment during his lifetime. Semmelweis died in a Vienna asylum in August 1865, possibly of the same type of infection he had spent his career trying to prevent.
Pasteur's work on germ theory in the early 1860s and Lister's antiseptic surgery in 1867 finally provided the conceptual framework that made Semmelweis's mortality data legible to his profession. His chlorinated lime protocol is now recognized as the first documented controlled intervention demonstrating pathogen transmission via contaminated hands, a finding that remains the basis for hand hygiene in clinical settings.
Key People
- Ignaz Semmelweis — Obstetrician at Vienna General Hospital who instituted mandatory hand washing
- Jakob Kolletschka — Colleague whose fatal autopsy-wound infection prompted Semmelweis's investigation
Vienna General Hospital, 1847
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