Advances in medical science, especially patient care, have been a long road fraught with obstacles. Unfortunately, many of these obstacles were erected by the established medical professionals of the day.
It was once orthodoxy that all diseases were the result of the four humors residing in the human body: blood, black bile, yellow bile, and phlegm. This unfounded dogma persisted in the medical training of the past.
A healthy individual would have a perfect balance of these four humors. The reverse was true, an unhealthy individual would have an imbalance which resulted in the various maladies affecting the body and mind.
To complicate matters these humors were as unique as each man, woman, and child on this planet traversing the cosmos. This uniqueness made treatment specious and based on a set of procedures which resulted in many patients dying or suffering needlessly because of accepted practice.
When individuals did arise to challenge the status quo, the old guard, with their unyielding influence and societal prestige, chose either to ignore them or suppress their unprecedented ideals. The old guard was very intractable in their thinking.
So, it was with a young doctor by the name of Ignaz Philipp Semmelweis who, based on observations and personal research, concluded that washing hands and instruments before treating patients would reduce the infection and death rate. In Vienna in the 1840s mainly the young doctors saw the value of his methods, but as is usual in these circumstances, Semmelweis’ superiors were not impressed by this Hungarian upstart and undoubtedly ethnic prejudice and his age played major roles in rejection of him personally and of his sterilization methods.
Physicians viewed themselves as gentlemen (sometimes as gods). For them to stoop to washing their hands constantly was perceived as inglorious based on their arrogance of station and societal norms.
The Hippocratic Oath which required that a physician abstain from deleterious and mischievous practices regarding their patients was easy to ignore in the times of yesteryear based on erroneous assumptions. Unfortunately, there are times today when patients are not given the level of care necessary for their well-being.
Doctor Semmelweis’ life ended on August 13, 1865 at an asylum in Vienna. Cause of death was blood poisoning from a beating he received at the asylum when he attempted to leave.
He was 47. However, his legacy continues.
“When I look back upon the past, I can only dispel the sadness which falls upon me by gazing into that happy future when the infection [puerperal fever] will be banished. But if it is not vouchsafed for me to look upon that happy time with my own eyes … the conviction that such a time must inevitably sooner or later arrive will cheer my dying hour.”
COVID-19 had once again reminded us that hand washing is not a nuisance or a mother’s plea before eating but a necessity to maintain health of ourselves and others. Hygiene etiquette should be a part of our daily routines as we live in a world of increasing hostility from the pathogens hovering in the miasma waiting for their opportunity to unleash their virulent strains of miseries.
G. D. Williams © 2020
Links and References:
Dyscrasia: Any disease condition, especially in hematology, as in “blood dyscrasias.” The term “dyscrasia” was borrowed from the Greek meaning “a bad mixture” referring to the ancient belief that an imbalance between the four humors – blood, phlegm, yellow bile, and black bile- which caused disease. https://www.medicinenet.com/script/main/art.asp?articlekey=22642
Hygiene Etiquette & Practice
Hygiene is typically thought of in terms of proper handwashing, body washing, and facial cleanliness. Although these practices are essential to overall cleanliness and interrupting the spread of disease, another component of good hygiene consists of practicing good hygiene etiquette.
July 1, 1818-August 13, 1865
This is the story of Doctor Ignaz Semmelweis, who in the 19th Century fought to convince his fellow doctors that washing their hands could save patients’ lives. But despite the success of his theory, he met a tragic end.
Video by Fernando Teixeira & Izabela Cardoso
Semmelweis observed that, among women in the first division of the clinic, the death rate from childbed fever was two or three times as high as among those in the second division, although the two divisions were identical with the exception that students were taught in the first and midwives in the second. He put forward the thesis that perhaps the students carried something to the patients they examined during labour. The death of a friend from a wound infection incurred during the examination of a woman who died of puerperal infection and the similarity of the findings in the two cases gave support to his reasoning. He concluded that students who came directly from the dissecting room to the maternity ward carried the infection from mothers who had died of the disease to healthy mothers. He ordered the students to wash their hands in a solution of chlorinated lime before each examination.
Under these procedures, the mortality rates in the first division dropped from 18.27 to 1.27 percent, and in March and August of 1848 no woman died in childbirth in his division. The younger medical men in Vienna recognized the significance of Semmelweis’ discovery and gave him all possible assistance. His superior, on the other hand, was critical—not because he wanted to oppose him but because he failed to understand him.
Semmelweis was born on 1 July 1818 in Buda, Hungary, which in 1837 combined with Pest to form Budapest. He was the fifth child born to Teresia Müller and Josef Semmelweis, Jewish immigrants to Hungary from Germany. His parents were storekeepers that earned enough money to give their eight children an education. Growing up, Semmelweis spoke German at home instead of Hungarian. Semmelweis attended grammar school in Buda, and he finished his primary education at the Catholic Gymnasium of Buda in 1835. After his primary education, Semmelweis left Buda in 1837 to study law at the University of Vienna in Vienna, Austria. Semmelweis studied law on the advice of his father. In 1838, after attending an anatomy class with a medical student, Semmelweis transferred to the University of Pest, later called Eötvös Loránd University in Budapest, Hungary, and began studying medicine. In 1840, Semmelweis returned to the University of Vienna and obtained his doctorate of medicine in 1844. Semmelweis missed his graduation ceremony because his mother died and he returned to Buda for her funeral.
After receiving his medical degree in 1844, Semmelweis completed a master’s degree in midwifery and received training in surgical procedures at the Vienna General Hospital in Vienna. Afterwards, the hospital appointed Semmelweis to the maternity ward as an assistant to physician Johann Klein in 1846. Semmelweis’s examined patients, assisted in obstetrical surgical procedures, taught obstetrics students, and organized clerical records. The Vienna General Hospital was a lying-in hospital, meaning that after pregnant women gave birth there, they stayed at the hospital for a few days to recover, even if there were no medical complications during delivery.
On this date in 1850, a prickly Hungarian obstetrician named Ignaz Semmelweis stepped up to the podium of the Vienna Medical Society’s lecture hall. It was a grand and ornately decorated room where some of medicine’s greatest discoveries were first announced. The evening of May 15 would hardly be different — even if those present (and many more who merely read about it) did not acknowledge Semmelweis’s marvelous discovery for several decades.
What, exactly, was the doctor’s advice to his colleagues on that long ago night? It could be summed up in three little words: wash your hands!
Known as the “father of infection control”, Dr Ignaz (or Ignac) Semmelweis (fig 1) was a Hungarian born physician who received his MD degree in Vienna in 1844. In 1847 he was given a 2 year appointment as an assistant in obstetrics with responsibility for the First Division of the maternity service of the vast Allgemeine Krankenhaus teaching hospital in Vienna.4 There he observed that women delivered by physicians and medical students had a much higher rate (13–18%) of post-delivery mortality (called puerperal fever or childbed fever) than women delivered by midwife trainees or midwives (2%).
This case-control analysis led Semmelweis to consider several hypotheses. He concluded that the higher rates of infections in women delivered by physicians and medical students were associated with the handling of corpses during autopsies before attending the pregnant women. This was not done by the midwives. He associated the exposure to cadaveric material with an increased risk of childbed fever,5 and conducted a study in which the intervention was hand washing.
The text of the Hippocratic Oath (c. 400 bc) provided below is a translation from Greek by Francis Adams (1849). It is considered a classical version and differs from contemporary versions, which are reviewed and revised frequently to fit with changes in modern medical practice.
I swear by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation—to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this Art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!