Wash your hands....

While we were attending to inducing anesthesia for the next patient, our Consultant Surgeon - Dr R D Yapa- popped a question to us as usual.
"Who discovered Antisepsis?". Chandaná was quick to answer "Joseph Lister...". We nodded in agreement. "No.. It's Semmelweis" & we've never heard of a 'Semmelweis' until now.

That's how I found about an ugly chapter in "The Art of Medicine".

Ignaz Philipp Semmelweis (July 1, 1818 - August 13, 1865), was a Hungarian doctor who practiced under Klein, Professor of Obstetrics at Lying-in Hospial, Vienna.

He noticed that,

• the neonatal death rate due to Puerperal fever (childbirth fever) was 13% in his unit compared to 2% in the other unit in the same hospital
• his unit was managed by doctors & medical students & the other unit was managed by midwives
• his colleague Jakob Kolletschka died of similar symptoms after he cut his finger accidentally during a post mortem.
• women admitted with "street-births" (who had delivered in the streets) had lower fever rates compared to his unit's
• student doctors attended to autopsies & then to women in delivery

With these observations in 1847, he introduced a new rule that everybody must wash their hands with chlorinated lime before examining patients & later on added the instruments also to be washed. Death rate felt immediately to 2% which was comparable to the other ward.
The ugly chapter starts here. Semmelweis was not keen to report his findings to his superiors & was eventually dismeissed from his post by Prof. Klien. He returned to Hungary in 1850 & worked in St. Rochus Hospital in Pest.
He published his work in a book in 1861, "The aetiology, understanding and prevention of childbed fever" (Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers). It was accepted by Hungarian government, even though it was widely criticised by German speaking doctors in Vienna. Even Viennese Medical Journal editorial reminded its readers "It was time to stop the nonsense about the chlorine hand wash".
He suffered a nervous breakdown and was admitted to a insane assylum & died 2 weeks later.
Cause of his death is speculated to be due to infection he received from a wound during autopsy. But the real cause was found to be something else. He had become violent while in the assylum & was beaten by assylum personnel. He died due to injuries received, in a fortnight.
Only in 1867 Joseph Lister introduced Carbolic Acid spray for asepsis. The scientific growth in asepsis had been halted for 20 years.

I remembered, during a class in Microbiology when I was a medical student, the lecturer told, "Wash your hands, that's the single most important action to prevent infections"

Further readings:

• http://en.wikipedia.org/wiki/Ignaz_Semmelweis
• http://general-anaesthesia.com/images/ignaz-semmelweis.html
• http://www.np.edu.sg/~dept-bio/ssm/news/apr_jun99/ignaz.htm
• http://inventors.about.com/library/inventors/blantisceptics.htm
• http://www.uh.edu/engines/epi622.htm