Until the 1850s, Doctors Would Go from Dissecting a Cadaver to Delivering a Child Without Washing Their Hands

Hand washing critical in fight against coronavirus

Until the mid-1800s, doctors didn’t bother washing their hands – they would go from dissecting a cadaver to delivering a child. Then a Hungarian medic made an essential, much-resisted breakthrough.

As one of the few things we can do to significantly stop the spread of coronavirus while out in the infectious world, the new rules for this everyday habit have become the meme du jour.

It seems this kind of pandemic event is kind of like being a passenger on the Titanic and watching it all unfold. It also feels like going back to the early 20^th century, when infectious diseases such as tuberculosis and smallpox were the No. 1 cause of death, and the new science of germs had led to the first mass obsession with hand hygiene.

Religious hand washing rituals have been around for thousands of years in Islamic, Jewish and other cultures, but the notion of disease spreading by hand has been part of the medical belief system for only about 130 years.

However, the first recorded discovery of hand washing‘s life-saving power came 50 years earlier, in 1818, as a huge, unwelcome shock.

If there had to be a father of hand washing it would be Ignaz Semmelweis (The Hand Book: Surviving in a Germ-Filled World 2016). While working at Vienna General Hospital, the Hungarian doctor was at the forefront of a more scientific approach to medicine.

Faced with a doctor-led maternity ward in which maternal deaths from the dreaded childbed fever were significantly higher than in the midwife-run clinic there, he racked his brain for clues as to why.

Germs were yet to be discovered, and it was still believed in the 1840s that disease was spread by miasma – had smells in the air – emanating from rotting corpses, sewage or vegetation.

Victorians kept their windows firmly shut against such malevolent forces.

So it didn’t seem a problem that trainee doctors at Vienna General would hang out in the morgue dissecting corpses to figure out what had rendered them dead and then pop up to the maternity ward to deliver a baby without washing their hands.

One of them accidentally got cut by a scalpel during a dissection and died, seemingly of the same childbed fever the mothers had been getting.

Semmelweis hypothesized that cadaverous particles from the morgue were to blame and that such particles on the hands of doctors were making their way into women’s bodies during childbirth.

To test his theory, he ordered doctors to wash their hands and instruments in a chlorine solution, a substance he hoped would dispatch the deadly smell of cadaverous particles.

Before the experiment, the mortality rate for new mothers was as high as 18 percent. After Semmelweis implemented hand hygiene between the morgue and the delivery room, the rate of mortality for new mothers dropped to about 1 percent.

Despite his success, his idea faced great resistance and met a tragic end. He lost his job and is thought to have had a breakdown. He died in a psychiatric institution, a very despondent person at the untimely age of 47.

Part of the problem was that people didn’t have that conception of themselves as sort of walking Petri dishes. The majority of doctors in Vienna at this time were from middle- or upper-class families and they thought of themselves as very clean people compared with the working-class poor.

Over the next 40 years, an understanding of germs developed, and attitudes to hygiene gradually shifted. In 1857, while Semmelweis’s mental health declined, Louis Pasteur, of pasteurization fame, raised awareness of pathogens, and how to kill them with heat.

In 1876, the German scientist Robert Koch discovered the anthrax bacillus, kicking off the new research field of medical bacteriology. Cholera, tuberculosis, diphtheria and typhoid bacilli were subsequently identified.

Surgeons started hand washing in earnest; if they were cutting open someone’s skin – that protective layer – they needed to take extraordinary precautions.

The British surgeon Joseph Lister pioneered antiseptic surgery, which included hand washing, and by the 1890s and into the early 1900s, hand washing moved from being something doctors did to something everybody had been told to do.

Florence Nightingale helped. Despite still laboring under miasma theory, she intuitively improved hygiene in military hospitals during the Crimean war in the 1850s and, after returning in the UK, set about revolutionizing nursing.

Nightingale influenced a new interest in household cleanliness as a goal that a good wife and mother need to instill in her family.

The turn of the century saw the first popular public health campaigns being launched around tuberculosis. Koch had shown that tuberculosis was not something you inherited from your grandmother, but that your grandmother coughed on you, and that’s why you got it.

The anti-tuberculosis movement was aimed at both adults and schoolchildren. They really were getting little kids taught these rules about being clean and washing their hands.

People got totally phobic about shaking hands or kissing each other when they understood that their mouth, their skin and their hair had all these germs on them.

It was one reason why young men started eschewing beards at the turn of the century. And why foods started being sold individually wrapped, because of “this fear of germs and hands touching things.” But this hygiene-centric era was short-lived.

The combination of public health messaging and the development of vaccines and antibiotics in the early 20^th century saw death rates from bacterial diseases plummet. The hyperattention to this kind of cleanliness became less important. A laxity crept in in healthcare and in everyday life after the Second World War.

People were the product of the countercultural baby boomer generation, which rebelled against the rules imposed by their parents’ and grandparents’ generations. They thought all this [hygiene] stuff was bourgeois nonsense. Being a hippy involved embracing the wonders of your microbial self.

Sexually transmitted diseases started increasing again in the 1970s. People started to realize, well, these things can come back if we get careless.

But it was really with HIV coming in the 1980s – a novel, deadly, sneaky kind of virus – that everyone started to get hyper again about personal cleanliness. Even though, of course, HIV is transmitted by blood, semen, vaginal fluids and breast milk, so hand hygiene isn’t a significant factor in prevention, we had been operating with a more aware mindset in general since then.

Hospital superbugs became a problem, and now we had these novel viruses coming pretty regularly, but we’re also getting the re-emergence of bacterial diseases because of antibiotic resistance.

Actual handwashing compliance, pre-coronavirus, was still worryingly low, however, in the public realm and in medical care.

In the American Journal of Infectious Control, in the 2016 issue, it had found that after urinating, 69 percent of women washed their hands and only 43 percent of men. After defecating, 84 percent of women and 78 percent of men washed their hands. And before eating – a critical time to wash your hands – 10 percent of men and 7 percent of women washed their hands.

How effective is hand washing?

Dr. Petra Klepac, Professor of Infectious Disease at the London School of Hygiene & Tropical Medicine, looked into this question in 2018 while predicting how a few pandemics would spread in the UK.

“We were looking for systematic reviews and meta-analyses, and pooled from these studies in 2017,” she says; it was found significant effects from hand washing, compared with nonsignificant effects from face-mask use.

She drilled down into the highest quality data, gathered from a clinical setting, with clinical diagnosis and a control group (who didn’t increase hand hygiene) she discovered that if you washed your hands five to ten times more than usual, “that would reduce your risk by a quarter.”

At the start of a pandemic, this is pretty much all you’ve got.   “You don’t have pharmaceutical interventions,” says Dr. Klepac. “You don’t have a vaccine. This is why we’re looking at nonpharmaceutical measures that are easily implemented.”

This knowledge, I think, feels empowering. You can say to people: ‘Here’s one thing you can do to lower your risk.’ It’s simple. It’s right there and doesn’t cost anything. Wash your hands with soap before you touch your mouth, your nose or your eyes. It’s empowering because it really does make a difference.

Take Steps to Protect Yourself

Clean your hands often

Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.

If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.

Avoid touching your eyes, nose, and mouth with unwashed hands.

For comprehensive instructions on how to protect yourself and others from COVID-19 go to Centers for Disease Control and Prevention.

ABOUT THE AUTHOR

Dr. Arvind Dhople graduated from the University of Bombay and then joined Johns Hopkins University School of Public Health, first as a postdoctoral fellow and then Assitant Professor. In 1980, he joined Florida Tech as a Professor and Director of their Infectious Diseases Lab. His specialty is microbial biochemistry and he performed research in leprosy and tuberculosis. He is a Fellow of the American Academy of Microbiology and has published nearly 150 articles in peer-reviewed journals. He has also served as an advisor to the World Health Organization, National Institutes of Health, German Leprosy Relief Association, and the Bill and Melinda Gates Foundation. Currently, he is Professor Emeritus at Florida Tech and a free-lance writer. 

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