Short Wave - The Surprising Origin Of Some Timely Advice: Wash Your Hands

Episode Date: January 31, 2020

Today we know that one of the easiest and most effective things you can do to protect yourself from the cold, flu, and other respiratory illnesses (including those like the novel coronavirus) is to wash your hands. But there was a time when that wasn't so obvious. Dana Tulodziecki, a professor at Purdue University, tells the story of Ignaz Semmelweis, the scientist who's credited with discovering the importance of handwashing. We'll hear how he figured it out and why there's more to the story. Follow host Maddie Sofia on Twitter @maddie_sofia. Email the show at [e-mail]. See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. If you've been paying attention to the news this week, you've heard a lot about viruses. Let's get right to our top story, the expanding outbreak of the deadly coronavirus. There's the coronavirus that's come out of China. And it's clear the pathogen is nowhere near contained. And let's not forget that other, more familiar respiratory virus, the flu. Flu is now widespread in almost every single state. But guess what?

Whether it's the coronavirus or the flu, public health officials say there's a simple thing you can do to protect yourself. Wash your hands. In fact, the CDC says it's the number one step people in the U.S. can take to avoid coronavirus, besides, you know, never coming in contact with it in the first place. We take it for granted now that handwashing helps keep us healthy. But somebody had to figure that out. And most of the credit goes to one guy, a Hungarian doctor named Ignaz, Semmelweis. All right, Donner, are you comfortable? Do they have y'all set up? Let me just drink some water.

Purdue University professor, Donna Tulitziki, has been digging a little deeper into his story. So basically, if I mess something up terribly, we'll just do that again. Yes, and you will be ejected from the studio by your seat. So it would be a very quick interview. It was not a quick interview. And that's because the history of handwashing is complicated. I mean, think about it. It's kind of amazing that people figure. this out in a time when most people thought disease was caused by things like bad air.

Until Ignat Semmelweis, as the story goes, a story I first heard in grad school, solved a mystery that changed everything. But that's not the whole story. I'm Maddie Safaya, today on the show, the history of handwashing, and why, according to Professor Donna, I have been telling this story wrong for years. So the story begins in this time of crisis. We're in Vienna. It's 1844. And we're at the largest maternity hospital in the world, Vienna General. As you can imagine, hospitals were just really, really different back then. They didn't know about germs. And they were so crowded. It really wasn't unusual to have more than one patient in the same bed. The bed linens might, well, by our standards, it would be filthy.

So the conditions for healing weren't exactly great from our perspective. And unsurprisingly, mortality rates were really, really high. One especially deadly disease was called childbed fever. Women would notice symptoms just a few days after birth. And now we know that it was caused by a bacterial infection. But remember, they didn't even know about germs yet. Childbed fever really was quite a dramatic disease, partly because you're supposed to be so happy about your new child,

but then things could go bad very, very quickly for the mother. They would be screaming because of the pain. they would be delirious, and she would die this horrible, horrible death. It was terrible. And Vienna General was so crowded that they actually had to split the maternity ward into two clinics. One was run by doctors, and the other one was run by midwives. But the wild thing was, is that way more women were dying of childbed fever in the doctor's clinic than in the midwives clinic. And nobody could figure out why.

And, of course, it really seemed counterintuitive to people because the doctors were supposed to supposed to know a lot more than the midwives. So this was a big puzzle. That's where Ignat Semmelweis comes in. At Vienna General, he worked in the doctor's clinic. And Semmelweis, like lots of others, just wanted to figure out what was going on there. Why was the mortality rate so high in the first clinic and how could they reduce it? So what were some of the things he tested to try to figure out what was going on? So the first thing he did was to look at some of the existing explanations about what might be causing the difference. And some of these he could just exclude right away.

So, for example, the idea that childbirth fever was, in fact, caused by overcrowding because that was the same in both the clinics. So that couldn't have explained the difference. But Ignaz does notice some differences between the two clinics. So he does what any good scientists would do. He sets up some carefully controlled experiments. First test. In one clinic, women gave birth on their sides.

and in the other they gave birth on their back. So he switched those up so everybody was giving birth in the same position. But that didn't make a difference. Second test. In the doctor-run clinic, a priest would walk the floor, ringing a bell as he passed the patients in their beds. He was bringing last sacrament to the dying women, and Samuel Weiss thought, well, maybe psychological terror plays a role here, but that one didn't pan out either. He still was not any closer to solving the mystery of childbed fever.

But then, in 1847, he had a breakthrough. But it came at a terrible cost. His pathologist colleague Kalechka was injured with a scalpel during an autopsy and developed an infection and died. And what Zemovai's noticed was that the post-mortem results of Kalechka were just like those of the women who had childbed fever. And so he thought, okay, maybe they actually were all killed by the same thing. So Ignaz thought that his friend died.

after getting infected by something from an autopsy. That's exactly right. So his hypothesis was that it was the cadaveric matter from the scalpel. That's little pieces of dead people, by the way. That had entered Kuletschka's blood and caused the infection. And that very same material could then be transferred to the women on the hands of the doctors. Because what the doctors were doing were autopsies in one room, and then they would go straight to examine the women who had given birth in the next room

without washing their hands, without changing their clothes. without basically taking any hygienic measures at all. So the doctors were literally doing autopsies, not washing their hands, bringing their infected hands back into the maternity ward, and then delivering babies and infecting the moms. That's exactly what they were doing, yeah. Oh, that's so, it grosses me out so much. I know that they didn't know that, but it's still pretty gross.

How did anybody survive? Right, right. Okay, okay, so Ignaz thinks he's figured this out, right? So what does he do next? So he then says, okay, I've got this hypothesis, I need to test this. And what I'm going to do is require people who perform these autopsies to wash their hands with chlorinated lime, which was a disinfectant. And he required them to do this before attending the women in the maternity ward. And then, lo and behold, after he instituted this, the mortality rate in the first clinic fell to pretty much that of the second clinic, which had the midwives.

So the mortality rates at this point were the same in both the clinics. You might think at this point everybody's like, yeah, Semmelweis, you did it, you figured it out. And then chlorinated lime flies off the shelves in Vienna, and everybody starts washing their hands. But no, that is not how the rest of this story goes. The story that I've heard takes a tragic turn. Nobody in the medical community will listen to Ignaz, and women keep dying around him. And he kind of loses it. He starts accusing other doctors of murdering women because they won't listen to him.

And eventually they shun him. Ignaz winds up in this psychiatric hospital and he ends up dying alone. And that's pretty much the way I heard it in grad school. But Donna doesn't buy it. She's done a lot of research and she thinks that that story sounds a little too Hollywood to be true. For one, his idea really wasn't rejected as much as it's often said. so people did adopt hand washing. It just didn't get rid of all childbed fever.

And so they thought there had to be some other causes. And this is really the interesting part is that the part that they did reject was not the hand washing part, but it was the idea that there was exactly one cause causing all cases of childbed fever. And Ignaz would not let go of this idea. The tissue from cadavers was the only cause of childbed fever, even in situations where that theory didn't really make sense. For example, there was all this childbed fever not connected to autopsies or even hospitals. So they were really interested in just preserving all these other causes because Semmelweis couldn't explain all the cases of childbirth fever. Right. So they had good reasons to be skeptical of his one prevailing theory.

That's exactly right. And Semmelweis, he was a difficult person. He didn't really go out of his way to answer them, which certainly didn't help. And so I guess, you know, I mean, you're a science philosophy person, right? Why do you think the, story gets told this way with this lone wolf guy that had the truth, but nobody listens to it. Why is it told that way over and over? So that's a good question. I can only speculate. The first thing I want to say is that he wasn't really the lone wolf. So what's interesting is that there were other people before Semmelweis who pretty much hit upon the same idea as early as 50 years before him. So already in 1795, long before Semelvice, Alexander Gordon and Scotland pointed this out.

Then in 1843 in the US, there was Oliver Wendell Holmes, who in contrast to Zemelweiss wrote a very elegant treatise on all this. And then James Young Simpson in Britain in 1850 also arrived at pretty much the same conclusions as Semmelweis. But of course, that kind of story doesn't make for the kind of hero narrative that people really seem to like. And maybe part of the explanation is that from our perspective, it just now seems so obvious. But of course, we have a lot of knowledge and evidence that they didn't have. I don't want to diminish this achievement. And it's just, I think, also important to recognize that there were lots of other people doing really, really good science alongside him, even when they held different views. Donna Tulitziki is an associate professor of history and philosophy of science at Purdue University.

By the way, right around the time of Ignaz's death, scientists figured out that germs caused disease. And that couldn't have happened without the work of Ignauts and people like him. So wash them pause. Soap and water, please. your immune system will thank you. Final request. We want all the questions you have about coronavirus. We know you have them,

and we'll try to give you answers in an upcoming episode. Email us at shortwave at npr.org. This episode was produced by Rebecca Davis and Brett Bachman, with editing from Viet Le. Emily Vaughn checked the facts. I'm Maddie Safaya, and thanks for listening to Shortwave from NPR.