The first clear evidence of clinical benefit from hand hygiene came from Semmelweis, working in the Great Hospital in Vienna in the 1840s. The hospital had two obstetric departments, and women were admitted alternately, whatever their clinical condition, to one or the other. In the first, they were attended by medical students who moved straight from the necropsy room to the delivery suite. In the second, they were attended by midwives and midwifery students who had no contact with the necropsy room. The incidence of maternal death was as high as 18% in the first department, with puerperal fever the main cause, but only 2% in the second. Semmelweis observed that a colleague died from an illness similar to puerperal fever after being accidentally cut during a necropsy. He concluded that the infecting particles responsible for puerperal fever came from cadavers and were transmitted by hand to women attended by medical students in the first department. He therefore instituted hand disinfection with chlorinated lime for those leaving the necropsy room, after which maternal morbidity in the first department fell to the levels achieved by the second department. (1, 2)
Semmelweis’ discovery directly confronted with the beliefs of science and medicine in his time. His colleagues and other medical professionals refused to accept his findings mainly because they did not find it convincing that they could be responsible for spreading infections. The reaction reflected on his job as well when he was declined a reappointment in 1849.
The continued criticism and lash out finally broke him down. By 1865, he was suffering from depression, forgetfulness and other neural complaints and was eventually committed to an asylum. He only lasted there for two weeks and died on August 13, 1865 at the age of 47. (3)
Most sites reproducing the case of hand-washing and doctors bad attitude towards it simply emphasize the fact that doctors in the abovementioned clinic used to perform autopsies and then go treat pregnant women, while midwives in the other clinic did not. Although this was indeed the main case (see the original paper here), there is much more to see. Things you can find if you look deeper. Things not immediately evident from reading Wikipedia scientism-biased articles.
The first important teaching from this story is the way doctors treated advice towards them by someone outside the mainstream “cast”. They could not accept the fact that they were the cause of death. They could not accept that they even had dirty hands (!) (4, 5, 6) (“gentlemen do not have dirty hands”)
The second important thing to note is the way normal people (midwives) used to have more wisdom than the scientists. To complete the story in the beginning of the article, except the obvious difference between doctors and midwives (that the latter did not perform autopsies) there was another one which was the truly important one: that midwives tended to wash hands more often that doctors. This was something noted by the renowned Lister (7, 8). Researches on the matter show that midwives did have good hygiene practices (9 – see for example Midwifery Act 1902), (something one could see showcased by the “mysterious” fact of the World Health Organization celebrating “Washing hands” – see here – and the ICM celebrating International Midwife Day – see here – on the same date).
It is interesting to note that in the early 20th century rich women were more likely to die in childbirth than poor women. (Mary Wollstonecraft was one victim of an incompetent doctor; she died of puerperal fever after delivering a daughter who would grow up to write Frankenstein.) For almost any other cause of death, the poor were more likely to die than the rich. But for childbirth, poor women could afford only midwives. Rich women could afford doctors. (11)
After we (men) chased down women healers as witches (12) (yes, the ability to HEAL was one of the charges against witches!) we now have men ruling obstetrics. And even though home births are AS SAFE AS hospital births (13), the man-midwife (doctors) replaced the “bad witches” (14, 15).
Everything is good now.
Now we can all afford doctors or – even if we can’t – must see one or simply die.
Now we dogmatically “know” that we know better and that the old ones were useless humanoids simply lucky to be alive.
Sure medicine has learnt its lesson. Sure it saves lives now. (Does it? See here)
But how many lives has it killed so far due to its dogmatism? How many more lives can be saved if the “all lightly” doctors listen to the popular wisdom of “ordinary” people like the midwives – even today?
Dogmatism can be truly deadly. Even before birth…