For every 10 pregnant women who walked into a hospital in 1840s Europe, only 9 would ever leave.1 One in 10 pregnant women died of a disease known at the time as puerperal fever, a bacterial infection of the female reproductive tract in the postpartum period that can spread to the blood and produce sepsis.2 To put this rate in perspective, using the current maternal mortality rate in the United States for every 10,000 pregnant women who enter a hospital 9,999 will leave.3
Physicians in 1840s Europe were perplexed by the high maternal mortality rate, but were relieved that Yelp’s rating system had not been invented yet to document their poor performance. One enterprising young doctor, however, was not content dwelling in Yelp-free mediocrity and undertook a study at his clinic. The doctor’s name was Dr. Ignaz Semmelweis, and he was an obstetrician in Vienna, Austria.
Dr. Semmelweis worked at a teaching clinic in which both midwives and medical students studied. When Dr. Semmelweis joined the staff, the hospital instituted an alternating admission policy wherein the midwife students admitted on one day, the medical students on next, and so on and so forth, alternating admitting days between the two groups. This alternating schedule provided the inadvertent soil for a fruitful experiment.
Townspeople quickly realized that a lot more women were dying at the hands of eager medical students than midwives, and pregnant townspeople began requesting admission to the midwife service. Dr. Semmelweis decided to quantify the disparity. After careful study, Dr. Semmelweis concluded that the midwife service had a mortality rate about 2.5 times lower than the medical student service.1
Dr. Semmelweis generated many hypotheses to explain the disparity and to reassure his students of their competency, but he could not find a satisfactory answer. Dr. Semmelweis almost had to admit academic defeat, but then his colleague, Dr. Kolletschka, fell on the proverbial sword and inadvertently provided the answer.
Dr. Kolletschka was working in the morgue conducting autopsies of recently deceased patients when an overeager medical student accidently skewered him with a contaminated scalpel. Dr. Kolletschka soon fell ill and died shortly thereafter. Dr. Semmelweis performed Dr. Kolletschka’s autopsy and was shocked by the similarities between Dr. Kolletschka’s pathology and the pathology present in patients who had succumb to puerperal fever. Dr. Semmelweis finally made the connection between the medical students’ lack of hand hygiene following their contact with cadavers and the high incidence of puerperal fever in the patients whom they contacted thereafter.
Today, it seems rather obvious that a medical student should wash his or her hands between rooting around in a corpse and delivering a baby, but at the time, medicine was still operating on the four humors theory developed by Galen between 100 and 200 CE.
The four humors theory alleged that health and disease could be explained by the balance or imbalance of four primary fluids: blood, black bile, yellow bile, and phlegm. The treatment involved bringing the humors back into balance through blood-letting. Insurance companies and professional boards tend to frown on this practice nowadays, but it was standard of care back in Dr. Semmelweis’s time.
When Dr. Semmelweis began to insist that his students use bleach in between cadaver exploration and baby extraction, other members of the medical establishment were at first perplexed, and then annoyed. At the time, the closest approximation of our modern germ theory was the theory that miasmas, or “bad air,” spread disease.4
Colleagues and superiors were put out by the notion that as gentlemen they might have unclean hands requiring washing. They were unfazed by the fact that in the months following Dr. Semmelweis’s hand washing mandate maternal mortality rates dropped by 90%.1
Dr. Semmelweis refused to give in to his critics who insisted that he had no scientific basis for his claim. Dr. Johann Klein, Dr. Semmelweis’s superior, decided he had enough of