Some history about handwashing

As some of you know, I’ve been working at the Biology and the Built Environment Center at the University of Oregon for the last few months as a microbial ecologist. The first project with them has come to fruition: a review of the concept of hygiene as it relates to human-associated microbial ecology. I blogged about that at (you can read that post here, which includes a link to the BioRxiv preprint of the full review article).

Today, I’d like to discuss a bit of history that only made it into the Review briefly, but I think is absolutely fascinating. It turns out, you can trace hand hygiene back to a discrete starting point in the middle of the 19th century. In Boston, Oliver Wendell Holmes, Sr. — now more famous as one of the Fireside Poets, along with Longfellow, but renowned as a physician in his own time — noticed the contagious nature of puerperal fever, which affects women shortly after childbirth. He published his findings in 1843 (though it went largely unnoticed until reprinted in longer form as a book in 1855), arguing that physicians with unwashed hands spread the disease. Holmes’s views were ridiculed by the established obstetricians of the time, but laid the foundations for thought about hygiene and the spread of infection in the American medical establishment.

Oliver Wendell Holmes, Sr., on the left, and Ignaz Philipp Semmelweis on the right. Images shamelessly taken from their wikipedia pages.

At roughly the same time, the Hungarian physician Ignaz Philipp Semmelweis was grappling with the spread of the same disease in Vienna, but unaware of Holmes’s work in America. After beginning work in the maternity clinic of the Vienna General Hospital, Semmelweis found that the mortality rates of women giving birth were different in between Clinics in the Hospital: the First Clinic, which was primarily used to train medical students, had a 10% mortality rate, while the Second Clinic, used to train midwives, had a mortality rate of only 4%. Semmelweis made the connection that the medical students often went straight from the autopsy theatre to the birthing room, and concluded that they must be transmitting “cadaverous particles” from the corpses to the patients. To combat this spread, he instituted a policy of scrubbing the hands in chloride of lime (calcium hypochlorite; bleach, basically) for anyone moving between the autopsy theatre and the maternity wards; the mortality rate in the First Clinic promptly fell to be the same as that of the Second Clinic. Interesting, hypochlorite solution was not chosen for any anti-microbial properties; it was the way it removed odours that was thought to be the method of action. Remember, this was before the germ theory of disease was formalized, and the prevailing thought of the time was that miasmas, smells or vapours, were responsible for the spread of disease.

Semmelweis published his findings and theory of transmission of puerperal fever in 1861, including the data showing that hand washing is effective at reducing disease transmission. Sadly, Semmelweis’s theories were ridiculed by the medical elite of Vienna, and the sound medical advice was lost in political power struggle; Semmelweis turned to alcohol as his calls for reform were consistently ignored and refused, and was eventually tricked into entering an insane asylum in 1865. When he tried to escape, he was severely beaten, and died two weeks later from a gangrenous wound, probably a result of the beating.

Around this time, in France, Louis Pasteur was working on germ theory and fermentation, formally publishing the pasteurization method in 1865, followed by the initial publication on germ theory in silkworms, in 1870. Pasteur was likely aware of Semmelweis’s work, because he was also working on puerperal fever; in 1880, he published microbiological observation and recommendations concerning the disease, which were much more well received by the medical establishment than Semmelweis’s recommendations, perhaps because of a shift in culture due to the groundwork laid by Semmelweis and Holmes.

Holmes’ and Semmelweis’ work is discussed a number of places, but are probably best summarized in this lovely article by Hilary Lane, Nava Blum, and Elizabeth Fee.

This is the ship of pearl, which, poets feign,
Sails the unshadowed main,—
The venturous bark that flings
On the sweet summer wind its purpled wings
In gulfs enchanted, where the Siren sings,
And coral reefs lie bare,
Where the cold sea-maids rise to sun their streaming hair.

Its webs of living gauze no more unfurl;
Wrecked is the ship of pearl!
And every chambered cell,
Where its dim dreaming life was wont to dwell,
As the frail tenant shaped his growing shell,
Before thee lies revealed,—
Its irised ceiling rent, its sunless crypt unsealed!

Year after year beheld the silent toil
That spread his lustrous coil;
Still, as the spiral grew,
He left the past year’s dwelling for the new,
Stole with soft step its shining archway through,
Built up its idle door,
Stretched in his last-found home, and knew the old no more.

Thanks for the heavenly message brought by thee,
Child of the wandering sea,
Cast from her lap, forlorn!
From thy dead lips a clearer note is born
Than ever Triton blew from wreathèd horn!
While on mine ear it rings,
Through the deep caves of thought I hear a voice that sings:—

Build thee more stately mansions, O my soul,
As the swift seasons roll!
Leave thy low-vaulted past!
Let each new temple, nobler than the last,
Shut thee from heaven with a dome more vast,
Till thou at length art free,
Leaving thine outgrown shell by life’s unresting sea!

~The Chambered Nautilus,
by Oliver Wendell Holmes, Sr.

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