Look up maternal mortality figures for Britain and the United States in the eighteen and nineteenth centuries and through to the 1930s, and you’ll see why childbirth was so feared. Every year, between four and eight women would die for every 1000 total births, during the birth or within the following 42 days. Factor in that few couples practiced ways of limiting conception, and women faced this risk time after time. Breastfeeding was a time-honoured way of spacing babies, since conception is suppressed in many women while fully breastfeeding, but by the nineteenth century, wet nurses were fashionable for the upper classes, so men commonly had nine or ten children, often with two or more wives in succession.
Puerperal fever, the killer in many cases, was no respecter of persons. Indeed, physicians were more likely to carry the disease than midwives, since they went from attending to autopsies and infectious diseases straight to assisting at a birth. Mary Wollstonecroft died in 1797, after a doctor was called to help remove the placenta when she gave birth to the baby named for her, who would later become well known as Mary Shelley.
The father of hand-washing
Use the internet to look up who first discovered that hand-washing saved lives, and the name Ignaz Semmelweiz will populate your search screen. He was a Hungarian doctor who, in the 1840s, began collecting mortality statistics in two maternity wards. In one, staffed by doctors and their students, mortality rates were five times as high as the other, staffed by midwives. He made several changes to align the routine between one ward and the other, but to no effect. Then one of the pathologists died. He’d pricked his finger during the autopsy of a woman who died of puerperal fever, got very sick, and died. Apparently, such deaths among pathologists were not uncommon, but Semmelweiz noticed that the man had shown all the symptoms of puerperal fever.
Semmelweiz realised that puerperal fever wasn’t uniquely a post-natal disease of mothers. He then theorized that doctors were getting little pieces of corpse on their hands when they dissected bodies, and those caused the fever. He made his doctors and students wash their hands and instruments in a chlorine solution, and maternal deaths in the doctors’ ward dropped dramatically.
Problem solved.
Hold on. Not so fast.
While all the facts about Semmelweiz are true, the appellation ‘father of hand-washing’ is wrong for two reasons.
First, he wasn’t the first
He wasn’t the first to notice the correlation. In the 1790s, Alexander Graham, a naval doctor who had retired from the sea to work in a hospital in Aberdeen faced an epidemic of puerperal fever, and recorded his conclusions about the 77 cases in his care.
‘… it is a disagreeable fact that I, myself, was the means of carrying the infection to a great number of women.’
He recommended burning the women’s bedclothes and told doctors to carefully wash themselves and to change their clothes between patients.
In the United States, a few years before Semmelweis, physician and poet Oliver Wendell-Holmes drew the same inferences.
‘… the disease known as puerperal fever is so far contagious as to be frequently carried from patient to patient, by physicians and nurses.’
They weren’t the only ones.
In France, there was Antoinne Germain Labarraque. In Ireland, Robert Collins, In Britain, Thomas Watson. All of them advocated hand-washing to save lives.
Second, no one wanted to know
Medical science laughed at the notion that doctors might be inadvertently killing patients.
Gordon was hounded out of Aberdeen, and had to return to the navy, where his knowledge of handwashing informed his surgical practice and undoubtedly saved many sailors. But not medical practice. Labarraque, Collins, and Watson fared better, being honoured for their medical achievements, but scoffed at for their theories of hygiene, their recommendations disregarded.
Semmelweiz, perhaps because of his aggressive attitude, was the worst treated of all. He publicly berated those who didn’t agree with him, in increasingly abusive terms. In one letter, he said:
I declare before God that you are a murderer and [history] would not be too unfair if it remembers you as a medical Nero.
In 1865, aged only 47, he was committed to an asylum, probably beaten, and died of sepsis — ironically, the same infection of the blood stream that was still killing all those women he tried to save.
There’s good news, and there’s bad news
Even after Lister proved the connection between germs and disease, hand-washing took a long time to catch on. In the Scandinavian countries, midwives adopted hand-washing early, and had the earliest drop in maternal deaths. Other countries reluctantly followed, the United States as late as 1930. All the evidence in the world is not enough to change minds that are set on what they want to believe.
Even today, close to one third of maternal deaths in Africa and other developing parts of the world are from puerperal fever. They could be prevented by washing hands in an antiseptic solution and wearing clean clothes (if such supplies plus the knowledge we take for granted were available to birth attendants).
I saw about this issue on documentary magazine series and didn’t remember which one it was about. The historical mystery-true crime Maul and the Pear Tree talked about 19th century medical/coroner issues. It’s fascinating in a sad way.
I was wondering, you have a followup for all these discoverers you listed except Oliver Wendell-Holmes. I do know the washing hands for surgery was still not universal during our civil war. Was there anything further about the poet? Nice background!
One article I found says that, after his theory was published in 1843: “Holmes was promptly attacked by the leading Philadelphia obstetrician, Charles D. Meigs, who derided his arguments as the “jejeune and fizzenless dreamings” of a sophomoric writer, and declared that any practitioner who met with epidemic cases of puerperal fever was simply “unlucky.”” His reputation as a physician and as a poet saved him from the kind of savage treatment the others met with, however.
That’s good at least. Philly still gets an attitude sometimes today… (Why yes, I lived an hour away, and they are unreasonably cocky for a city without any particular specialty) I suspect the ‘father’ was expecting more deaths from midwives when he did his comparison. Of course Holmes was eventually proved right. Hope he lived long enough to see it.
Hmm. 1840s? Maybe too late for my hakimas to incorporate that into their work.
I’ve found that Arabic medicine placed great emphasis on hygiene from as early as the 9th century. And Ana is French, so might have come under the influence of the French hand-washing pioneer, Labarraque. His work was published in 1828, though it wasn’t specific to child-bearing.