October 5, 2012

Medicine in the Nineteenth Century: Did You Wash Your Hands After Going to the...Autopsy?


Picture this:  it’s the first day of pathology residency and I, newly minted medical doctor, am about to do my first autopsy. Cloaked head to toe in scrubs, surgical mask, gown, shoe covers, waterproof (or should I say blood proof) sleeve covers and a cap to cover my hair, I hovered queasily over the deceased.  About to pull on thick gloves, I was stopped by the teaching pathologist at the highly prestigious medical institution (which shall remain unnamed) and informed: “We don’t wear gloves. It’s not macho.”

A tense pause, cringe, gasp. He had to be kidding.  Muck around in a dead body without gloves, barehanded, unprotected?  Well, being a true blue double X chromosome female (we jokingly pronounced it like “tamale”), I didn’t care if I was considered macho or not.  I pulled on the gloves.  True story, I swear.

Perhaps the teaching pathologist at the prestigious medical institution never got the memo that dead bodies have germs and germs cause disease. Ignaz Semmelweis proved conclusively in 1847 that unwashed hands spread germs.  At an obstetrical clinic in Vienna, Semmelweis noted that women who gave birth attended by medical students were dying of childbed fever (puerperal fever in medical speak) much more often than those whose deliveries were attended by midwives.  Why?  He investigated and found that the medical students came straight from performing autopsies on patients who had died of sepsis (bacterial infection) and attended the births without washing their hands. When he instituted a strict policy of hand washing with a chlorinated antiseptic solution, the death rate from childbed fever dropped 10-20 fold in three months. The use of gloves didn’t come along until much later, but hand washing was a major medical breakthrough in preventing the spread of disease.




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