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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 August 25; 335(7616): 402.
PMCID: PMC1952521
Past Caring

Now wash your hands

Wendy Moore, freelance writer and author

Pontius Pilate washed his hands of blame. Lady Macbeth feverishly tried to scrub away the “damned spot.” Yet healthcare professionals have remained imperviously resilient to the handwashing message.

Ever since the first tentative hints that a brief encounter with soap and water might be a good idea between examining patients, doctors have guffawed at the suggestion that their healing hands might actually spread disease. Charles White, the obstetrician who helped found Manchester Royal Infirmary, was possibly the first to mention the unmentionable. Observing the high death toll of mothers and babies in obstetrics practice, White advocated cleanliness as far back as 1777.

As with his many successors, White was rewarded for his insight by hostility and incredulity. Less than 20 years later, the Scottish physician Alexander Gordon met with a similar response when he blamed midwives and obstetricians for transmitting puerperal fever between patients. His 1795 treatise urged that nurses and doctors “ought carefully to wash themselves.” And in common with many of his fellow pioneers, he observed sadly that, “It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women.”

Disagreeable as it was, Gordon's message was obstinately ignored until Oliver Wendell Holmes, a Boston physician who was also a popular poet, revived the call. There was little rhyme but much reason in his 1843 essay “The Contagiousness of Puerperal Fever.” Forcefully recounting the evidence that practitioners were transmitting infection to their patients, especially after post-mortems, Holmes urged a rigorous routine of handwashing as well as gaps between attending autopsies and deliveries. Inevitably, he was roundly mocked by his contemporaries, including Philadelphian obstetrician Charles Meigs who threw up his pus-encrusted hands in horror and declared: “I never was the medium of this transmission.”

Most famously, the Hungarian physician Ignaz Semmelweis studied mortality rates on the maternity wards of Vienna General Hospital in 1847. Observing that women giving birth on the midwife-led clinic were four times less likely to die from puerperal fever than their counterparts labouring on the ward run by doctors, Semmelweis realised that doctors were transmitting disease from the corpses they dissected to the women they delivered. Having himself conducted more autopsies than any of his colleagues in his quest for knowledge, poor Semmelweis miserably concluded that “only God knows the number of patients who went prematurely to their graves because of me.”

Despite proving that handwashing with chlorine solution drastically reduced mortality, Semmelweis failed to convince his fellow medics and died ignobly in an asylum.

So if England's chief medical officer, Sir Liam Donaldson, despairs that the handwashing message has still not sunk in with an estimated 40% of healthcare professionals 160 years later, at least he knows he stands hand in hand with innumerable unheeded predecessors of the past.

Articles from The BMJ are provided here courtesy of BMJ Publishing Group