Doctor’s Orders: Physicians must practice good hygiene principles

Medical school is roughly a four-year curriculum that is divided into two parts. The first two years are spent studying the basic sciences like physiology, biochemistry, pharmacology and gross anatomy. The second two years are spent “rotating” through the various clinical specialties like general surgery, internal medicine, pediatrics, obstetrics, gynecology and psychiatry.

I did my rotation through obstetrics and gynecology at San Francisco General Hospital (SFGH). This is a busy public hospital much like Stroger (Cook County) Hospital. When I was at SFGH in the mid 1980s the obstetrics service was very busy and we students loved the chance to study and learn there. Every third or fourth night we took call and spent the night at the hospital anxiously awaiting the arrival of women who were about to deliver. I got to deliver (under close supervision) five babies during my time with the obstetrics service. The young women who delivered were healthy and were always kind to the students. The new mothers would be instructed on breastfeeding and after one or two days would be discharged home.

However, until the late nineteenth and early twentieth centuries the above scenario was frighteningly uncommon. Women who gave birth in hospitals had an alarming rate of death from a horrible infection called puerperal fever. These women would develop fevers, swelling and overwhelming sepsis in a matter of days after delivering.

In the mid-19th century at the general hospital in Vienna, Austria, women were assigned to one of two wards. One ward was staffed by physicians and the other ward was staffed by midwives. There were about 3,500 deliveries a year on each of the two wards. In the physician-staffed wards 600 to 800 women died from puerperal fever. But in the midwife staffed wards only 60 died from this infection. Many theories were advanced as to what caused the problem (at that time there was no germ theory of infectious diseases).

Finally, one of the physicians figured it out. Ignaz Semmelweis, who was originally from Budapest, Hungary, was curious about puerperal fever. But it was only after one of his colleagues died from it after accidentally cutting his finger during an autopsy of one of the women who died, that Semmelweis began to really investigate this phenomenon.

What he discovered was that the physicians would perform an autopsy and then go directly to performing internal exams on the women. He postulated that “cadaveric particles” were transferred to the pregnant women thus causing the affliction. On the other hand, the midwives did not perform autopsies. And as is emphasized in Florence Nightingale’s “Notes on Nursing,” cleanliness is the axis upon which hospital care should turn.

Semmelweis went on a one-man campaign to change the horrible statistics of his ward. He made physicians wash their hands prior to examining any patient. The mortality rates dropped.

However, for various reasons including Semmelweis personality, the conservative thinking of the medical establishment at that time and the fact that the discovery of bacteria lay in the future, many physicians did not adopt handwashing until late in the 19th and early 20th centuries. (For a fascinating account of Semmelweis, I recommend Sherwin Nuland’s, “The Doctors’ Plague.”)

Sadly, we still have instances of surgical infections and hospital-acquired infections. Also, now many of the bacteria responsible for hospital-acquired infections are becoming resistant to current therapy.

The good news is that governmental agencies, professional societies and the general public are encouraging the medical profession to follow in the footsteps of Dr. Semmelweis and the other pioneers of antisepsis and prevent the next “Doctors’ Plague.”

Dr. Alan Jackson is a cardiologist and chief medical officer at Roseland Community Hospital and clinical assistant professor of medicine at the University of Illinois Chicago. He also is a member of the Sun-Times board of directors.