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Nix the Handshake and the Cheek Kiss

Handwashing is the most effective means of preventing germs from spreading and the idea is not a new one.

The custom of double kissing on the cheek as a form of greeting has always bugged me. Microbugged me. Do we really need to punctuate an encounter by exchanging oral microbes? What’s wrong with a good old-fashioned firm handshake? As it turns out, plenty!

It seems that hand-to-hand contact may be a more efficient way of transmitting bacteria and viruses than mouth to face, or even mouth-to-mouth. The numerous fat-laden crevices on our hands are an ideal breeding ground for microbes. Shaking hands and then touching the nose or the eyes is a great way to get infected. In fact, you’re more likely to get bugged in this fashion than by being directly coughed on or being kissed. This is not just wild speculation. Thanks to sixteen self-sacrificing people, we have the data to back it up. These pioneers of science volunteered to smooch for a minute with a cold-infected partner to study the likelihood of transmission of the cold virus. And only one caught a cold! But when mutual hand stroking was the order of the day, colds spread like wildfire. Unless of course, there was frequent and scrupulous hand washing. Ignaz Semmelweiss would have loved to have seen the results of this study.

Who was Ignaz Semmelweiss? Only one of the greatest figures in the history of medicine! The man who discovered that the simple process of washing hands could save lives. Unfortunately, he wasn’t able to convince his contemporaries of the significance of this breakthrough discovery. Born in Hungary, Semmelweiss graduated from the University of Vienna Medical School in 1844 and became assistant to the highly respected Dr. Johann Klein who was at the time Professor of Obstetrics. There, the young doctor quickly discovered that the joy of childbirth was often followed by tragedy. Numerous women were dying within a week of giving birth from a disease that had come to be known as “childbed” fever. Nobody at the time knew what caused this catastrophe but the prevailing opinion was that the culprit was some sort of infectious vapour in the air that was somehow related to the weather. This seemed to make sense to most physicians because the death rate had a seasonal variation. But it didn’t make sense to Dr. Semmelweiss. He had observed that the death rates were quite different in the hospital’s two geographically separated obstetrics wards. Surely the air was not different in one part of the hospital from the other! Furthermore, why was it that many more women were dying after giving birth in the hospital than after giving birth at home?

It was a strange business. In the “death ward,” women were attended to by highly trained doctors, whereas women who delivered at home and in the ward where childbed fever rates were lower, were looked after by midwives. Semmelweiss became obsessed by this conundrum. He performed numerous autopsies on the dead women in search of some causative agent but found none. Until he came upon a tragic breakthrough. One of his colleagues accidentally cut himself during an autopsy and soon died of symptoms that were remarkably similar to childbed fever. Semmelweiss surmised that some sort of cadaver particles must have gotten into his colleague’s bloodstream and killed him. And perhaps it was these same cadaver particles that were also killing the women! The difference between the two obstetrics wards now became clear. The doctors who assisted in the births in the infamous “death ward”, and who performed internal exams on the women before and after birth, often came directly from the autopsy room where they were trying to solve the horrific problem of childbed fever. Could they have been infecting their patients with some sort of cadaver particles? This now seemed possible. After all, doctors’ hands constantly smelled of cadavers. Even the seasonal variation of childbed fever could now be rationalized. Semmelweis found that there was an increase in the death rate when a new crop of students entered the Medical School, as they were always keen on doing. The rates then went down once they began studying for exams.

The conclusion now seemed obvious. Semmelweis urged all doctors and students to thoroughly wash their hands after performing autopsies. Yet even with this thorough washing, a faint smell of the autopsy room persisted. So Semmelweis decreed that the hands should be rinsed in a chlorine solution. At the time, chlorine was already known to eliminate smells although why it did so was not understood. The results of the handwashing bordered on the miraculous. Within a year the death rate fell from a high of 30% to 3% and the notorious “death ward” was no more. Semmelweiss was elated by this result but also troubled by it. He realized that he himself had probably been responsible for many deaths as he rushed back and forth between the obstetrics ward and the autopsy room. His feelings of guilt, coupled with his conviction that he had made a major discovery, converted Semmelweis into a hand wash promoting zealot. This didn’t sit well with many of his Viennese contemporaries who resented being called murderers by the Hungarian outsider. Indeed, they made his life so miserable that he fled to Hungary to take up a post at a hospital in Budapest, where he produced the same kind of drop in the death rate associated with childbirth as he had done in Vienna. In the meantime, the Viennese death rate started to climb steadily after Semmelweis departed.

Historical accounts often suggest that Semmelweis was a medical martyr driven out of Vienna by the “establishment” physicians who were unwilling to accept a novel approach, yet that was not exactly so. In a sense, Semmelweis was the architect of his misfortune because he never published his results or the details of his procedures. As a result, the critics never got to evaluate the data. All they got was Semmelweis’ browbeating rhetoric. Those who tried to follow in his footsteps often failed because they did not realize how extensive the handwashing had to be. All in all, because of arrogance and poor communication, Semmelweis’ efforts, as notable as they were, failed to produce the scientific breakthrough that they merited.

Haunted by the rejection of his theories, the pioneer of antisepsis ended up in a mental asylum. Although he wasn’t there for long. Two weeks after being admitted, he was dead. Popular lore has it that he acquired an infection during one of his last surgical procedures, an infection just like the one that caused childbed fever. Historical facts, however, are more consistent with his death being caused by a beating from the attendants. In any case, not a fitting end for the man who saved many a life just by washing his hands.

Vindication finally came in 1879, when in the middle of an anti-Semmelweis harangue by a French obstetrician at a scientific meeting, a short man in the audience stood up, went to the blackboard and drew a picture of a streptococcus bacterium. “This,” he said, “is the killer that Semmelweis eliminated.” The man was Louis Pasteur. Case closed. Soon doctors around the world were washing and scrubbing to protect their patients and themselves.

Today, attention to hand washing is more important than ever. And that is not only because of the Coronavirus. Hospital-acquired infections are often of the MRSA type (Methicillin Resistant Staphylococcus Aureus), which are difficult to deal with. Good hygiene can reduce the risk. Of course, it is not only physicians who need to pay attention to hand washing. We all do. This may be one of the most effective disease prevention measures since microbes lurk everywhere. You would be amazed at what can be cultured from toilet flush levers, faucets, cell phones, and of course, other people’s hands and cheeks.


@JoeSchwarcz

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