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PBS NewsHour

In 1850, Ignaz Semmelweis saved lives with three words: wash your hands

The Vienna General Hospital

On May 15, 1850, Dr. Ignaz Semmelweis urged doctors at Vienna General Hospital to wash their hands. Photo via Wikimedia

On this date in 1850, a prickly Hungarian obstetrician named Ignaz Semmelweis stepped up to the podium of the Vienna Medical Society’s lecture hall. It was a grand and ornately decorated room where some of medicine’s greatest discoveries were first announced. The evening of May 15 would hardly be different — even if those present (and many more who merely read about it) did not acknowledge Semmelweis’s marvelous discovery for several decades.

Ignaz Semmelweis

Ignaz Semmelweis, circa 1860. Photo via Wikimedia

What, exactly, was the doctor’s advice to his colleagues on that long ago night? It could be summed up in three little words: wash your hands!

At this late date, we all expect our doctors to wash their hands before examining us or performing an operation in order to prevent the spread of infection. Surprisingly, physicians did not begin to acknowledge the lifesaving power of this simple act until 1847

It was then that Dr. Semmelweis began exhorting his fellow physicians at the famed Vienna General Hospital (Allgemeines Krankenhaus) to wash up before examining women about to deliver babies. His plea was far more than aesthetic; it was a matter of life and death and helped to prevent a deadly malady known as “childbed” or puerperal (from the Latin words for child and parent) fever.

In the mid-19th century, about five women in 1,000 died in deliveries performed by midwives or at home. Yet when doctors working in the best maternity hospitals in Europe and America performed deliveries, the maternal death rate was often 10 to 20 times greater. The cause was, invariably, childbed fever. And a miserable end it was: raging fevers, putrid pus emanating from the birth canal, painful abscesses in the abdomen and chest, and an irreversible descent into an absolute hell of sepsis and death — all within 24 hours of the baby’s birth.

The reason seems readily apparent today, if not back then. Medical students and their professors at the elite teaching hospitals of this era typically began their day performing barehanded autopsies on the women who had died the day before of childbed fever. They then proceeded to the wards to examine the laboring women about to deliver their babies.

Dr. Semmelweis was brilliant but had two strikes against him when applying for a position at the Vienna General Hospital in 1846: he was Hungarian and Jewish. Medicine and surgery were considered to be the premier specialties in Vienna but because of his background and religion Semmelweis was relegated to running the less desirable division of obstetrics. Nevertheless, his claim to immortality was the result of an obsession with finding the means to end the childbed fever epidemics that were killing nearly a third of his patients. (The hospital ward run by midwives, without autopsy duties, had far better outcomes with their deliveries).

Every day he heard the heart-rending pleas of women assigned to his care begging to be discharged because they believed these doctors to be the harbingers of death. Fortunately, Dr. Semmelweis was smart enough to listen to his patients.

The obstetrician made the vital connection that puerperal fever was caused by the doctors transferring some type of “morbid poison” from the dissected corpses in the autopsy suite to the women laboring in the delivery room. That morbid poison is now known as the bacteria called Group A hemolytic streptococcus.

 Photomicrograph of Streptococcus pyogenes bacteria, 900x Mag. A pus specimen, viewed using Pappenheim's stain. Last
         century, infections by S. pyogenes claimed many lives especially since the organism was the most important cause of puerperal
         fever and scarlet fever. Wikimedia

Streptococcus pyogenes bacteria, seen through a microscope, the cause of puerperal fever. Photo via Wikimedia

Historians are quick to remind that Semmelweis was not the first physician to make this clinical connection, one that many expectant mothers of the era called “the doctors’ plague.” For example, the obstetrician Alexander Gordon of Aberdeen, Scotland, suggested in his 1795 Treatise on the Epidemic of Puerperal Fever that midwives and doctors who had recently treated women for puerperal fever spread the malady to other women. More famously, in 1843 Oliver Wendell Holmes, the Harvard anatomist and self-proclaimed “autocrat of the breakfast table,” published “The Contagiousness of Puerperal Fever,” in which he discerned that the disease was spread by physicians and recommended that actively practicing obstetricians abstain from performing autopsies on women who died of puerperal fever as one of their “paramount obligations to society.”

That said, it was Dr. Semmelweis who ordered his medical students and junior physicians to wash their hands in a chlorinated lime solution until the smell of the putrid bodies they dissected in the autopsy suite was no longer detectable. Soon after instituting this protocol in 1847, the mortality rates on the doctor-dominated obstetrics service plummeted.

Unfortunately, Semmelweis’s ideas were not accepted by all of his colleagues. Indeed, many were outraged at the suggestion that they were the cause of their patients’ miserable deaths. Consequently, Semmelweis met with enormous resistance and criticism.

A remarkably difficult man, Semmelweis refused to publish his ”self-evident” findings until 13 years after making them despite being urged to do so repeatedly by those who supported him. To make matters worse, he hurled outrageously rude insults to some of the hospital’s most powerful doctors who deigned to question his ideas. Such outbursts, no matter how well deserved, never go unnoticed, let alone unpunished, in the staid halls of academic medicine.

Becoming more shrill and angry at each detractor’s critique, Semmelweis lost his clinical appointment at the Vienna General Hospital and in 1850 abruptly left for his native Budapest without even telling his closest colleagues. In 1861, he finally published his work, “Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers” (“The Etiology, the Concept, and the Prophylaxis of Childbed Fever”), in which he explained his theories on childbed fever, the ways to avoid spreading it by means of vigorous hand-washing and an attack on every one of his critics with a vitriol that still leaps off the page.

Dr. Semmelweis’s behavior became more and more erratic and he was finally committed to an insane asylum on July 30, 1865. He died there, two weeks later, on Aug. 13, 1865, at the age of 47. Historians still argue over what caused Semmelweis’s mental health breakdown and subsequent death. Some point to an operation Semmelweis performed, wherein he infected himself with syphilis, which may also explain his insanity. Others believe he developed blood poisoning and sepsis while imprisoned in the asylum for what may have been an unbridled case of bipolar disease. More recently, some have claimed that the obstetrician had an early variant of Alzheimer’s disease and was beaten to death in the asylum by his keepers.

Semmelweis’s professional timing could not have been worse. He made his landmark discovery between 1846 and 1861, long before the medical profession was ready to accept it.

Although Louis Pasteur began exploring the role of bacteria and fermentation in spoiling wine during the late 1850s, much of his most important work initiating the germ theory of disease occurred between 1860 and 1865. A few years later, in 1867, the Scottish surgeon Joseph Lister, who apparently had never heard of Semmelweis, elaborated the theory and practice of antiseptic surgery, which included washing the hands with carbolic acid to prevent infection. And in 1876, the German physician Robert Koch successfully linked a germ, Bacillus anthracis, to a specific infectious disease, anthrax.

Since the early 1900’s, however, physicians and historians have heaped up high praise for Semmelweis’s work and expressed sympathy for his emotional troubles and premature death. Today, in every school of medicine and public health, his name is uttered with great reverence whenever the critical topic of hand washing is taught. Sadly, in real time, he was derided as eccentric at best and, at worst, as an angry, unstable man who ought to be drummed out of the profession.

The real truth of the matter is that his detractors were wrong and he was right. Dr. Semmelweis paid a heavy price as he devoted his short, troubled life to pushing the boundaries of knowledge in the noble quest to save lives.

On the 165th anniversary of publicly announcing his landmark medical discovery, it seems fitting that we pay grand tribute to the great Dr. Semmelweis. Perhaps the gesture he might appreciate the most, however, is for us all to simply wash our hands often and well.

Dr. Howard Markel writes a monthly column for the PBS NewsHour, highlighting the anniversary of a momentous event that continues to shape modern medicine. He is the director of the Center for the History of Medicineand the George E. Wantz Distinguished Professor of the History of Medicine at the University of Michigan.

He is the author or editor of 10 books, including “Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892,” “When Germs Travel: Six Major Epidemics That Have Invaded America Since 1900 and the Fears They Have Unleashed” and “An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine.”

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Twitter chat: What’s behind the push to remove artificial ingredients from restaurant menus?

Chipotle Becomes First Non-GMO US
         Restaurant ChainLast week, Panera Bread announced that it will be removing more than 150 artificial ingredients from the items on its menu. The restaurant chain follows Chipotle and Kraft as the latest company to jump on the menu-makeover bandwagon.

Allison Aubrey, who covers food and nutrition for NPR, and Michael Moss, author of the book “Salt Sugar Fat: How the Food Giants Hooked Us,” recently joined Gwen Ifill to discuss some of the forces driving this trend.

“The reason why these companies are making these changes now is that they’re talking to their customers, and consumer sentiment has really changed,” Aubrey told Ifill.

“Much of what this is about are these food giants trying to regain the trust of customers who are caring more and more about what they put in their bodies and caring less and less for some of the strategies we have seen from the processed food industry over the years,” Moss agreed.

To what degree is consumer pressure contributing to brands’ decisions to strike artificial additives, GMOs and more from their menus and ingredients lists? What factors sparked the natural food revolution? How great are the health risks posed by these ingredients, and what is the impact (both economic and in terms of taste) of these changes?

We discussed this topic with Aubrey (@AubreyNPRFood) and Moss (@MichaelMossC) on Twitter. Read a transcript of the conversation below.

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USDA develops first government label for GMO-free products

An employee stocks produce near a sign supporting a ballot initiative in Washington state that would require labeling
         of foods containing genetically modified crops at the Central Co-op in Seattle, Washington October 29, 2013. Major U.S. food
         and chemical companies are pouring millions of dollars into efforts to block approval of the initiative. Photo by Jason Redmond/Reuters

An employee stocks produce near a sign supporting a ballot initiative in Washington state that would require labeling of foods containing genetically modified crops at the Central Co-op in Seattle, Washington October 29, 2013. Major U.S. food and chemical companies are pouring millions of dollars into efforts to block approval of the initiative. Photo by Jason Redmond/Reuters

WASHINGTON — The Agriculture Department has developed the first government certification and labeling for foods that are free of genetically modified ingredients.

USDA’s move comes as some consumer groups push for mandatory labeling of genetically modified organisms, or GMOs.

Certification would be voluntary — and companies would have to pay for it. If approved, the foods would be able to carry a “USDA Process Verified” label along with a claim that they are free of GMOs.

Agriculture Secretary Tom Vilsack outlined the department’s plan in a May 1 letter to employees, saying the certification was being done at the request of a “leading global company,” which he did not identify. A copy of the letter was obtained by The Associated Press.

Right now, there are no government labels that certify a food as GMO-free. Many companies use a private label developed by a nonprofit called the Non-GMO Project.

Vilsack said the USDA certification is being created through the department’s Agriculture Marketing Service, which works with interested companies to certify the accuracy of the claims they are making on food packages — think “humanely raised” or “no antibiotics ever.” Companies pay the Agricultural Marketing Service to verify a claim, and if approved they can market the foods with the USDA label.

“Recently, a leading global company asked AMS to help verify that the corn and soybeans it uses in its products are not genetically engineered so that the company could label the products as such,” Vilsack wrote in the letter. “AMS worked with the company to develop testing and verification processes to verify the non-GE claim.”

A USDA spokesman confirmed that Vilsack sent the letter but declined to comment on the certification program. Vilsack said in the letter that the certification “will be announced soon, and other companies are already lining up to take advantage of this service.”

Certification would be voluntary — and companies would have to pay for it. The USDA label is similar to what is proposed in a GOP House bill introduced earlier this year that is designed to block mandatory GMO labeling efforts around the country. The bill, introduced earlier this year by Rep. Mike Pompeo, R-Kan., provides for USDA certification but would not make it mandatory. The bill also would override any state laws that require the labeling.

The food industry, which backs Pompeo’s bill, has strongly opposed individual state efforts to require labeling, saying labels would be misleading because GMOs are safe.

Vermont became the first state to require the labeling in 2014, and that law will go into effect next year if it survives a legal challenge from the food industry.

Genetically modified seeds are engineered in laboratories to have certain traits, like resistance to herbicides. The majority of the country’s corn and soybean crop is now genetically modified, with much of that going to animal feed. GMO corn and soybeans are also made into popular processed food ingredients like high-fructose corn syrup and soybean oil.

The FDA says GMOs on the market now are safe. Consumer advocates pushing for the labeling say shoppers still have a right to know what is in their food, arguing that not enough is known about the effects of the technology. They have supported several state efforts to require labeling, with the eventual goal of having a federal standard.

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USDA to require safety labels on mechanically tenderized beef

A butcher prepares cuts of beef on January 13, 2014. Photo by  Joe Raedle/Getty Images

A butcher prepares cuts of beef on January 13, 2014. Photo by Joe Raedle/Getty Images

WASHINGTON — The government will soon require labels on packages of beef tenderized by machines so shoppers know to cook it thoroughly.

The Agriculture Department said Wednesday the labels will be required starting in May 2016. Mechanically tenderized meat is poked with needles or blades to make it tender, a process that can transfer bacteria from the outside of the cut of beef to the inside. Since many people eat cuts of meat that aren’t fully cooked in the center, that bacteria can pose a safety hazard.

The labels will say that the meat has been “mechanically tenderized,” ”blade tenderized” or “needle tenderized.” They also will include cooking instructions to ensure consumers cook the meat long enough to kill any bacteria.

The Centers for Disease Control and Prevention says there have been six outbreaks of illness linked to mechanically tenderized beef in the last 15 years. USDA predicts that the new labels and cooking instructions could prevent hundreds of illnesses annually.

“This common sense change will lead to safer meals and fewer foodborne illnesses,” said Al Almanza, head of USDA’s Food Safety and Inspection Service.

Meat industry officials say they have worked to make tenderized products safer over the years, and they don’t think the products need to be labeled. But the North American Meat Institute’s Barry Carpenter said USDA worked with the industry on the rules, which were initially proposed in 2013, and the meat companies will put them in place.

“We are confident in the safety of products that are mechanically tenderized to increase tenderness, a trait that consumers desire in meat products,” Carpenter said.

Consumer groups pushed for the labels, saying consumers don’t always know when meats have been tenderized or that they can be unsafe.

Rep. Rosa DeLauro, a Connecticut Democrat who has long argued for stricter food safety rules, called the potential illnesses from tenderized beef a critical public health issue. She praised USDA for moving to require the labels.

“The serious and urgent health risks associated with consuming mechanically tenderized meats are clear,” DeLauro said.

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