Wash your hands!

 James Garfield, the 20th President of the United States of America died on September 19, 1881 (I knew this because someone posted it this past Saturday on Twitter).  President Garfield, as many of you learned in school, was one of the four U.S. Presidents that have been assassinated (Lincoln, Garfied, McKinley, and Kennedy).  What's unique about Garfield is that he was actually shot on July 2, 1881 (all the other Presidents died shortly after being shot - in William McKinley's case, he died about 8 days after being shot twice in the abdomen).  

I've always been interested in President Garfield.  He was a Civil War hero (he was a Major General in the Union Army), lawyer, college professor, and an accomplished mathematician!  Well, at least he published a proof for the Pythagorean Theorem (see his proof here).  After the Civil War, he served in the U.S. House of Representatives for the state of Ohio, and he later became a U.S. Senator.  He was nominated to run for President at the 1880 Republican Party Convention as a compromise candidate (he actually wasn't seeking to run for President) and just barely beat Democrat Winfield Scott Hancock (another famous Civil War General) to become our 20th President.

President Garfield was shot by Charles J. Guiteau, a disappointed office seeker, at the Baltimore and Ohio Railroad Station in Washington, D.C. on July 2, 1881.  Garfield was shot twice, once in the arm and once in the back, exclaiming, "My God, what is this?"  Ironically, Robert Todd Lincoln, surviving son of President Abraham Lincoln was a witness to the assassination.  Garfield was removed from the scene and examined by doctors - who probed the wound with unwashed hands (handwashing was not a common practice at that time).  Several doctors, in fact, probed the wound with unwashed hands and unsterile instruments, but unfortunately no one could find the bullet (X-rays would not be invented until 14 years later).  Alexander Graham Bell, the inventor of the telephone, apparently used a primitive metal detector in an unsuccessful attempt to locate the bullet.  All of this uncleanliness later caused an infection ("blood poisoning"), and the President ultimately died of sepsis on September 19th, just over 2 months after being shot.

In all likelihood, if President Garfield's physicians had washed their hands or sterilized their surgical instruments, Garfield probably would have survived - one can only speculate.  Handwashing was first proposed as the best way to minimize the risk of infection in hospitals by the Austrian physician, Ignaz Semmelweis in the late 1840's.  Semmelweis found that handwashing significantly reduced the risk of mortality from puerperal fever (an infection that occurred after childbirth).  

As the story goes, Semmelweis operated two labor and delivery wards at Vienna General Hospital.  The First Clinic had a much higher rate (and mortality) of puerperal fever compared to the Second Clinic.  The only difference was the personnel - there were more medical students working in the First Clinic, while there were mostly midwifes working in the Second Clinic.  Semmelweis noticed that the medical students often came directly to the clinic from the autopsy room, and they almost never washed their hands or cleaned their instruments.  The midwifes, on the other hand, never worked in the autopsy room and almost always washed their hands.  Once Semmelweis changed the practice, so that everyone washed their hands, the rate of puerperpal fever in the First Clinic declined precipitously.

Unfortunately, most physicians didn't believe Semmelweis's data.  They ridiculed him, and the harder he pushed, the harder they pushed back.  He eventually went insane, and in the ultimate irony, died of sepsis in 1865.  So by the time President Garfield was shot, handwashing was still not an accepted practice in medicine.

I can't help but wonder if there is a lesson here.  Even today, hospitals still (believe it or not) struggle to reach universal handwashing (compliance with handwashing practices almost never reach 100%).  Even now, during the COVID-19 pandemic, evidence-based practices such as handwashing and universal masking have not been universally accepted (while most, if not all, hospital workers have accepted universal face masking, the public has certainly not).  

Change is hard - even with overwhelming evidence.  But that shouldn't excuse the fact that (1) washing your hands and (2) wearing a mask can dramatically reduce your risk of acquiring COVID-19.  Wash your hands.  Wear your mask.