by Melinda Pillsbury-Foster
The
persistence of the avoidance of facts in medicine must include the experience
of Ignaz Philipp Semmelweis, a
Hungarian physician whose first job was in obstetrics as appointed assistant to
Professor Johann Klein, work which was carried out at the First Obstetrical
Clinic of the Vienna General Hospital beginning on July 1, 1846.
Semmelweis’s duties included examining patients every morning in
anticipation of Professor Klein’s rounds.
He also provided supervision for difficult deliveries and performed
other tasks assigned to him.
There were two maternity clinics at the
hospital.
The First Clinic had an average maternal mortality
rate from puerperal fever of approximately 10%.
There were two maternity clinics at the Viennese hospital. The First
Clinic had an average maternal mortality rate due to puerperal fever of about
10%. The mortality rate at the Second Clinic rate averaged less than 4%. This
fact was known beyond the bounds of the hospital. Poor women being admitted would routinely
give birth on the street rather than face being admitted to the First
Clinic.
This surprised and intrigued Semmelweis and he
began looking for an answer. He was
quoted as saying this, “made me so miserable that life seemed
worthless”. The two clinics used nearly the same techniques – so where was
the difference to be found?
The First Clinic was part of the training regimen
for medical students; the Second was used for the instruction of only
midwives.
Semmelweis systematically eliminated possible
causes for the difference in outcome.
First, he eliminated “overcrowding’; the Second Clinic always
experienced a higher volume of patients.
In 1847 a breakthrough occurred for Semmelweis
arising from the death of an associate and friend, Jakob Kolletschka. Kolletschka had accidentally poked by a student’s
scalpel as the student was performing a postmortem exam. The postmortem on Kolletschka revealing a
pathology similar to those from women who had died of puerperal fever.
Semmelweis realized this could be the variable he
had been seeking, material from contaminating cadavers which carried puerperal
fever. Medical students had contact only
with the First Clinic patients, not those from the Second Clinic with its much
lower mortality rate.
A policy mandating the use of chlorinated lime, known today as
calcium hypochlorite, ordinary household chlorine bleach for the First Clinic. He chose the solution because it was known to
eliminate the putrid smell of infected tissue studied during autopsies.
The mortality rate in the First Clinic dropped 90%, becoming comparable
to that in the Second Clinic. “The
mortality rate in April 1847 was 18.3%. After hand washing was instituted in
mid-May, the rates in June were 2.2%, July 1.2%, August 1.9% and, for the first
time since the introduction of anatomical orientation, the death rate was zero
in two months of the year following this discovery”, according to Source
Cases of puerperal fever, which was a form of septicemia, could be
reduced to near zero if doctors washed their hands in the formula Semmelweis
had identified. However, this conflicted with the Theory of diseases which was
accepted as fact by the existing medical and scientific opinions of his
time. Semmelweis’ ideas were
rejected.
Semmelweis continued his work in 1848, despite having his
ideas and the protocols for eliminating the persistence of puerperal fever; he and
documented the outcome, which went far toward eliminating incidences of the
puerperal fever all together from the hospital wards.
Disagreements with
conservative physicians, including his immediate superior, Professor Klein,
resulted in Semmelweis leaving the hospital to return to his native Pest in
1851.
There, he took on
oversight of Pest’s obstetric ward at the small St. Rochus Hospital. Semmelweis virtually, again, eliminated
incidents of puerperal fever. From 1851 –
1855 only 8 patients died from childbed fever from 933 births.
In his 1861 book, The
Etiology, Concept and Prophylaxis of Childbed Fever, Semmelweis lamented
the slow adoption of his ideas saying, “Most medical lecture halls continue to
resound with lectures on epidemic childbed fever and with discourses against my
theories. The medical literature for the last twelve years continues to swell
with reports of puerperal epidemics, and in 1854 in Vienna, the birthplace of
my theory, 400 maternity patients died from childbed fever. In published
medical works, my teachings are either ignored or attacked. The medical faculty
at Würzburg awarded a prize to a monograph written in 1859 in which my
teachings were rejected.”
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