Influential Medical Interventions: Semmelweis

Background

• Ignaz Semmelweis was a physician working in Vienna in the 19th Century.
• He is one of the early pioneers of antiseptic procedures.
• He worked on the First Obstetrical Clinic of Vienna General Hospital, and was responsible for examining patients, teachings students, keeping records, and supervising difficult deliveries.

Source: npr.org

Childbed Fever

• Childbed fever, otherwise known as puerperal fever, is an infection of women’s reproductive organs following childbirth.
• It affects women within the first few days after childbirth, and progresses quickly, with acute symptoms such as fever, severe abdominal pain, and debility.
• During Semmelweis’ time, before the advent of antibiotics, a diagnosis of puerperal fever was usually fatal.

The First Clinic of Vienna General Hospital

• Semmelweis worked on the First Clinic of Vienna General Hospital, which had a maeternal mortality rate of around 10% due to childbed fever.
• The Second Clinic had a much lower rate of around 4%.
• Semmelweis described scenes of mothers begging to be placed on the Second Ward due to their lower rates of childbed fever.
• Some would even go to the lengths of giving birth on the street and then claiming it had ‘been on the way to hospital,’ in order for them to be eligible for child care benefits.
• Surprisingly, Semmelweis found that these ‘street births’ still had a lower rate of childbirth fever than the First Clinic.

First Clinic Vs Second Clinic

• Semmelweis compared both clinics in order to find possible differences that could explain the disparity in maternal mortality rate.
• Both clinics used the same techniques, and Semmelweis concluded that the only major difference was the staff working there.
• The First Clinic was the teaching service for medical students, while the Second Clinic had been selected in 1841 for the instruction of midwives only.

The Cause

• Medical students would regularly perform autopsies and post-mortems before and in-between delivering children.
• Jakob Kolletschka, a friend of Semmelweis, died after being poked with a student’s scalpel during a post-mortem, and Semmelweis found that his pathology showed similar signs to mothers who had suffered from childbed fever.
• He concluded that students were carrying ‘cadaveric particles’ from the dead bodies during autopsies and affecting the women in the First Clinic.
• He instituted a policy of using a solution of chlorinated lime for washing hands between autopsy work and the examination of patients.
• He did this because he found that this chlorinated solution worked best to remove the putrid smell of infected autopsy tissue, and thus perhaps destroyed the contaminating “cadaveric” agent being transmitted by this material.
• The result was a decline of mortality rate by 90% in the First Clinic!

Source: nytimes.com

An Unhappy Ending

• Unfortunately, even with statistics and data supporting and justifying this policy, Semmelweis didn’t receive much support from his colleagues and the hospital.
• The Germ Theory of Disease was not yet accepted in Vienna, and doctors were offended and did not accept that they could be the cause of the high mortality rate.
• Semmelweis was mocked. In 1865, he suffered a nervous breakdown and was admitted into an asylum.
• In the asylum he was beaten by the guards. He died 14 days later from a gangrenous wound on his right hand that may have been caused by the beating.
• Semmelweis’s practice earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory, and Joseph Lister, practised and operated using hygienic methods, with great success.
• While only appreciated after his death, Semmelweis had a great contribution in furthering medical innovation, and saved the lives of many both during his life, and after. He’s deserving of his title: “saviour of mothers”.

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Refererences

Baum, Hermann (2018) Ignaz Semmelweis His ancestors on the paternal and maternal side

Breisky, August (1861), “Semmelweis”

Carter, K. Codell; Carter, Barbara R. (2005), Childbed fever. A scientific biography of Ignaz Semmelweis

Hanninen, O.; Farago, M.; Monos, E. (September–October 1983), “Ignaz Philipp Semmelweis, the prophet of bacteriology”

Nuland, Sherwin B. (2003), The Doctors’ Plague: Germs, Childbed Fever and the Strange Story of Ignac Semmelweis