Ignaz Semmelweis (1818-1865)

           In the mid-nineteenth century, a maternity ward of the Vienna General Hospital used to offer  free care to poor people. Actually, it used to offer two kinds of services: At the First Clinic, child-birth by medical students under the supervision of reputed professors; and at the Second Clinic, the midwives and learners were responsible for the medical services. If the pregnant women arrived at the hospital on Mondays, Wednesdays, Fridays and Saturdays, they would be attended to the First Clinic. If they arrived on the other days, they would be at the Second Clinic.

            However, in the 1840’s there was a high mortality rate caused by puerperal fever in these clinics, but particularly severe in the First. Consequently, the pregnant women started to avoid be treated in these two places. Having child-birth at the First Clinic was synonym for anguish and concern. Many women supplicated to be attended to the Second Clinic by the midwives. Others delayed their arrival but sometimes could not wait, which resulted in giving birth on the street. For these women, who gave birth on the street, there was a low rate of puerperal fever.

            In this time, Ignác Fülöp Semmelweis, a young Hungarian physician who was born in 1818 in Budapest, was highlighted for his work. He graduated in medicine in 1844 and in the same year started to work as an intern at the Vienna General Hospital. In 1846 he was promoted to assistant. Being concerned and unsatisfied with the explanations of the physicians, Semmelweis strongly dedicated his studies to discover the reason for so many deaths. Shortly thereafter he confirmed with statistics the huge difference in the death rate caused by childbed fever between the two clinics, as you can see in the table below. He realized that, at the First Clinic, women who gave birth during a long process usually died, meanwhile the women who had a premature birth or even on the street, hardly became sick. He also identified that the characteristics of the babies who died at the same time as their mothers were very similar to each other.

            Semmelweis was convinced that the difference in mortality between the two clinics was due to an endemic cause, unknown and not the result of the action of miasmas, as the doctors of the hospital believed. He also did not accept other attempts of explanations that, for example, these deaths were due to their fear or shame in being attended to men.
At the General Hospital, autopsies were an important part of medical education. In early 1847, Professor Jacob Kolletschka was wounded by the scalpel of a student during an autopsy and soon developed a serious illness and died in a few days. Semmelweis concluded:
            “He (Kolletschka) died of bilateral pleurisy, pericarditis, peritonitis and meningitis (…) I could clearly see that the disease from which Kollestchka died was identical to those of which many hundreds of maternity patients had also died.”

              Concluding that the professor was a victim of the same disease that killed the mothers, Semmelweis had the intuition or “insight” that the cause had been a contamination of the scalpel by “cadaverous particles” that were introduced into the vascular system. Therefore, in his words:
             “I was compelled to ask if the cadaverous particles were introduced into the vascular system of those patients I had seen dying with the same disease. I was forced to answer affirmatively.”

              As the students had frequent contacts with bodies in autopsies and examined the patients immediately after these contacts, he concluded that these cadaverous particles were taken to the patient by the hands of students and physicians.
              Although there was resistance, Semmelweis managed to make it mandatory that before exams of patients, the hands of students and physicians were washed with soap and water and disinfected with chlorinated solutions. He said that the use of chlorinated solutions was important because only water and soap were not able to remove the cadaverous particles, which could be identified by the smell which remained on the hands after handling corpses. Note that the use of chlorinated water was empirical, there was no concept of antisepsis, and asepsis. Besides that, there was no concept that micro-organisms could cause disease. This scenery and unfounded situation attest the importance and pioneering of Semmelweis.

             As a result of these changes, established in May 1847, the mortality from puerperal fever dramatically fell. In April, 18.3% of the patients had died. In May, 12.2%. In June the rate fell to 2.2% and in July to 1.2%.
Ignaz Semmelweis was revolutionary. He modified concepts and attitudes. He was one of the pioneers of antisepsis and germ theory. He  knew how to use the art of observation and especially the art of thinking and challenging established theories, realizing that they not only did not explain, but also were contrary to the strength of the evidence he watched. Suffering, however, strong resistance from doctors of his time to his ideas, which brought serious and tragic consequences. We will talk about it in the next post.