Semmelweis

It was said in the previous post that there were two kinds of services in the maternity ward of the Vienna General Hospital. At the First Clinic, children were delivered by medical students under the supervision of reputed professors; and at the Second Clinic, the midwives and learners were responsible for the assistance to the parturients. It was also said that the Austro-Hungarian physician Ignaz Semmelweis showed that the high mortality rate caused by puerperal fever, much more severe in the First Clinic than in the Second, was largely caused by contamination of doctors’ and students’ hands. In a time when there was no knowledge about microorganisms being the cause of diseases, Semmelweis established the idea that, handling dead bodies in autopsies, students and phisicians were carrying “cadaverous particles” through their hands and it was infecting women during gynecological examinations and child-birth procedures. In 1847, the institution of basic hygiene procedures, as such as washing hands and using chlorine solution until the dissipation of the specific hand’s smell after autopsies, resulted in immediate mortality decreasing at the Vienna General Hospital. To see the previous post, click here.

Some of the most important physicians of that hospital, who also are reputed in the story of Medicine, such as Karl Freiherr von Rokitansky, Joseph Skoda and Ferdinand Ritter von Hebra understood and supported Semmelweis’ theories. Karl Freiherr von Rokitansky was the pioneer of Pathological Anatomy; Joseph Skoda revolutionized Semiology and Ferdinand Ritter von Hebra was the founder of modern dermatology. Despite being the author of the theory, Semmelweis did not publish an article about his discovery. However, two of these important physicians, Hebra and Rokitanski, wrote and published articles about the Semmelweis’ theory, which were presented and defended at the Austrian Academy of Medicine by Skoda.

Professors of Viena Hospital -1853  Von Hebra is the penultimate standing. Rokitansky is the 3rd, Skoda is the 4th sitting. (from left to right) Source Wikipedia

One of the doctors that believed Semmelweis’ ideas was the professor Gustav Adolph Michaelis, from Kiel, who commited suicide in 1848. This desperate act was because, with the new knowledge about microorganisms and contamination, he realised that he could have been responsible for his niece’s death and he was tormented by this thought. She died of puerperal fever after having her child delivered by her uncle Michaelis.

What should have been immediately recognized as a breakthrough was not well received for the majority of the medical community at the hospital. Semmelweis’ ideas had strong opposition from colleagues, especially Johann Klein, boss of obstetrics of the hospital, and Eduard Lumpe, another reputed obstetrician.They used to explain the high mortality rate from puerperal fever as a result of heavy miasma, weather or telluric causes, the current concepts at that time. There was also the theory that puerperal fever was contagious and one patient transmited the disease to the other. Other reasons that they used to believe were: maternity ward overcroweding; malpractice of some students, particularly the Hungarians (Klein threw out many of them); and psycological causes including the terror caused in patients by the priest who used to come to the extreme unction ringing a bell on its way inside the hospital. Lumpe was the main contester of Semmelweis. He advocated that the medical science required an external cause to explain the mortality rate. Finally, it is very important to consider that accepting Semmelweis’ ideas, the physicians of the hospital would assume that they had caused many deaths. Therefore, this is another likely reason for the resistance against Semmelweis.

Semmelweis did not have good skills to defend his opinions. Besides that, he had an aversion to writing. In 1850, during the controversy with Lupe, he went to the University of Pest, where he could reduce mortality from puerperal fever to less than 1%. Only in 1858 did he publish his first article: The Etiology of Puerperal Fever. In 1861 he published his book, Etiology, concept and prophylaxis of childbed fever. At that time the Hungarian doctor started to manifest psychiatric symptoms. He had moments of depression, melancholia, agitation, aggression. In some of these situations he posted flyers on the streets urging parents to require disinfection of doctor’s hands in childbirth. He thundered against the doctors who did not accept his theory. In 1862 he began to publish open letters to his opponents. One was the great Rudolf Virchow. Semmelweis wrote an open letter saying that anyone of his 823 pupils knew more than Virchow and that he (Semmelweis) was more enlightened than the members of the German Academy of Medicine.

The real nature of their psychiatric illness is unknown. It is considered the possibility of an early form of Alzheimer’s disease. However, it is also identified as hypothetical causes: post-traumatic psychosis or even tertiary syphilis. The fact is that the psychiatric condition became worse and Semmelweis was admitted to a mental institution, carried by his wife and his friend Hebra on July 30, 1865. On August 13th  Semmelweis died of septicemia at 47 years old. One of the theories accepted by historians is that he could have been accidentally injured during an autopsy a few days before being hospitalized (some also say that this injury was intentional) and acquired the disease which he fought against during all his medical life. Another hypothesis is that he was assaulted in a hospice and generalized infection would have been a result of the injuries caused.

Semmelweis would have unlikely known that, in the same year of his death, Pasteur made his famous study about diseases of the silkworm, showing that microbes can cause illness, and also that Joseph Lister demonstrated the efficiency of phenol as an antiseptic.

Translated by Ana Raquel Costa Geraldes