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Ignaz
Semmelweis
"Ignatz Semmelweis, whose story
this is, was a pioneer in medical prophylaxis,
the innovator of hand-washing and antiseptic
solutions for surgeons and obstetricians.
Unbelievable as it seems, professors and their
students in medical universities went from the
dissecting room, where they demonstrated and
practiced delivering babies from cadavers, to the
Lying In rooms where they examined women about to
give birth — all without washing or
disinfecting their hands. A gratuitous rubbing of
their bloody hands on their lab coats was
considered ample readiness, and in fact the
presence of bloody matter on their coats was
deemed almost a badge of honor. Semmelweis turned
that all around in a revolution that was to save
millions of new mothers' lives all over the
world.
Did the
majority of the doctors take kindly to removing
their "badges of honor" for the sake of
saving lives? One would think so, and one would
be very wrong."
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The Cry and the Covenant
by
Morton Thompson
Published by Garden City Books/NY in 1949
Book Review by Bobby Matherne ©2001
Web www.doyletics.com
This is a book that begged for a re-reading. I first read
it almost twenty years ago while taking a course in Dr.
Andrew Galambos' Volitional Science from Evan Soulé
— it was part of the reading library that he
provided for students of the course. Ignatz Semmelweis,
whose story this is, was a pioneer in medical
prophylaxis, the innovator of hand-washing and antiseptic
solutions for surgeons and obstetricians. Unbelievable as
it seems, professors and their students in medical
universities went from the dissecting room, where they
demonstrated and practiced delivering babies from
cadavers, to the Lying In rooms where they examined women
about to give birth — all without washing or
disinfecting their hands. A gratuitous rubbing of their
bloody hands on their lab coats was considered ample
readiness, and in fact the presence of bloody matter on
their coats was deemed almost a badge of honor.
Semmelweis turned that all around in a revolution that
was to save millions of new mothers' lives all over the
world. Did the majority of the doctors take kindly to
removing their "badges of honor" for the sake
of saving lives? One would think so, and one would be
very wrong. Therein lies a tale, one that Morton Thompson
relates in all the gory details. So gory that even with a
movie-going public enured to scenes of violence and gore,
one cannot imagine a movie made that incorporates details
of screaming bloated women filling a maternity ward and
closeups in the dissecting rooms where women who had
recently died from childbed fever or puerperal fever were
used to practice deliveries in the dissecting room. The
upper torso was removed and the lower torso was prepared
by inserting a dead baby in preparation for delivery.
After about a dozen deliveries, new cadavers and babies
were brought into replace the old ones.
Semmelweis was a country bumpkin from Hungary in the
sophisticated milieu of Vienna and his cup of social
graces was as empty as his font of empathy for his
patients was full. Exactly the opposite of what the noble
profession of medical doctor, surgeon and professor of
medicine required. Also he had a dangerous penchant for
innovation that was unwelcome in a university whose job
was deemed to be that of teaching what was known of
medicine as it existed at the time. Childbed fever had
always existed and always will, one of his friends told
him. Ignatz, or Naci, as his friends called him, rebelled
at the thought that there was no hope for stemming this
carnage of human life. Unanswered questions filled his
thoughts: Why did the women who gave birth in the streets
not die of childbed fever? Why was the rate of death in
the Second Ward one-third that of the First Ward? Why was
the rate in Vienna so high compared to England? To
France?(1) And most importantly
what was the etiology, the one true cause of childbed
fever?
There was no dearth of explanations of what caused
childbed fever: mother's milk, errors in diet, chilling,
gastric-bilious fever, miasma, congested rooms, bad
ventilation, male sperm, fear, constipation, modesty,
epidemic peritonitis, and so on. The remedies to be
applied to prevent death were as diverse as the suspected
causes.(2) When Semmelweis
finally gets complete control over a small maternity ward
back home in Hungary, his superior prescribes bowel
purging as the remedy of choice to a condition he is
convinced is due to constipation. Semmelweis was given
free rein, as long as he prescribed purging, to insist on
hand cleaning and antiseptic washing with a hypochlorite
solution and the deaths went to zero the first year. Did
his superior proclaim Semmelweis' success as due to
prophylaxis? Not at all — his superior attributed
his success to Semmelweis' assiduous application of bowel
purges.
Let's see what his first boss, Dr. Klein in Vienna,
taught him about childbed fever and how he was supposed
to react to it:
[page 170] "Henceforth, Dr. Semmelweis, you will
regard puerperal fever as an ailment traceable to milk.
You will regard it as an aliment for which no human mind
has ever found a remedy. No remedy ever will be found.
You will accustom yourself to the unhappy incidence and
the consequent fatalities of this disease as one of the
normal expressions of living and of giving birth, and you
will behave toward it as a doctor is expected to react to
the inevitable occurrences of life and of death."
And what was this medical director's authority for saying
this? None other than the words of the Emperor of Austria
himself, which were spoken when he founded the division.
Here is how Semmelweis' boss instructed him, quoting the
Emperor's words directly.
[page 171] "'Keep yourself to what is old, for that
is good. If our ancestors have proven it to be good, why
should we not do as they did? Mistrust new ideas. I have
no need of learned men. I need faithful subjects. He who
would serve me must do what I command. He who cannot do
this or who comes full of new ideas may go his way. If he
does not, I shall send him.' Do you understand, Dr.
Semmelweis?"
How did Semmelweis begin his search for a cure for
childbed fever? In the diseased bodies of the dead women
themselves, in the autopsy room. Surely the answer would
be found there, right in the diseased tissues. Corpse
after corpse he dissected and always noted the same milky
fluid, the same inflammation of tissues, but never a clue
as to the cause. As he searched for the answer to the
horrendous deaths of the women, he was taking his hands
from the autopsy room to the delivery rooms and causing
more deaths. Somehow he had to look somewhere else for a
clue. The first clue came in the statistics. He began
tallying the deaths by ward and found a huge difference
between two otherwise identical wards of the hospital.
The First Division had three times as many deaths as the
Second Division. The Second trained only midwives and the
First students. Perhaps the men were rougher with the
women, their bigger hands, etc, came the hypothesis from
the head of the Second Division. Not much help, but here
was a doctor making a systematic study of the etiology of
a disease from statistics, perhaps for the first time in
history.(3)
Still the big break was to come with the unfortunate
death of Kolletschka, a colleague of his who had his
finger stabbed by a student during an accident while
teaching dissection. He developed a fever and died.
Ignatz was out of town when his friend died, and decided
to review the death certificate for the medical findings.
To his amazement, the descriptions of the autopsy on his
friend matched that of every autopsy he'd done of a case
of childbed fever. What if the dreaded fever was not
specific to women, but was due to cadaveric poisoning? It
would be simple to test: simply wash one's hands and
disinfect them and see if any deaths occurred. Ah, if
life in the real world of intrenched paradigms and
university politics were as simple. Semmelweis began
using a liquid chlorine which was too expensive, so he
had to innovate a solution of chlorated lime that was
strong enough to remove all traces of the smell of the
autopsy room from his hands. Then he began insisting that
every student wash his hands and dip them in the chorated
lime solution before working on women in the delivery
rooms.
The students balked and he discharged them. Some of the
students fought back and his boss, Dr. Klein, insisted
that he drop the hand cleaning. Semmelweis persisted with
his washings and eventually Dr. Klein had Semmelweis
removed from his position at the hospital. As soon as the
washings were removed, the death rate of the women
returned to where it was before, almost 30% at times. One
in three of the thousands of women per year who came into
the First Division died within days after a normal child
birth experience. To Dr. Klein, this was the natural
order of things; to Dr. Semmelweis, this was grotesque
murder. Semmelweis made this observation to a colleague:
[page 252] There will always be doctors like Klein. I
don't think the Kleins of the world are in the majority.
But while other doctors are healing people, the Kleins
are making a secure position for themselves. They don't
use medicine to do this. They use the protection of
medicine and the politics of medicine. And because of the
way medical liberals split up among themselves, it's the
Kleins who really run the universities and the hospitals.
One of Semmelweis' disciples explained how he saw the
situation of medicine vis-a-vis innovation.
[page 301] "Do you know," said Arneth slowly,
"it's true of your discovery as it has been of every
discovery in the whole history of medicine. When we take
our medical oath we undertake to lengthen life and ease
suffering. We are all united in seeking new means. And
every time a man has come forward with a demonstrable
truth, a remedy for good, the profession seems to have
done its best to crush the discoverer and hide the
discovery. No quackery — no criminality —
nothing seems to make us so furious as a discovery."
Finally Semmelweis was stripped of his position at the
university by Klein and was blocked at every turn from an
appointment as Privat-Dozent, or private practice where
he could use and teach students to use his methods of
prophylaxis. Running out of money he returned to Hungary
and worked in a very small clinic where he was allowed
free rein to practice his methods and the death rate from
childbed fever went to zero, all the while the wards of
the prestigious Lying In Hospital in Vienna remained a
scene of grotesque carnage. He published papers around
the world and the journal editors added footnotes to the
effect that “Everyone knows the cause of childbed
fever is x.” where x was whatever their pet theory
was. He wrote a book on his work, but those that needed
it most never read it, because it was a new theory and
they were in a profession that respected the old tried
and true methods.
Semmelweis died in obscurity in Hungary at the age of
about fifty, but the work that he pioneered has
subsequently saved untold millions of lives. As Naci's
friend said to him once, "As long as there are
trees, there will be crosses." Ignatz Phillipe
Semmelweis took up his cross at a young age and
single-handedly wiped out the scourge of womanhood known
as childbed or puerperal fever. Not only a martyr to the
medical profession, but a martyr to every innovator who
makes a discovery that can ease the pain of humanity and
benefit every one till the end of time.
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