Ignaz Semmelweis
Ignaz Philipp Semmelweis[A] (German: [ɪˈɡnaːts ˈzɛml̩vaɪs]; Hungarian: Semmelweis Ignác Fülöp; 1 July 1818 – 13 August 1865) was a Hungarian physician and scientist, now known as an early pioneer of antiseptic procedures. Described as the "saviour of mothers",[2] Semmelweis discovered that the incidence of puerperal fever (also known as "childbed fever") could be drastically cut by the use of hand disinfection in obstetrical clinics. Puerperal fever was common in mid-19th-century hospitals and often fatal. Semmelweis proposed the practice of washing hands with chlorinated lime solutions in 1847 while working in Vienna General Hospital's First Obstetrical Clinic, where doctors' wards had three times the mortality of midwives' wards.[3] He published a book of his findings in Etiology, Concept and Prophylaxis of Childbed Fever.
Despite various publications of results where hand washing reduced mortality to below 1%, Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Semmelweis could offer no acceptable scientific explanation for his findings, and some doctors were offended at the suggestion that they should wash their hands and mocked him for it. In 1865, the increasingly outspoken Semmelweis supposedly suffered a nervous breakdown and was committed to an asylum by his colleague. He died 14 days later, at the age of 47, from a gangrenous wound on his right hand which might have been caused by a beating from the guards. Semmelweis's practice earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory, and Joseph Lister, acting on the French microbiologist's research, practised and operated using hygienic methods, with great success.
Ignaz Semmelweis was born on 1 July 1818 in Tabán, neighbourhood of Buda, Hungary, today part of Budapest. He was the fifth child out of ten of the prosperous grocer family of József Semmelweis and Teréz Müller.
Of German ancestry, his father was an ethnic German (hienc, stem from Heanzenland [de], a German term for the historical Western-Hungary) born in Kismarton, then part of Hungary, now Eisenstadt, Austria. He achieved permission to set up a shop in Buda in 1806[B] and, in the same year, opened a wholesale business for spices and general consumer goods.[C] The company was named zum Weißen Elefanten (at the White Elephant) in Meindl-Haus in Tabán (today's 1-3, Apród Street, Semmelweis Museum of Medical History).[4] By 1810, he was a wealthy man and married Teréz Müller, daughter of the coach (vehicle) builder Fülöp Müller.[5]
Ignaz Semmelweis began studying law at the University of Vienna in the autumn of 1837, but by the following year, for reasons that are no longer known, he had switched to medicine. He was awarded his doctor of medicine degree in 1844. Later, after failing to obtain an appointment in a clinic for internal medicine, Semmelweis decided to specialize in obstetrics.[6] His teachers included Carl von Rokitansky, Joseph Škoda and Ferdinand von Hebra.
Semmelweis was appointed assistant to Professor Johann Klein in the First Obstetrical Clinic of the Vienna General Hospital on July 1, 1846.[7][8][D] A comparable position today in a United States hospital would be "chief resident."[9] His duties were to examine patients each morning in preparation for the professor's rounds, supervise difficult deliveries, teach students of obstetrics and be "clerk" of records.
Maternity institutions were set up all over Europe to address problems of infanticide of illegitimate children. They were set up as gratis institutions and offered to care for the infants, which made them attractive to underprivileged women, including prostitutes. In return for the free services, the women would be subjects for the training of doctors and midwives. Two maternity clinics were at the Viennese hospital. The First Clinic had an average maternal mortality rate of about 10% due to puerperal fever. The Second Clinic's rate was considerably lower, averaging less than 4%. This fact was known outside the hospital. The two clinics admitted on alternate days, but women begged to be admitted to the Second Clinic, due to the bad reputation of the First Clinic.[10] Semmelweis described desperate women begging on their knees not to be admitted to the First Clinic.[11] Some women even preferred to give birth in the streets, pretending to have given sudden birth en route to the hospital (a practice known as street births), which meant they would still qualify for the child care benefits without having been admitted to the clinic. Semmelweis was puzzled that puerperal fever was rare among women giving street births. "To me, it appeared logical that patients who experienced street births would become ill at least as frequently as those who delivered in the clinic. [...] What protected those who delivered outside the clinic from these destructive unknown endemic influences?"[12]
Semmelweis was severely troubled that his First Clinic had a much higher mortality rate due to puerperal fever than the Second Clinic. It "made me so miserable that life seemed worthless".[13] The two clinics used almost the same techniques, and Semmelweis started a meticulous process of eliminating all possible differences, including even religious practices. The only major difference was the individuals who worked 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.
He excluded "overcrowding" as a cause, since the Second Clinic was always more crowded and yet the mortality was lower. He eliminated climate as a cause because the climate was the same. The breakthrough occurred in 1847, following the death of his good friend Jakob Kolletschka, who had been accidentally poked with a student's scalpel while performing a post mortem examination. Kolletschka's own autopsy showed a pathology similar to that of the women who were dying from puerperal fever. Semmelweis immediately proposed a connection between cadaveric contamination and puerperal fever.
He concluded that he and the medical students carried "cadaverous particles" on their hands[E] from the autopsy room to the patients they examined in the First Obstetrical Clinic. This explained why the student midwives in the Second Clinic, who were not engaged in autopsies and had no contact with corpses, saw a much lower mortality rate.
The germ theory of disease had not yet been accepted in Vienna. Thus, Semmelweis concluded some unknown "cadaverous material" caused childbed fever. He instituted a policy of using a solution of chlorinated lime (calcium hypochlorite) 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 causal "poisonous" or contaminating "cadaveric" agent hypothetically being transmitted by this material.
The result was the mortality rate in the First Clinic dropped 90%, and was then 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 in the year following this discovery.
Efforts to reduce childbed fever
Semmelweis's hypothesis, that there was only one cause, that all that mattered was cleanliness, was extreme at the time, and was largely ignored, rejected, or ridiculed. He was dismissed from the hospital for political reasons and harassed by the medical community in Vienna, being eventually forced to move to Budapest.
Semmelweis was outraged by the indifference of the medical profession and began writing open and increasingly angry letters to prominent European obstetricians, at times denouncing them as irresponsible murderers. His contemporaries, including his wife, believed he was losing his mind, and in 1865, nearly twenty years after his breakthrough, he was committed to the Landesirrenanstalt Döbling (provincial lunatic asylum). He died there of septic shock only 14 days later, possibly as the result of being severely beaten by guards. Semmelweis's practice earned widespread acceptance only years after his death, when Louis Pasteur further developed the germ theory of disease, offering a theoretical explanation for Semmelweis's findings. He is considered a pioneer of antiseptic procedures.
Conflict with established medical opinion
Semmelweis's observations conflicted with the established scientific and medical opinions of the time. The theory of diseases was highly influenced by ideas of an imbalance of the basic "four humours" in the body, a theory known as dyscrasia, for which the main treatment was bloodlettings. Medical texts at the time emphasized that each case of disease was unique, the result of a personal imbalance, and the main difficulty of the medical profession was to establish precisely each patient's unique situation, case by case.
The findings from autopsies of deceased women also showed a confusing multitude of physical signs, which emphasized the belief that puerperal fever was not one, but many different, yet unidentified, diseases.
The rejection of Semmelweis's empirical observations is often traced to belief perseverance, the psychological tendency of clinging to discredited beliefs. Also, some historians of science[15] argue that resistance to path-breaking contributions of obscure scientists is common and "constitutes the single most formidable block to scientific advances."
As a result, his ideas were rejected by the medical community. Other, more subtle, factors may also have played a role. Some doctors, for instance, were offended at the suggestion that they should wash their hands, feeling that their social status as gentlemen was inconsistent with the idea that their hands could be unclean.[16][F]
Semmelweis's results lacked scientific explanation at the time. That became possible only some decades later, when Louis Pasteur, Joseph Lister, and others further developed the germ theory of disease.
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