Friday, December 7, 2012

Ignaz Semmelweis (1818-1865)

Ignaz Semmelweis was an early, important, and heroic contributor to the development of the germ theory of disease.

Semmelweis was born in the city of Buda, then part of the Austrian Empire, on July 1, 1818. He was the fifth child of ten. His father was a prosperous merchant.

In 1837 Semmelweis enrolled in the University of Vienna and began to study law. A year later he switched to medicine and earned his doctorate in 1844.

In 1846, he started his first job as a physician, working in First Obstetrical Clinic of the Vienna General Hospital. Male medical students were trained in First Clinic. In Second Clinic, female midwives were trained.

The death rate of mothers from puerperal (or childbed) fever, a bacterial infection contracted during childbirth, was nine times higher in First Clinic than in Second. This fact greatly troubled Semmelweis. (Why him and not others?)

Semmelweis began to systematically compare the procedures used in each clinic in an attempt to discover the cause of the much greater mortality of mothers in First. He eliminated differences in climate, air quality, crowding, religious practices, emotions, and diet as factors.

In 1847, a colleague and good friend of Semmelweis died. This friend had been accidentally poked with a scalpel by a student doing an autopsy at the hospital. He then had quickly died of a disease strangely similar to puerperal fever.

Semmelweis immediately hypothesized that some sort of particle found in dead bodies was being passed to women in First Clinic and causing puerperal fever. Male medical students in First Clinic routinely went straight from examining cadavers to delivering babies. Female midwives never did.

The germ theory of disease did not exist at this time. Semmelweis did not know that the particle in question was in fact a bacterium.

To test his hypothesis, Semmelweis required all medical students to wash their hands, using a little bleach mixed in water, when going from working with cadavers to helping women give birth. In April 1847, before Semmelweis introduced this procedure, the death rate of women in First Clinic was 18%. Three months after he put this procedure into effect, the death rate had dropped to 2%. In 1848, he extended his procedure to include the washing of any medical instrument being used to deliver babies.

Despite this mercifully dramatic reduction in the number of women dying, other doctors in Vienna were not impressed. At the time, the culturally accepted theory of disease understood subjective factors, such as an imbalance in bodily humors, to be the cause of disease. Because each sick person was a unique individual, doctors had to discover the subjective nature of each person’s imbalance. They then had to determine exactly how much bloodletting or purging was needed to restore equilibrium.

Semmelweis had two significantly different ideas. One, he believed that a single impersonal cause was responsible for all the puerperal fever killing the women in First Clinic. Two, he believed this single objective cause could be eliminated by having the gentlemen of First Clinic wash their hands before delivering babies.

His initial contract of employment at First Clinic ended in March 1848. It was not renewed. Unable to find other work in obstetrics in Vienna, Semmelweis left for Pest in October 1850.

From 1851-1857, Semmelweis worked in a small hospital in Pest and reduced the mortality rate from puerperal fever there to less than 1%. After 1855, he also worked at the university hospital in Pest and did the same there. In 1861, he published his major work, The Etiology, Concept and Prophylaxis of Childbed Fever.

During the 1850s, the medical community in Europe remained unimpressed with the work of Semmelweis. Meanwhile, the rates at which women were dying of puerperal fever remained savagely high and continued to rise. When leading obstetrical colleagues published unfavorable reviews of his book in 1861, Semmelweis wrote open letters denouncing them as murderers.

In 1865, a professional colleague tricked Semmelweis into going with him to an institution for the mentally ill. There Semmelweis was involuntarily committed, severely beaten, restrained in a straight jacket, and left in a dark cell. He died of an infection two weeks later.

Copyright © 2012 by Steven Farsaci.
All rights reserved. Fair use encouraged.