Saturday, December 25, 2010

Life Lines 94 -- Ignatz Semmelweiss and Childbed Fever

Ignatz Semmelweiss was a Hungarian born physician who went to Vienna for his advanced medical training. The Vienna General Hospital was a model of the modern mid-nineteenth century hospital. It stressed research and a scholarly approach to finding the causes of illness. The hospital had two large wards for obstetrics. One was for the poor and it was managed by midwives. The women ranged from working married poor to unmarried unfortunate young women cast out into the streets. The rooms were simple and clean but relatively austere as one would imagine for a public clinic. The other ward was for the middle class women who could afford a physician to attend them when they became pregnant. About 1840 a new chief of obstetrics came in. He wanted his medical students to do autopsies on every death to see what caused those losses. He wanted his medical students to train, under supervision, with female patients, not with the then much used leather models that had been the standard.

When Semmelweiss arrived there was a good deal of confusion. The death rates for women in the middle class ward were considerably higher than in the ward for the poor. This was the reverse of expectation because otherwise the poor were dying more often than the well to do. The pregnant women died of childbed fever after delivery. Their bodies would fill with a milky fluid and they entered into a delirium and coma as their bodies became overwhelmed. Semmelweiss plunged in and studied temperature, fresh versus stagnant air, cleanliness of bedclothes, even the color of the rooms. Nothing he examined was of help. After a few years he was on vacation and he got word that a senior physician who was his mentor had died.

He returned to Vienna and read the autopsy report. His friend had cut his finger and the description of his tissues were identical to those for childbed fever. Semmelweiss rejected the prevailing view that misplaced milk was the cause. Instead he imagined “putrid particles” had entered and killed his friend just as they had entered the bodies of the dozens of women who died each month. He tried cleaning his hands after autopsy with soap and water but the fingers still smelled of cadaver. He tried chloride of lime (very much like Clorox) after a soap and water scrubbing that was very thorough. That worked. He forced his medical students to wash their hands as he did and carefully supervised them. The rates fell and he had found a way to prevent childbed fever. It would be another twenty five years before the germ theory would be introduced.

The revolutions of 1848 got Semmelweiss into political trouble and he fought with his supervisor who considered his theory insulting and metaphysical. Semmelweiss wrote only a few notes and didn’t push his ideas. He was fired and went back to Budapest. He became abusive at home and his wife and brother-in-law conspired to get him back to Vienna on a ruse where he was brought to an asylum. He tried to escape when he saw he was being betrayed and he was severely beaten. He died a few weeks later, of childbed fever. Semmelweiss joins that small body of heroes, despised in their own time and revered with monuments generations later.

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