He was supposed to be a lawyer, he became a doctor. He wanted to educate, but his theories turned out to be too bold for the conservative medical community. His colleagues laughed at him for telling them to wash their hands before examining patients. Powerlessness in the face of this ignorance made him mentally ill. Its origins stem from the grief caused by the terrible situation in the maternity clinic where he worked. His patients – en masse and in great suffering – died shortly after giving birth. When he understood why, he was speechless with terror. It was enough just to wash your hands after an autopsy before entering the room …
- Ignaz Semmelweis, Hungarian obstetrician, laid the foundations for modern antiseptics by introducing a hand disinfection procedure in his department before examining patients
- He discovered that the cause of the puerperal fever is, among others, lack of hand hygiene among medical staff who started delivering deliveries and examining obstetricians right after the postmortem examination
- His theory was not favored by other physicians; Semmelweis therefore called them “murderers of women”
- A widespread misunderstanding of his ideas led him to become mentally ill
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Body problem
1847, Vienna, city hospital. The newly minted medical doctor Ignaz Semmelweis, assistant to the head of this place, Professor Johann Klein, visits his patients in one of the two clinics in the maternity ward. He is genuinely worried. Newly-born mothers develop puerperal fever, characterized by high body temperature and chills, followed by rapid deterioration of their condition and death. He looks at the statistics with concern: the death rate in the ward is as high as 10 percent. On the one hand – it happens this way, it is a popular ailment, especially in the milieu of women who come here. Pregnant women with obstetric complications are referred to the facility (today we would say: with a higher-risk pregnancy, at risk) or too poor to hire a midwife and give birth at home, bearing illegitimate children, with no prospects not only for a dignified life, but also for life in general. On the other hand – it’s not normal, because there is another clinic next door, where patients are born with the same material and life situation. Mortality in this ward is “only” 4 percent. Something was wrong.
“Bringing a child into the world is as dangerous as first degree pneumonia, ‘noted Semmelweis in his journal. In the month he started working, as many as 36 out of 208 obstetricians died at the clinic. He listened with horror that women admitted to his hospital are ready to give birth on the street, as long as they do not end up in the “death ward”. He did not understand why no one was interested in this topic. He was not convinced by speculations that the cause of maternal fever was overpopulation, poor ventilation or the beginning of lactation. He did not agree to treat these cases as “unavoidable” deaths. He searched for the truth and felt that the solution to this tragic puzzle was near.
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The breakthrough came with a personal and professional drama: the death of a friend and associate professor of forensics Jacob Kolletschka, who died of an infection following an accidental injury. It happened during an autopsy that he and his student carried out. After shaking off the loss, it dawned on Semmelweis that his friend had seen the symptoms his friend had experienced before his death more than once in his ward, and then on the autopsy table, when he examined the corpses of deceased women (peritonitis and blood vessel ulceration, and in the worst case, inflammatory outbreaks). in the lungs, heart, brain and other organs). All this suggested severe blood poisoning. The common denominator consisted of one more fact: students were present in both places. The same students. As the doctor put the facts together, he froze. The answer to the question why women die shortly after giving birth was both banal and terrifying. It was the medical staff who brought the “deadly venom” to the delivery room – hands were not washed after an autopsy, and they were used to deliver births and examined newly-born mothers. It was also the only issue that distinguished the twin clinics of the maternity ward in a Viennese hospital – the latter, where the mortality rate was lower, no medical students trained and the women were looked after by midwives.
Dr. Ignaz Semmelweis was not going to waste any time. And so – as he repeated years later – he had too many human lives on his conscience (“Only God knows how many women descended into the grave prematurely through me”, he noted). He quickly introduced procedures in the ward: he recommended that doctors, students and other members of the medical staff should disinfect their hands with a calcium hypochlorite solution.
The effects were visible immediately. One month after introducing the obligation to wash hands before examining patients, the percentage of deaths due to maternal fever fell from 18,3%. (April 1848) to 2,2% (June of the same year), and the statistics improved week by week (in July as much as 1,27%, and at the beginning of 1849, no patient died in the ward of puerperal fever). Now it was enough to propagate the theory and save patients in other hospitals all over Europe, and maybe the world. It quickly turned out that it was not that simple.
The rest of the text is below the video.
Persona non grata
Ignaz Semmelweis was born in Buda in 1818 to a Hungarian German family, the fifth of ten children. His parents were merchants, which indirectly enabled him to study in good educational institutions and – as a consequence – start his studies in Vienna. First he tried his hand at law, but it was his father’s wish, which Ignaz was not very enthusiastic about. A year later, he began medical studies, which he graduated in 1844, obtaining the title of doctor of medicine, and two years later, specialization in the field of surgery and obstetrics. Shortly thereafter, he started working at the Viennese general hospital. It was here that he made the discovery that formed the basis of antisepsis (decontamination).
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Semmelweis was self-confident, which is why he implemented the new rules on the ward so quickly and unprecedentedly, even though he did not manage it. Such a shoe did not appeal to Professor Klein, who not only liked to have the last word, but also had his own theory about the causes of the disease decimating the clinic in his hospital. He believed – like many Viennese doctors – that puerperal fever is caused by undefined atmospheric factors, perhaps even cosmic or telluric (related to the Earth). His assistant was far from questioning his boss’s faith, but he was looking for sound logic. “If the weather conditions of the city of Vienna are causing the puerperal fever epidemic in the womb, then it should also be spread throughout the city – after all, the inhabitants are subject to the same influence. Meanwhile, all over Vienna, there are a lot of women who have recently given birth and are not getting sick, “he wrote in his book” Etiology, Concept and Prevention of Postpartum Fever “.
Anyway, pride was a characteristic not only of the head physician, but also of the entire medical community. The idea that medics – the “saviors” of the multitude – would bring death with their hands was as outrageous as it was absurd. There was no intention of letting some unknown young physician defame their good name and respect for the profession.
In the fall, postpartum fever returned to Professor Klein’s ward with redoubled strength. Semmelweis did not understand what was happening, and his supervisor and colleagues were already proclaiming the triumph of their convictions with mocking smiles. It turned out, however, that they were not right again. The outbreak of the epidemic was caused by the lack of hygiene inside the department itself – although doctors and students disinfected their hands after returning from the mortuary, not inside. Meanwhile, one of the patients suffered from a purulent uterine tumor. After examining her, they passed to the next woman without washing their hands.
Ignaz Semmelweis realized that not only germs from the dead but also from living patients can be fatal. Unfortunately, this was where his cognitive abilities ended – in his time no one had heard of the pathogenicity of microbes. In the eyes of scientists, the lack of support for his observations with scientific evidence erased it from the very beginning. The doctor was openly mocked and his beliefs were considered senseless and harmful.
Semmelweis was expelled from the municipal facility shortly thereafter (his contract was not formally extended). Although this was not related to the preached views on the insufficient hygiene of medical personnel (officially, it was about Semmelweis’ participation in the events of 1848; he was a member of the national guard and openly supported the uprising in Hungary), subsequent unsuccessful efforts to become a lecturer at the University of Vienna confirmed the suspicions of the person concerned. : He has become an unwelcome person here. After a short academic period in Zurich (where he lectured in obstetrics), he returned to Pest, where he found favorable conditions for professional development. In the hospital of St. Rocha reduced the mortality from maternal fever to 0,85 percent. At the same time in Vienna, the index was still hovering around 15%.
Fate’s irony
Despite the good prospects for the future in Pest and success in his personal life (the obstetrician started a family here by marrying 1857-year-old Maria Weidenhofer, the merchant’s daughter in 18, with whom he had five children), Semmelweis’s health deteriorated from year to year . Professional failures, and above all the senseless resistance of the medical and scientific community to his theory, made him feel misunderstood and rejected. He could not come to terms with the fact that patients were still dying of puerperal fever, which in many cases and in such a simple way can be avoided. His relatives noticed that he was becoming obsessed with it. He had symptoms of neurosis and depression, perhaps he even suffered from Alzheimer’s disease, and some spoke of untreated syphilis. He drifted away from his family, began to drink and hang out with prostitutes.
At the same time, he was not passive in his grief – he sent open letters to eminent specialists in the field of obstetrics, working in various European countries, sparing no accusations or even slander, calling them directly “murderers of women”. Public incidents involving him began to jeopardize the image of medics, so it was seriously suggested that a physician losing contact with reality should be referred to psychiatric treatment. In the end, it succeeded, but Semmelweis tried to save himself until the end.
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In his attempt to escape, he initiated a series of tragic events. He was severely beaten by the guards, and then in a straitjacket to a lonely cell, where he was subjected to torture-like treatments (pouring cold water, administering laxatives). Exhaustion was exacerbated by an infection that got into a wound on his hand, inflicted by one of the torturers (in another version: which he contracted during one of the last operations he performed). Doctor Ignaz Semmelweis died on August 13, 1865, two weeks after entering the hospital for the insane. Cause of death: Sepsis, which he has devoted his entire life to.
“Ignaz Semmelweis was one of the most important doctors of his time and a great fighter for medical innovation. Medicine owes him a lot. If he were alive now, he would be a favorite for the Nobel Prize. Unfortunately, his great achievements were recognized only after his death at the age of 47 ”- with these words on July 1, 2018, Markus Müller, Rector of MedUni Vienna, inaugurated the ceremony of unveiling the doctor’s monument.
More than 150 years after the death of the Hungarian obstetrician, no one doubts that he was an outstanding doctor and observer, although more than in the memory of posterity, he remained in the language in which he functions to this day. the phrase “Semmelweis reflex”. It means rejecting a scientific discovery without considering or examining the facts as contrasting with generally accepted knowledge, usually for fear of upsetting one’s own position or reputation.
While history has proved Semmelweis right, his mistakes have also been noticed, in particular his incomprehensible restraint in publishing his findings. His theories were known mostly second-hand, from the publications of his students or the few allies who tried to explain what their mentor meant. The obstetrician himself was not very fond of writing – he published his flagship work, describing the observations and results of implemented preventive measures, only about 15 years after the discovery. In addition, he did not update his knowledge. In his work, he completely ignored the fact that Louis Pasteur had in the meantime shown the link between bacteria and the fermentation process. Perhaps this is why today the father of antiseptics is considered not a Hungarian, but a British, Joseph Lister, who presented his – widely recognized in the 80s – system of antiseptic treatment scientifically and publicly. It was ironic that it happened only two years after the death of Ignaz Semmelweis.
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