#018: Dr. Ignaz Semmelweis

A CAUSTIC PROPHET: DR. IGNAZ SEMMELWEIS (1818-1865)

Ignaz Semmelweis, a Hungarian doctor who worked in Vienna in the mid 19th Century was a man who literally saved countless lives--by making a science out of something mothers have been saying for thousands of years.

Always wash your hands.

He should be remembered for two reasons: one, as an example of a courageous member of the Remnant, standing against established opinion; secondly, as an example of someone who, though absolutely and utterly right, might have made a bit more impression if he had been just a little more politic in what he had to say.

In 1846, Dr. Semmelweis was the Assistant (a title meaning, roughly, Chief of Surgery) in one of Vienna's finest hospitals. Vienna, then as now, had a small problem with infanticide that nobody really wanted to talk about. Since poor women lacking husbands were essentially rejected by society, the abandonment and death of newborns was a horrific, ongoing problem. Accordingly, those hospitals in place in Vienna opened special clinics that treated poor women who were expecting children. The fees were paid by voluntary contributions through charity and from the rich nobility.

His hospital was so well known, and so well regarded, that they opened not one, but two clinics, to treat the women in labor.

But there was a strange statistical fluke that nobody understood: at the hospital where he worked, for reasons truly unknown, the women of Clinic 1 died of puerperal, or childbed, fever at an astoundingly higher rate than the women in Clinic 2. In Clinic 1, deaths varied between ten to an astounding thirty three percent! from month to month. In Clinic 2, deaths were steadily under 5%.

This became so widely understood on the streets of Vienna that women literally begged not to be assigned to Clinic 1 for their cases.

But how could this possibly be?

The superficial difference between the two clinics was that Clinic 1 was run by medical students and Clinic 2 run by midwives, i.e., former prostitutes who had been retrained in childbirth procedures.

Furthermore, it was known that deaths at home from childbed fever did not come near matching the death rate of Clinic 1.

How was it possible that doctors and medical students were killing their patients through puerperal fever while those treated by women--whores!--were not?

You know the answer of course: dirty hands. He and his students had been working in a dual environment: with women in labor and then also with corpses under dissection. They carried "something" from the corpses to the women (we know of course that the something was germs, but this was some 25 years before Pasteur, so there was no germ theory as yet).

The key event was the death of a friend, one Dr. Jakob Kolletschka. Dr. Kolletschka, like Semmelweis, worked daily performing autopsies and medical training with corpses. On one occasion, Kolletschka, while at work, cut his finger. His slow and terrible death that followed exhibited precisely the same symptoms that killed the women in Clinic 1.

That was the key. Although nobody knew what the agent was, Semmelweis made the connection. The women were dying from contamination from the corpses.

Dr. Semmelweis discovered that, once he had his students wash their hands in what was essentially a primitive form of Chlorox, that the death rate dropped to near zero almost immediately. In April 1847, deaths reached 17%. In July and August, under 5%. In September 1847, 0%.

You'd think that such an astounding advancement in treatment, such a dramatic drop in the deaths of the innocent–particularly as it required almost no expense to implement!--would be news that would be trumpeted from the rooftops and immediately incorporated by doctors worldwide. Semmelweis's name should have taken its place within his lifetime next to Galen, Edward Jenner, and William Harvey.

Such was not the case, at least not while he lived.

To begin with, Dr. Semmelweis, although a determined surgeon and statistical analyst, clearly did not understand the politics of the medical world. At the beginning of his successful discovery, he chose not to publish the results of his discovery immediately, or to notify other doctors through medical journals–the standard procedure, then and now, of publicizing key scientific discoveries, particularly those in the medical world. Word spread–but through word of mouth, not through rigorously challenged peer review. Semmelweis's discovery therefore was imperfectly transmitted, and, being imperfectly transmitted, was not well received.

His treatment required hand washing using a sort of diluted lime solution not unlike our Chlorox. However, other doctors, getting the word wrong through word-of-mouth, merely washed with soap and water, leaving infectious agents in place and not significantly improving survivability of the women in their care. His methods therefore were considered suspect even when he finally formally published them.

Furthermore, the good doctors who recieved his advice were often very personally offended at the implication that they, themselves, through touching their patients, were infecting them with childbed fever and therefore killing them their very own selves. Much easier it was to blame "miasmas" (whatever they were) than face the possibility that they were killing their own patients.

Needless to say, Dr. Semmelweis's discovery did not make him very popular.

As time went on, Dr. Semmelweis himself became marked by the struggle to educate the medical mainstream. He clearly fell into some sort of mental illness--but whether it was early Alzheimer's, or syphilis (easily caught in his line of work), overwork and exhaustion, depression, or something else is impossible to say now. But that deterioration was very real. It affected his work, his marriage, and his efforts at publicizing his discovery.

Again, Wikipedia:

Beginning from 1861 Semmelweis suffered from various nervous complaints. He suffered from severe depression and became excessively absent minded. .... He turned every conversation to the topic of childbed fever. ...After a number of unfavorable foreign reviews of his 1861 book, Semmelweis lashed out against his critics in series of Open Letters. They were addressed to various prominent European obstetricians [and] were full of bitterness, desperation, fury, and were "highly polemical and superlatively offensive", at times denouncing his critics as irresponsible murderers or ignoramuses. ...The attacks undermined his professional credibility.

... On July 30[, 1865, an associate, Dr.] Ferdinand von Hebra lured him, under the pretense of visiting one of Hebra's "new Institutes", to a Viennese insane asylum ... Semmelweis surmised what was happening and tried to leave. He was severely beaten by several guards, secured in a straitjacket and confined to a darkened cell. Apart from the straitjacket, treatments at the mental institution included dousing with cold water and administering castor oil, a laxative. He died after two weeks, on August 13, 1865, aged 47, from a gangrenous wound, possibly inflicted by the beating.

The autopsy revealed extensive internal injuries, the cause of death pyemia—blood poisoning.

Ironically, he died of the very disease he had fought so hard to prevent in women.

He was, like Mozart some 75 years earlier, buried in a pauper's grave. His death went unnoted by his professional compatriots–not surprisingly, as some of them had murdered him.

But he was not forgotten. Today, he is remembered with Pasteur, the discoverer of the germ theory of disease and Joseph Lister, the father of antisepsis. He has been honored on postage stamps and his birth home in Budapest is now a national museum.

If ever you have undergone a surgeon's knife or poke, thank this man. He may have saved your life. And the fact that he tried so hard to pound his truths into the head of an unthinking medical world–even if he was mentally ill by the time he began the effort in earnest–shows that, even ill, he was one of the Tattered Remnant.