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Ignaz Philipp Semmelweis, or in his native Hungarian spelling Ignác Fülöp Semmelweis, was born on July 1, 1818 in Buda, Hungary (then part of the Austrian Empire, and now Budapest, the capital of Hungary). After having studied medicine at the University of Pest he went to Vienna to further advance his learning, where he received his doctor's degree in 1844.

Vienna General Hospital

Semmelweis then began to work as an assistant at the obstetric clinic of the Vienna General Hospital. The Hospital had two wards for pregnant women, one for the poor and another for the more well-to-do.

The ward for the poor was the territory of midwives, who had always performed this duty for pregnant women before medicine became advanced enough for real doctors to enter into the picture. The doctors only focused on the ward for the richer women, however, and left the poor ward up to the midwives.

At this time in history the practice of true medicine was starting to emerge, and the Vienna General Hospital was one of the places where the discipline was taken seriously. The hospital was a proponent of research and wanted to find the causes for illnesses using a scholarly approach. This meant, however, that autopsies were regularly carried out to find out what the patient had died of and what effects illness had had on the body.

Puerperal fever

When Semmelweis came to work at the Hospital, the death rate due to puerperal fever in the rich ward was significantly higher - in the order of ten times as high - than in the poor ward. Semmelweis began studying this phenomenon and eventually came up with an answer.

In 1840 the new head of the obstetrics clinic wanted the students at the clinic to get hands-on experience, and under supervision the students started helping during deliveries. However, one of the other duties of the students was to perform autopsies on deceased patients for educational purposes.

When death rates in the rich ward began to increase the students were told to perform autopsies on every death in the ward to find out why so many deaths were occurring. Sadly, this measure was in part responsible for keeping that death rate high.

Scientific study

Semmelweis embarked on what was for the time a very thorough investigation and it is this in part which has in recent times given Semmelweis the recognition he deserved, but in his own lifetime never got. His investigation is probably the first true scientifically conducted study. Semmelweis set up different hypotheses for his problem and then tried to either prove or disprove each hypothesis in turn. He included variables such as temperature, fresh versus stagnant air, cleanliness of bedclothes, and even the color of the rooms in his study. And one by one he disproved each hypothesis he came up with.

This situation continued for some time, until Semmelweis focused on the fact that the only true difference in the two wards was the staff. What Semmelweis discovered was that the students and doctors would often go from the autopsy chamber to the delivery ward without washing hands, changing aprons or otherwise cleaning themselves up. He hypothesized that the deaths due to puerperal fever had something to do with these autopsies, and that the affliction was somehow carried over from the dead bodies to the women by the doctors and students themselves. This was of course a highly controversial hypothesis, putting the blame at the feet of the doctors.

Semmelweis tried to find proof for his hypothesis and instituted a rigid protocol for students (who were the ones that were doing autopsies most often). They were instructed to wash their hands thoroughly, and then to rinse their hands with chloride of lime, before entering the delivery ward. In the months following the institution of this protocol, the death rate in the rich ward steadily dropped until it was equal and even somewhat below that in the poor ward. This, for Semmelweis, was the proof that his hypothesis was correct.

His superiors, however, thought his hypothesis was highly insulting and untrue besides. Of course, if they did not disagree, they had to face the fact that they had themselves been the main reason for such a high death rate among the women who had given birth in the rich ward. Semmelweis was fired and went back to Budapest.

Differing ends

At this point my sources start to diverge. One states Semmelweis became abusive at home, whereupon his wife and brother-in-law conspired to have him admitted to a psychiatric asylum in Vienna. Discovering the betrayal he tried to escape and was caught and severely beaten. He died a few weeks later.

Others state that he was a manic depressive and was admitted to an asylum for that reason on August 1, 1865. According to this version a cut on his right hand, contracted during a gynealogical operation, was noted during his admittance. He died on August 13, 1865, in Vienna, Austria, suffering from septicaemia.

Recognition

Whatever the circumstances of his death, Ignaz Semmelweis never got the credit he deserved in his own lifetime. In later years however his work was noted and he is now somewhat revered as a hero far in advance of his own time. It wasn't until 30 years later that his ideas concerning cleanliness were implemented in western hospitals on a wide scale, mostly due to the work of people like Louis Pasteur and his colleagues, who in 1879 demonstrated that the cause of puerperal fever was usually streptococcus.

Semmelweis was, however, not the first to note that puerperal fever had something to do with hygiene, particularly after working with corpses. Alexander Gordon (1752-1799) of Aberdeen, Scotland, was probably the first to tie the two together, and Oliver Wendell Holmes published an essay in 1842 stating much the same. It was Semmelweis, though, who finally, through scientific study, provided the proof for this theory, even if in his own time it was not recognized as such.

And this aspect of Semmelweis brings me to why I, as a Civil Engineer to be, came to know about Dr. Ignaz Semmelweis. One of my courses, "research methodology", started out with a screening of a documentary about Semmelweis to illustrate what proper scientific research is and how it was first done by Semmelweis. This is the reason he should be entered into the annals of history.



Puerperal fever is caused by conveyance to the pregnant woman of putrid particles        
derived from living organisms, through the agency of the examining fingers.......        
Consequently must I make my confession that God only knows the number of women whom        
I have consigned prematurely to the grave.        

-- Ignaz Semmelweis --    



Sources:
http://www.sinc.sunysb.edu/Class/bio101/lifelines/34.html -- Semmelweis
http://www.umanitoba.ca/outreach/manitoba_womens_health/hist1b.htm -- Puerperal fever and Gordon, Holmes and Semmelweis
http://www.britannica.com/eb/article?eu=68445 -- Semmelweis
Unknown documentary I saw years ago

September 10, 2001

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