A Time of Shame, A Debt of Gratitude

In the 1840s in Vienna poor women were offered financial incentives to give birth in the city’s Lying-in Wards. In response, destitute women, once labor began, left the hovels in which they lived and hid in doorways and alleys praying they wouldn’t be caught. Once they’d given birth, they could claim they were on their way to the hospital when the baby arrived and could collect the financial help without risking their lives.

If the authorities caught them and forced them into the wards, many begged to be sent into Clinic B and not Clinic A. The women knew that the death rate in Clinic A soared to 30% on occasion, almost one third of all new mothers dying of childbirth fever.

A young doctor, Ignaz Semmelweis, assistant to Professor Klein in the First Obstetrical Clinic, was well aware of the differing rates of childbirth fever between the two clinics. In Clinic A, where student doctors attended the women, up to five times as many patients died as in Clinic B where midwives-in-training delivered the babies. Meanwhile street births were soaring and these new mothers almost always survived, as did those well-to-do women giving birth at home. So why was it that in Clinic A, under his supervision, so many healthy young women died? It made no sense and plunged him into despair.

Then came a tragedy that held a clue. A close friend, Jakob Kolletschka, fell victim to an unidentified disease that was suspiciously close to childbirth fever. Kolletschka had cut his finger while doing an autopsy and within days fell sick and died. Semmelweis jumped to the conclusion that his friend’s cut finger had caused his death. He had been poisoned by something in the corpse and this poisonous something was also causing the death of new mothers. The student doctors performed autopsies and then examined their women patients without washing their hands. In this way the doctors carried the deadly material from corpses to new mothers.

This was a startling insight on the part of a young doctor in 1847. The germ theory of disease had not yet been developed and doctors were still guided by the celebrated Greek doctor Galen and the two-thousand-year-old teaching that all disease was caused by an imbalance in the four bodily humors. To restore balance, the proper treatment for any medical problem was to bleed the patient.

Ignoring this ancient wisdom, Semmelweis ordered his doctors to wash their hands in a chlorinated lime solution following autopsies. Until then they had wiped their hands on their suit lapels, smearing blood and tissue from the corpses onto their clothing to indicate their status as practicing doctors. But no more. Washing your hands immediately after completing an autopsy was now mandatory.

This did not sit well with the doctors. Semmelweis could not offer any explanation for his insistence upon this. Such an explanation would not come until Louis Pasteur published his germ theory of disease decades later. The dramatic lowering of the death rate in Clinic A from 18.3% in April 1847 to 2.2% in June and an average rate of 1.3% in the following months, and not a single death from childbirth between March and August of 1848 in Semmelweis’ division, failed to impress his colleagues.

A high rate of maternal deaths was occurring not solely in Vienna but all across Europe, yet when Semmelweis gave a public lecture about his work in 1850, it was met with indifference and outright hostility. His appointment at the Lying-In Hospital expired and wasn’t renewed. He was ridiculed and harassed to such an extent that he left Vienna and moved to Budapest.

In Budapest Semmelweis found employment as the unpaid, honorary head physician of the obstetric ward of a small hospital. When he took over, childbirth fever was rampant. Once in charge, he reduced deaths to 0.85%, eight maternal deaths out of 933 births.

This remarkable result did not persuade the obstetricians in Budapest to accept Semmelweis’ ideas or follow his methods. When the professor of obstetrics at the University of Pest died in 1854, Semmelweis applied for his position but failed to get it. A year later the doctor who’d been appointed was dismissed and Semmelweis took his place. He immediately instituted chlorine washings in the maternity clinic and once again achieved remarkable results.

Dramatic results at three different obstetrical clinics failed to persuade the medical community that Semmelweis was right. His ideas were ridiculed and rejected in Budapest just as they had been in Vienna.

He went into private practice, nursing his wounds. In 1861 he wrote a book detailing his methods and his achievements. The book received poor reviews and Semmelweis reacted with frustration and rage. He began to suffer from nervous complaints. He was severely depressed and talked incessantly about childbed fever. He suffered a complete emotional breakdown in 1865 and was hospitalized. A few days later he died, at the age of forty-seven.

That same year famed English surgeon Joseph Lister, at a time when 50% of all surgical patients died, began spraying a carbolic acid solution during surgery. He gave Semmeilweis full credit for his decision to do this. Joseph Lister’s standing was such that antiseptic practices over time became commonplace – decades after Dr. Semmelweis first proved that such practices saved lives.

The treatment accorded Dr. Semmelweis is only one instance of the medical community’s long history of bracing itself against change, ignoring evidence, stubbornly clinging to the past. It is impossible even to estimate the number of people who died unnecessarily between 1847 when Dr. Semmelweis first ordered his doctors to wash their hands and the late 1800s when antisepsis became common practice.

To suggest that the medical profession needs to become less rigid is not to suggest that it should eagerly embrace every passing fad. But surely it would help to have medical practitioners who are open to the new when it works and willing to give up the old when it doesn’t.

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Excerpted from Plagues Past and Present, A Mind/Body/Approach by J. H. Hacsi. Paper, $14. Available at Baker and Taylor, www.Amazon.com or on order from any bookstore.

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J H Hacsi graduated from the University of California at Berkeley, is a member of Phi Beta Kappa, and earlier in her life wrote short stories (over 200 published) and romance novels (eight published). Throughout her life she has been greatly interested in history and science, also the role of the mind and mysticism.She has read widely in all these fields. She is a widow with five sons and five grandchildren and live in Claremont, CA. jhhacsi@aol.com