Nigel 
August 13th,2009
Portrait of the young Ignaz by Lenart Landau
While skimming the preface of a new book I came across a reference to Dr. Ignaz Semmelweis.
Who?
Never heard of him,but it sounded interesting.
He discovered that washing your hands before delivering a baby dramatically increased the mother’s chances of living.
Where did his conclusion come from,and why did things go so wrong after that?
Thank you Wikipedia,we love you. You provided the answers,and they’re enthralling. Least,I think so.
I’ll split my own version over two posts.
Ignaz was born in 1818 in what is now part of Budapest. Having qualified as a Doc in 1844 he couldn’t get his first choice of job so specialised in obstetrics (child birth).
He became a moderately senior doctor at Vienna General Hospital where they had two maternity clinics that provided free treatment to women who were ’underprivileged’ and therefore desperate enough to let trainee doctors and midwives learn on them.
Fair enough,but there was a problem.
In those days it was common for mothers to contract puerperal fever at child birth. With the fever they had a one in three chance of dying. Not great odds. Give me swine flu any day.
Ignaz was sharp enough to put together two apparently unrelated observations.
Death rates after birth varied a lot from year to year,but they were consistently much higher in the First Clinic than the Second. Here’s a graph to illustrate this situation. Don’t worry about the details,just notice how consistent the relationship between the clinics was. The graphs go up and down together. Quite extraordinary,but no one else cared enough to investigate. That was just the way it was. So Ignaz saw something weird and didn’t just shrug his shoulders.
Death rates in the two clinics
Ignaz was greatly moved by the plight of women treated at First Clinic so he began a systematic comparison of the two clinics looking for other variations which might explain the difference in death rates. They were similar in almost every way. They were equally crowded,in the same climate (obviously),and so on. The only clear difference was that First Clinic was the domain of trainee doctors,the Second of trainee midwives. But surely a doctor should be better for the patient than a midwife? After all,a doctor was a Gentleman.
The second observation was in 1847. During a postmortem examination of one of the mothers who’d had the fever a student accidentally poked one of Ignaz’s friends with a scalpel. The friend duly died,and his autopsy showed very similar problems to those caused inside women by the fever. Weird.
Weird yes,but it triggered the right thoughts. The trainee doctors were not just aiding with birth,they were also poking around the bodies of those who died.
The theory put forward by Ignaz was that the fever could be carried on some kind of ‘cadaverous particles’too small to be obvious to the eye. He introduced an experimental rule that doctors must wash their hands in a crude antiseptic solution before assisting with a birth.
And wow. It worked! Mortality rate in First Clinic crashed. They were reduced nearly ten-fold.
He observed something odd,investigated systematically,and kept his eyes and ears open for anything that might be relevant. He had an open mind and didn’t reject anything just because it wasn’t already in the text books.
Tomorrow we’ll look at the devastating response when he announced his results.
By the way,although Ignaz came up with his solution on his own,other people had been on the track. Amongst these were Alexander Gordon in Aberdeen,Thomas Watson in London,and Oliver Wendell Holmes in New England.
