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In the 1840s doctors would perform autopsies and then do surgeries or deliver babies. You might think, “What’s the big deal? Doctors go from surgery to clinic all the time!”
Well, they weren’t disinfecting their hands or wearing gloves.
Time for a thread on Dr. Semmelweis
Well, they weren’t disinfecting their hands or wearing gloves.
Time for a thread on Dr. Semmelweis
Dr. Ignaz Semmelweis was born in what is now Budapest in 1818 to Jewish parents who immigrated to Hungary from Germany. Initially, he studied law but then switched to medicine at the University of Vienna.
After graduating, Dr. Semmelweis applied for a position in internal medicine but was denied so he took up obstetrics at Vienna General Hospital.
At the hospital, there were two obstetric clinics, one staffed by physicians and medical students referred to as, "first clinic", and the other by midwives, referred to as, "second clinic". A change was made that mandated physicians perform autopsies while staffing the clinic.
Devastating results came from this change, though they were not recognized initially. The mortality rate in the physician-staffed clinic jumped to 9.9%, or about 1 in 10 women were dying after childbirth. This shocked the hospital staff and community.
Dr. Semmelweis endeavored to figure out why. “I was convinced that the greater mortality rate at the first clinic was due to an endemic but as yet unknown cause…the disease appeared sequentially among patients in the first clinic."
“...everything was in question; everything seemed inexplicable; everything was doubtful. Only the large was an unquestionable reality.” He felt, “like a drowning person grasping at a straw.”
Dr. Semmelweis went on to change the manner by which the women could give birth, from supine (belly up) to lateral positions. He also made the delivery process standard between the clinics to control for the variables he could. But, none of this reduced mortality in the clinic.
What were they dying of? A disease called puerperal fever, or infection of the uterus causing a high fever. What they actually died of was sepsis, which is a condition where the body mounts a severe reaction to an infection which can lead to multisystem organ failure and death.
Here’s the crazy part. At this time, no one routinely wore gloves. So, these doctors and medical students dissected the decedents with their bare hands! All they would do is rinse off their hands to remove the larger “cadaveric particles” as Dr. Semmelweis described it.
During one autopsy of a patient who died of puerperal fever, a pathologist and Dr. Semmelwies’ friend, Dr. Kolletschka, was nicked by a scalpel. He went on to develop similar symptoms to that patient and later died of sepsis.
Dr. Semmelweis made a connection. “Day and night I was haunted by the image of Kolletschka's disease and was forced to recognize, ever more decisively, that the disease from which Kolletschka died was identical to that from which so many maternity patients died.”
“I was compelled to ask whether cadaverous particles had been introduced into the vascular systems of those patients whom I had seen die of this identical disease.”
With this inference, he set out to collect data.
With this inference, he set out to collect data.
He watched physicians from the autopsy room to the clinic. He noticed that their hands would keep the cadaverous smell despite being washed with soap and water.
He made his 2nd inference, “Ordinary washing with soap is not sufficient to remove all adhering cadaverous particles."
He made his 2nd inference, “Ordinary washing with soap is not sufficient to remove all adhering cadaverous particles."
He noticed that patients were dying sequentially and that the physicians who had performed the autopsies had also delivered the babies of those same patients. He connected the cadaveric residual on their hands as the potential cause of the disease.
“In the examination of pregnant or delivering maternity patients, the hands, contaminated with cadaverous particles, are brought into contact with the genitals of these individuals, creating the possibility of resorption."
“This seemed all the more likely, since I knew that when decomposing organic material is brought into contact with living organisms it may bring on decomposition.”
Important to note that at this time scientists did not know of germ theory. So, he did not know of the true cause.
Important to note that at this time scientists did not know of germ theory. So, he did not know of the true cause.
He instructed all physicians and medical students to treat their hands with chlorinated lime because he assumed it worked the best because it rid the smell on the hands. So, in between autopsies and the first obstetric clinic, doctors were effectively disinfecting their hands.
The death rate in the first clinic decreased precipitously! Mortality dropped from 12.4% to 1.27%, with the physician-run first clinic mortality dropping below the midwife clinic. There were months over the next two years when not a single mother died.
You would think this would be heralded as a tremendous achievement at the hospital and in the greater medical community! Unfortunately, it wasn’t.
Dr. Semmelweis' findings were largely rejected and he met a tragic death before receiving the recognition he deserved.
Dr. Semmelweis' findings were largely rejected and he met a tragic death before receiving the recognition he deserved.
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Dr. T.
Medicine: Explained
Also, stay tuned for the youtube video! Learn more about the doctor who saved numerous young mothers' lives, the venerable Dr. Semmelweis. https://drtmedicine.substack.com/p/coming-soon?r=foa30&utm_campaign=post&utm_medium=web&utm_source=copy
Dr. T.
Medicine: Explained
Also, stay tuned for the youtube video! Learn more about the doctor who saved numerous young mothers' lives, the venerable Dr. Semmelweis. https://drtmedicine.substack.com/p/coming-soon?r=foa30&utm_campaign=post&utm_medium=web&utm_source=copy
