Like many people these days I have experienced the thrill of tracing my ancestors using some of the online resources and public archives available. In my case a large number of my ancestors that I can trace lived in Victorian London and in following their lines I am struck by the high mortality rates, especially among children and mothers in childbirth. It is particularly sad to learn that a significant number of those deaths could have been prevented if medical practitioners had paid attention to the work of Ignaz Philipp Semmelweis. That makes this entry in our series about “crackpots” who were right the most shocking case that I am aware of.
Medical knowledge in the early 19th century was very limited. The theory of diseases spread by germs was not understood until after the work of Louis Pasteur from 1864 and effective treatments for infections were not available until the discovery of the medicinal effects of penicillin much later. The leading theory of diseases was dyscrasia based on the ideas of an imbalance of the basic “four humours” and the usual treatment was bloodletting or extreme forms of hydrotherapy which often did more harm than good. It was thought that disease was spread by bad air until the 1854 Broad Street cholera outbreak when John Snow identified contaminated water as the source of the cotangent. Such advances dramatically improved the prevention of diseases, but an earlier discovery could have saved many more lives in London and other cities if it had been accepted more widely.
In 1847 Ignaz Semmelwies was a physician working at an obstetrical clinic of the Vienna General Hospital where his duties included inspections, teaching, supervision of difficult cases and record keeping. When he took on his responsibilities the clinic had a particularly bad record for maternal mortality due to puerperal fever which was causing the death of 10% of new mothers. A second clinic had a better rate of only 4% so women would beg to be admitted there instead. The situation was so bad that many would prefer to give birth at home with no medical supervision and indeed the survival rates were probably better under such circumstances. Naturally Semmelweis was not happy with this situation and he set about looking for the cause by carefully eliminating possibilities and keeping the best possible records of all cases. He soon found that the cause of the problem was related to cleanliness so he instructed the doctors and midwives to wash their hands with chlorinated lime solutions which were most effective at removing smells. The result was a dramatic ten fold decrease in mortality rates.
News of the breakthrough spread round Europe via lectures and reports delivered by students of Semmelwies. Given the clear evidence for the effectiveness of the washing procedure and its easy reproducibility you might expect that it would have been adopted quickly. But sadly there was considerable resistence and only a few hospitals in Germany followed the practice. As a result it can be estimated that some tens of thousands of mothers died needlessly following child birth.
In part the problem was that Semmelweis offered no explanation for why his procedure worked. It was a purely empirical observation that could not be explained until the theory of germs became current some twenty years later. At the time doctors believed that such deaths had numerous causes because autopsies seemed to show significant variations of the decease. Reactions to Semmelweis were very mixed. In England doctors thought that the fever was contagious and they mistakenly took the new result as simply a confirmation of this theory with nothing new to report. In part the fault lay with Semmelweis himself because he did not publish an explanation of his results himself and information passed secondhand via his students. Nevertheless it is clear that the failure to change hygiene practices was not just through misunderstanding. There was considerable resistence, not least because the egos of the top physicians of the time would not allow them to accept that their own uncleanliness could be a cause of disease. In 1956 Jozsef Fleisher, an assistant to Semmelweis reported supporting evidence from another clinic in the Viennese medical Weekly. The editor remarked sarcastically that it was time people stopped being misled about the theory of chlorine washings. Such reactions were not atypical. Semmelweis’s doctrine was finally rejected at a conference of german doctors which included the celebrated Rudolf Virchow who was considered a scientist of the highest authority at the time. It was the ultimate blow from which Semmelweis could not recover.
In 1861 Semmelwies’s apparently suffered a breakdown through depression. He would turn every conversation to the topic of childbed fever. By 1965 he was considered an embarrassment to his colleagues and was tricked into entering an asylum where he was held in a straightjacket against his will. His bad treatment there led to his death from gangrene that year and his work was conveniently forgotten. Some people speculate that he may have suffered from Alzheimer’s, bipolar disorder or some other mental ailment we recognise today. But consider this. He knew that each day mothers were dying needlessly at the moment that should have been their families greatest joy. It was an unnecessary tragedy perpetuated by the arrogance of doctors and could be stopped if only people would listen to him. Through his work in his own clinic he would have seen first hand the hurt that this caused. He was unwilling to accept that, and they called it madness.