Ignaz Semmelweis Research Paper

The life and work of Ignaz Semmelweis is among the most immediately arresting and moving stories in the history of science. A Hungarian physician in mid-nineteenth century Vienna, Semmelweis discovered that if the doctors of his hospital washed their hands in a chlorine solution in between performing autopsies and delivering births, it would effectively eliminate the outbreak of fatal puerperal infections among the laboring women, saving thousands of lives. Tragically, his work would largely go unrecognized and ignored within his own lifetime, contributing to his mental decline and eventual commitment to an insane asylum where he would die from gangrenous wounds sustained from beatings received by the guards there. The story is distinct

within the history of science not only because our understanding of it has resonated with the scientific community and the general public-at-large, but because of how the differences in each of these groups perceptions of the story offer a unique frame within which to observe history, philosophy, and science interacting. Attempting to understand science through the actions of those who perform it leads invariably to questions of how they use language and arrive at interpretations of truth and meaning as a community. In order to best approach those questions it becomes necessary to preserve the connection between the words of the people involved and the concepts they were going over as we trace out the environment of the discovery and development of a theory, as well as how regardless of its veracity personal politics can keep it from being disseminated. What happened to Ignaz Semmelweis was without a doubt a tragedy for medical science. However, there remains much to be understood as to why this occurred. In portraying Semmelweis as a martyr figure against the willful ignorance of his opponents harms our understanding history.

Environment, Discovery, and Development of a Theory
The Vienna General Hospital where Ignaz Semmelweis would eventually make his discovery would prove to be an ideal environment for its development, providing the necessary school of thoughts and circumstances. Begun in 1693 by Leopold I, over the next century and a half it would develop a reputation as one of the leading medical centers of Europe for both its continuous contributions to the field of medicine as well as its socially progressive policies of charity. By the early nineteenth century these included the establishment of departments for two of the growing fields, anatomical pathology and obstetrics. The former, under the leadership of acclaimed physician Carl von Rokitansky (1804-1878), marked one of the earliest instances of combining the then new approach of pathology with a systematic and documented methodology of autopsy in correlating clinical findings with the pathological changes that caused them. The obstetrics department grew alongside the same practices of documentation, yet was also set up as a means of the Austrian government to provide free maternal care to the expectant mothers of Vienna. Though eventually in the obstetrics department, shortly after earning his doctorate degree in medicine in 1844, Semmelweis had attempted and failed to acquire an appointment with the pathological department under Rokitansky. Nevertheless, though Semmelweis would not officially start his tenure at the hospital until 1846, under the guidance and permission of Rokitansky, the recent graduate became fully acclimated with the hospital, being allowed to perform autopsies, observe operations, and therefore become influenced by the meticulous investigatory methods of anatomical pathology. In particular, Rokitansky instilled in Semmelweis a keen sense of observation and perhaps most importantly that the patterns of findings were as important as the findings themselves.
Semmelweis was appointed assistant to Professor Johann Klein (1788-1856) in the First Obstetrical Clinic of the Vienna General Hospital on July 1, 1846. The Hospital had two clinics devoted to maternal care, the First Clinic, led by the operating physicians and observing students of the Obstetrics Department, and a Second Clinic led by a division of midwives. It was well-known throughout Vienna that the mortality rate of the First Clinic regularly exceeded that of the Second. As both clinics were gratis institutions for the public, often many of the expectant mothers of Vienna had little say in which clinic they were assigned. Semmelweis described being introduced to the hospital by scenes of young mothers pleading to avoid the First Clinic:
“Frequently one must witness moving scenes in which the patients, kneeling and wringing their hands beg to be released in order to seek administration into the 2nd Clinic.” (Etiology page 70)
A combination of such visceral sights and the extreme disparity of the mortality rates between the two maternal clinics acted as the main impetus behind Semmelweis setting out to determine the nature of puerperal fever.

There had been several hitherto attempts to explain the higher incidence of puerperal fever in the first clinic, ranging from the highly suspected principle of lochial suppression, to the more speculative theory of atmospheric disturbance (Nuland 33). Of the later, one of the first observations that Semmelweis made upon being appointed obstetrics assistant was that the two maternal clinics were located adjacent to each other in the hospital, and as such, any external atmospheric cause of puerperal fever would have afflicted both of the clinics equally. This led Semmelweis to a rigorous process of elimination of any conceivable variable between the two clinics. For example, Semmelweis noticed that the hospital priests who administered the last rites of the dying would walk through the length of the first clinic on their way to the afflicted, ringing their clerical bell and waving incense, whereas they usually took a shorter route through the second. Semmelweis believed this to be causing psychological distress to the patients of the First Clinic, so he ordered the hospital priests to take alternate routes. Though this led to no change in the mortality rate of the First Clinic, it is demonstrative of the lengths that Semmelweis was pursuing in addition to regular hospital duties. Semmelweis would go through a large number of other potential variables, such as changing the temperatures of the clinics, or even the positions in which the mothers had their deliveries, all the while accumulating a large amount of meticulously documented

data.
It was the death of Semmelweis’ friend and co-physician, Professor Jacob Kolletschka (1803-1847) that led to his breakthrough. While performing an autopsy with his students, Kolletschka was accidentally pricked on the finger by one of his students with a scalpel that was being used for the examination. Kolletschka soon after developed an infection and die just a few days later. Semmelweis noted that the symptoms that Kolletschka had displayed, along with specific attributes of his cadaver after his death were identical to those displayed by a victim of puerperal fever.
“…at once it became clear to me that childbed fever, the fatal sickness of the newborn and the disease of Professor Kolletschka were one and the same, because they all consist pathologically of the same anatomic changes. If, therefore, the case of Professor Kolletschka general sepsis [contamination of the blood] arose from the inoculation of cadaver particles, then puerperal fever must originate from the same source.
Semmelweis soon enough determined the means by which the cadaver particles were introduced to the patients. The agent of communication for the particles were the hands of the operating physicians and observing students who came to the First Clinic directly from the autopsy room where they had been performing post-mortem work on the bodies of women who had only just died of puerperal fever. The maternal clinic and all patients therein, being a part of a national institute with practices ever mindful of budget and efficiency, would have these same operating physicians demonstrating on the patients themselves for all observing students.
Semmelweis now understood the nature of puerperal fever, and that the means to prevent it would involve removing from the hands of the physicians and students any of the “invisible cadaverous particles.” Inferring that the presence of the cadaverous particles was recognizable by the odors on the hands of the operating physicians particular to the bodies of puerperal victims, Semmelweis determined that a solution of chloride-of-lime would be ideal for completely removing any trace of cadaverous particles. In May of 1847, Semmelweis ordered the placement of a bowl of chlorine solution be placed at the entrance of the First clinic and ordered that all entering physicians and students wash their hands in it before attending to deliveries or examinations. For the remaining duration of the year, only 56 of a total 1,841 women who had deliveries in the First Clinic contracted and died of puerperal fever, bringing the rate of mortality down to 3%, almost identical to that of the Second Clinic.

Failure of a Theory’s Dissemination

Semmelweis had discovered the underlying true nature of puerperal fever, had devised a means to prevent its occurrence, and did so in a manner that was consistent with the methodology of pathological anatomy, and yet his work would not go on to be widely adapted or recognized within his own lifetime, there are perhaps two main reasons as to why. The first would be that the concept of etiology (or cause) of disease that Semmelweis was positing with his work stood in direct contrast with what where firmly held notions behind what disease is and how it worked, and the second was that Semmelweis himself made several political mistakes with his peers and colleagues that only ended up harming the perceived validity of his work.
Semmelweis was, in fact, arguing for an incredibly radical conception of etiology in puerperal fever. According to Semmelweis, puerperal fever was,
“a resorption fever determined through the resorption of decaying animal-organic matter.” (etiology/Carter p71)
What Semmelweis was positing was that all cases of puerperal fever were caused by a single source (invisible decaying animal-organic matter). This understanding was totally at odds with contemporary views of not only puerperal fever, but of disease in general which normally placed emphasis on idiosyncratic factors particular to the body of the afflicted patient. German doctor Rudolf Virchow (1821-1903), eventually recognized as the “father of modern pathology, said at the time:
“Only the best physicians of all times have realized that similar cases of the most different diseases require the same treatment and that different cases of the same disease require different treatments. Conditions, rather than the disease, must be the basis for determination.” (Carter 73)
Operating under this prevailing view, much of the evidence that Semmelweis was staking his claims on become largely circumstantial.

Furthermore, that Semmelweis was attributing the cases of puerperal fever to the resorption of cadaverous particles that were unseen was problematic unto itself for true understanding of his work. Perhaps one of the most salient beliefs of the popular account of the Semmelweis story is that he was introducing the concept of hand washing to the doctors of his hospital, and that this was one of the underlying factors behind his being rejected. Semmelweis had offended his doctor colleagues by suggesting that their hands were not clean because doctors were “gentlemen, and a gentleman’s hands were always clean.” (CITE THREE TIMES) While Semmelweis may have offended his colleagues when attempting to implement his chlorine solution, it would have been because the doctors of the hospital did wash their hands. Following post-mortem work, the operating physicians would use a combination of soap and water to wash their hands to the point of being visibly clean. Though certainly still carrying and transmitting the decaying organic matter of the cadavers, it is not difficult to see that for a doctor operating before the adoption of the Germ Theory that the idea of invisible cadaverous particles were the cause of the disease would be seen as highly unlikely. For the most part, new truths in medicine were still being determined largely by what was readily apparent to the human senses. Even Semmelweis himself had based his determinations on the cadaverous odors that remained on the hands of the operating physicians.
These were all issues of understanding that Semmelweis could have clarified in detail. Available to him was the Vienna General Hospital’s statistical data for incidence of puerperal fever, as well as the support and urging of several of the Hospital’s most prominent physicians to publish his findings in a medical journal or before a forum of his peers. Semmelweis refused to do either and would not end up publishing his findings for a full thirteen years after the fact. As a result, the majority of word about his work during the interim was provided by his supporters in the form of letters and lectures. Unfortunately, in those crucial early moments, those second-hand sources often contained errors or miscommunicated essential aspects of Semmelweis’ theory. For example, an early and ardent supporter of Semmelweis was the renowned Austrian physician and editor of the Medical Society of Vienna’s Journal, Ferdinand von Hebra (1818-1880). Hebra submitted two editorials in 1847 and 1848 announcing Semmelweis’ findings and declaring that they had
“a pragmatic importance on the level of Edward Jenner’s pioneering of the Smallpox vaccine.” (p 53-54 Carter)
Though adequate in summarizing the process that Semmelweis had undertook in his work, Hebra’s emphasis on the role of the operating physicians communicating the infection after performing post-mortem work on the cadavers that had been infected with puerperal fever left a large number of readers, especially in England, believing that Semmelweis was merely stating that puerperal fever was contagious, that one could acquire it with proximity to those already infected. English physicians who read the editorials thought Semmelweis as being derivative or unware of the results of the American physician, Oliver Wendell Holmes, who had had purported as much in 1843. As true as the results of Semmelweis’ new conception of the disease was, and as practical as they promised to be, they were obfuscated beyond comprehension without his input.
It was a pattern that would repeat itself in the thirteen years in between Semmelweis’ findings and their eventual publishing. During that time, he would continuously reject offers to hold lectures and even offers of financial support to repeat his findings in repeatable experiments. Semmelweis opined that the truth of the work was inherent in the thousands of lives of delivering mothers that had been saved, and as such, only grew frustrated when his ideas were not universally adapted. According to those close to him, Semmelweis grew increasingly dogmatic, arrogant, and hostile, lashing out against anyone who opposed his views, making enemies and alienating his greatest supporters. (Nuland 131) Semmelweis finally responded to his detractors and dismissers with his only book, the 1861 “The Etiology, Concept, and Prophylaxis of Childbed Fever.” By this point, Semmelweis’ work was considered effectively refuted in the medical circles of Austria and Hungary, and thus, the book was a final opportunity for him to argue and clarify his ideas on his terms. Instead, “The Etiology, Concept, and Prophylaxis of Childbed Fever,” was a five-hundred page book that was repetitious, recursive, bitter, often digressing into vitriolic attacks (often by name) against the physicians who had refused to accept his work, and apt toward self-glorification:
“I am constrained to come before the public once more, since my silence has been futile, and despite the many bitter hours which I have suffered, yet I find solace in the consciousness of having proposed only conclusions based on my own convictions” (Semelweis, Etiology)
Of course, there are elements of truth to these claims, Semmelweis had been dismissed from his position at the Vienna General Hospital in 1848 largely for being a Hungarian at the time of the uprisings of 1848, and many who had rejected his findings had done so without ever making an attempt to recreate theme. As it occurred, Semmelweis’ lack of political finesse, the turbulence of the times, and his eventual failing sanity ensured that he and his findings would remain in obscurity within his lifetime.

CONCLUSION
A curious aspect of history is that all too often, despite evidence to the contrary, it is the popular account that overtakes the factual one. Though problematic for history in general, the human tendency to forego evidence and fact in favor of retaining the power of impression poses a unique set of issues for the study of the history of science. In the attempt to trace communicate the development of the system and body of knowledge that we know as science, the simplification and conflation