Reid3Semmelweis

Reid3Semmelweis - Ignaz Semmelweis. From a portrait by...

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Unformatted text preview: Ignaz Semmelweis. From a portrait by Abranyi Lajos in 1858 CHAPTER THREE ntil well into the twentieth century the death of a woman in or after childbirth was accepted as the recurring price of sexual intercourse. Childbed fever — puerperal fever — was a terrible blight on every lying—in hospital in Europe, particularly during the first half of the nineteenth century. The pattern the disease ran was cruel. On the third day after delivery the woman’s pulse would rise, she would become prostrate With fever, develop a discharge from her Womb, be- come delirious, have diarrhoea and shortly, as nothing could usually be done to stem the vicious progress of the disease, die. The extent to which childbirth fever swept up its victims was vastly different in different hospitals. In 1856 a newly graduated young doctor, working his first year in the Paris Maternité, was shocked to discover that the overall deathrate for that year was 6 per cent. The fever struck in sudden, uncontrollable waves. During one of these periods he wrote, ‘From the first of May to the 10th there were 32 cases of labour and we registered 3 I deaths’. Belatedly, the hospital was closed. If there were any useful lessons to be got from history, the Maternité had conspicuously failed to learn them. Seventy years earlier, in Man- chester, Charles White had claimed to have radically reduced his cases of the fever by insisting on cleanliness, isolation of cases whenever they occurred, and by getting women off their beds within twenty-four hours of delivery. And ten years after that Alexander Gordon in Aber- deen had shown just how fatally easy it was for midwives to spread the infection to their patients. But in most major cities of Europe the disease recurred with depress- ing persistence. Vienna of the 1840s had a particularly bad reputation in spite of the fact that it was the city which housed one of the most enlightened Medical Schools of Europe: the Vienna General Hospital. When Ignaz Semmelweis joined the lying-in clinic of this hospital as an obstetrical assistant in 184.4 he knew its reputation for puerperal fever rate very well; that year almost one in ten pregnant women who entered it died. Semmelweis, who came from an affluent Hungarian family to study in Vienna, had chosen medicine as a vocation, originally having travelled to Austria to read law. He was an emotional young man, and the condi- tion of the women suffering from Childbed fever moved him. The state of the wards which he had to walk, however, he probably accepted as commonplace; the primitive hospital management and facilities did not differ vastly from city to city. In the Vienna General, wards were crowded. The stench from the open sores of infection was appalling, and 27 MICROBES AND MEN 28 particularly so, the smell from the discharge from puerperal fever. But there were other sources of odours. It was customary for the closets, with their open sewers or buckets, to lead directly from the ward. In many cases — and the delivery room of the lying-in division in which Semmelweis worked was a case in point — autopsy rooms were joined by doors directly to the wards. Frequently students learned their medicine on the dead bodies of patients in the room next to which the patients had once lain. There was no universal tradition of cleanliness, either with respect to patients, practitioners or surroundings. A surgeon would not necessarily clean or change his apron between operations, and some would wear the bloodstains on it like medals, carrying them round from day to day, and from patient to patient. It was fashionable to tuck whip- cord, used for tying up arteries, in the buttonhole of the lapel of the coat. Wards were washed monthly or yearly according to nursing whim. Semmelweis was a well-built, prematurely bald young man, already running to fat, who looked older than he was and whose behaviour had the authority of age. His authority was mixed with a certain dynamism which would qualify him for the twentieth-century definition of a Hun- garian, as a man who goes into revolving doors behind you and comes out in front. When, quite soon after his arrival at the Vienna General, he began to question some of the techniques he saw in hospital practice, he was listened to with attention. He was also a truculent young man with no evidence of tact. As a new— comer to the hospital, he had no hesitation in letting anybody, including his superiors on the teaching staff, know his conclusions on all matters relating to obstetrics. His methods of communication seriously handi- capped him throughout his life, particularly here in this hospital: the pride of the Austro-Hungarian Empire, and founded by the Emperor himself. Semmelweis was over—conscious of his own Hungarian origins, spoke German with a thick Hungarian accent, and never mastered the art of written German. Semmelweis’s immediate superior at the Vienna General, Klein, was professor of midwifery and director of the teaching clinic of the lying-in division. There were two clinics in the division. These had been formed when the hospital had been reorganised in 1840. The second, staffed by midwives, was run in the same way as the first clinic, except that medical students were not taught there. The existence of the two clinics was to make Semmelweis, first by implication then de facto, a virulent critic of Klein. Semmelweis’ first untoward observation was not merely unoriginal, CHILDBED FEVER it was shared by the vast majority of those who, as patients, had ex- perience of one of the lying-in clinics; it was that the death-rate from childbed fever in the first clinic was far higher than that in the second. it was an opinion not generally shared by the rest of the medical teach- ing. staff. Semmelweis had become convinced that the gossip among patients was true when he saw the depths of their fears of the first clinic. His easily stirred emotions were disturbed by several experiences. He watched cabbies driving their horses round and round the hospital square late at night, waiting until midnight struck, so that the heavily pregnant women inside need not be taken in to the hospital until the early minutes of the morning. The midwives admitted women in labour only on certain days of the week. Some women would prefer to give birth in the streets rather than be taken in to the first clinic. Working in that clinic Semmelweis himself had seen women with dry tongues, with high pulse rates and high temperatures, feigning good health in order to get an early discharge. And he had seen them get down on their knees to beg to be released from what he soon began to agree appeared to be a sentence to a higher chance of death. ‘ There was even a young wives’ tale as to what caused the death-rate in the teaching division; it was due, women said, to the examination by doctors. As he walked the wards, Semmelweis watched how obstetri- Cians and midwives worked. Fundamentally he could see no diflerences either in the way stafl' behaved, or in the organisation of the two clinics: but there was a way in which he could investigate. The chance organisa- tion of the lying-in division itself presented him with an experimental technique which could be applied to medicine as it had never been i applied before. The arrangement of the divisions into two parts pro- vided Semmelweis with a control group of patients in one clinic against which he could measure the effects of any changes of conditions in the other. Even better, the Vienna General, being a Teutonically efl'iciently documented establishment, kept an exact record of admissions, deaths and causes of deaths, to which Semmelweis had access. He collected the statistics of childbed mortality for the two years to 1846 that he had worked in the hospital, and for the four previous years. The results were unambiguous. In the teaching clinic in those six years 1989 Viennese Women had died: ten per cent of the total admissions. In the midwives’ clinic the figure was nearer three per cent. However bad the figures for the midwives’ clinic had been, in no single year had they shown any sign of being as devastating as those in the teaching clinic. This discovery of a control group, and the application of simple statistical methods, was a landmark in the understanding of the nature 29 MICROBES AND MEN 3O \ of disease. So far Semmelweis, the large blunt Hungarian among the Austrians, now so frequently depressed by the deaths around him, had only used the technique with already existing data to emphasise to those with whom, and for whom, he was working, that there was something seriously wrong in their system. But the technique was such that he could easily use it to try to discover how puerperal fever was so effec- tively killing-off so many young women. . There were almost as many theories of the origin of the disease as there were deaths. It was said to occur frequently in cases of still-births, to depend on whether a woman was married or single, to be influenced by the weather or to be caused by a mysterious halo clinging to the obstetrician. For many years obstetricians had taught that it was a fever of the milk, and one French worker even claimed to have found milk in the peritoneal cavity. Some practitioners had decided that diseases such as scarlet fever, measles, smallpox and erysipelas were related to child- bed fever and that one could turn into the other. How the disease spread was another tale of ignorance. Some medical schools had it that the disease was contagious, but there was no useful theory as to how the contagion spread. Much mumbo-jumbo was talked about ‘atmospheric telluric influence’. Looking back over more than a hundred years it is easy to despise this terrible replacement of ignorance by ignorant phrases. Nevertheless, this sort of phrase is not far removed from some in daily use in modern medicine. In 184.0, the year the Obstetric Division of the Vienna General Hos- pital had been divided into its two clinics, a German pathologist, Jakob Henle, had formulated a theory in which he supposed that disease could be caused by ‘miasms’, or polluted air, and that ‘contagia’ were miasms that had developed in the human body. There was nothing new in the idea that bad odours carry disease, as readers of the Bible or Shakespeare well know. Henle’s originality lay in the fact that he sup- posed contagia to be organic, living things which survived on the human body as parasites do. _ Henle’s guess - it was no more — was a significant contribution to the germ theory of disease, and it was available to Semmelweis when he began his work on puerperal fever. But like the rest, it was only a theory. Henle had done nothing to confirm it and had no technique by which he could do so. There is no evidence that Semmelweis knew of it. And even if he had, there were too many other theories available to him to assume that it might have influenced him unduly. Semmelweis was an obses- sive, pragmatic Hungarian. As he strode round the wards to see what he could see, no existing theory of that time could tell him what practical THE TWO CLINICS measures to take to eliminate the disease causing one bed in ten to be emptied of a dead woman. The patients and midwives in the hospital would talk freely to the fat, rather humourless foreigner with the forthright manner. When some whispered that the cause of death in the first division’s delivery ward was due simply to the fear that women had of being there, he took the suggestion with absolute seriousness; he did not reject the possible psychological origin of illness. Besides, he had already had the affecting experience of women crouching at his feet, clinging to his trousers, begging not to be sent to the first division. No matter how na'i've his approach, the control group of patients at his disposal made it a relatively simple matter to test, falsify and discard what was of no use. He went to some trouble to dispose of the ‘fear’ theory. He had noticed during the time he spent in the five wards in his clinic that the daily event which more than any other evoked a reaction of dread and worry among the women lying in their beds was the sight of a robed priest and the sound of his attendant’s bell as they walked through the wards to reach the sick-room to give the last sacrament to a dying patient. Semmelweis also noticed that the priest’s route from the chapel to the sick-room of the midwives’ clinic was not through the wards. A quiet word from Semmelweis soon had the man walking to the sick- room by a roundabout route and without his bell. The result had no effect whatever on the deathrate in the first clinic. The simplicity of the technique, however, encouraged Semmelweis to look for more dif- ferences in procedure between the teaching ward and the midwives’ ward, whose influence he could easily assess. He rejected ideas about some of the differences without bothering to apply them in a comparative study with his control group. For example, there was a suggestion that childbed fever in the first division was linked to the low social class of the patients by the sense of shame felt by poor women when they were being examined by medical students. Semmelweis argued, not unreasonably, that the high-society patients who were lucky enough to be attended by a doctor in their own homes ought to suffer an even greater wound to their modesty at being handled by a strange man; yet the incidence of puerperal fever in these home deliveries was far less than in hospital. Another suggestion was that the examination of patients by the mid- wives was an altogether gentler process than that carried out by the students in their first division teaching rounds. But how small, said Semmelweis, is the likely damage of a student’s finger in the long vagina of a pregnant woman compared with the injury inflicted by a baby on 31 MICROBES AND MEN 32 its birth passage? His supposition was correct, but had he used his control group as a verification it might have led him to some related important conclusions. Semmelweis compared as many of the conditions in the two clinics as appeared relevant. Ventilation was identical, there was no perceptible difference in the standard of cleanliness, the laundry was washed in the same way, food was supplied by the same caterer. There was no obvious solution. However, Semmelweis’s emotional involvement with the problem confirmed its existence at every turn. There was a poor and worsening life-expectancy of women lying in the teaching clinic. But there was one group of women which was the rule’s exception. The General hospital was a charitable institution and the city was vast. Many poor women arrived at the gates having failed to reach the place in time by foot, carrying their babies in their arms. They had given birth in shop doorways, under archways, in horse-drawn cabs, or any- where they could find shelter. Yet the mortality rate from puerperal fever among these women was low and, Semmelweis found, roughly the same in both divisions. It was a consolation for poverty. The other embarrassing statistic which Semmelweis extracted was that under the regime of the previous professor of midwifery, mortality had been extremely low. Under Professor Klein, it was extremely high. A tactful junior doctor would not have bandied about the information carelessly. But Semmelweis’s uncontrollable volatility and emotion were incompatible with tact. Klein, his regime and methods, were firmly implicated with the cause of the high childbed fever death rate. Klein had the reputation of being a dull, unadventurous and insecure man. Semmelweis was humourless too, but also manically depressive and volatile by turns. It seems, in retrospect, that however Semmelweis had presented the results of his findings to Klein, the characters of the two men were such that Klein’s instinct to territorial protection could not fail to surface. When one of Semmelweis’s more senior friends at the hospital, Skoda, a diagnostician with a growing European reputa- tion, proposed that a commission of inquiry should meet to investigate Semmelweis’s statistical results, Klein felt bound to take action. He invoked the protection of the Minister of Education and the commission was never allowed to meet. But when in 1846 the numbers of deaths in the first division from puerperal fever reached more than four times that in the second, a com- mission did meet and made a recommendation. It was that the most likely cause of the disease was injury to the genital organs inflicted by rough examination by students during their course of instruction. More SEMMELWEIS AND KLEIN particularly, it was concluded that the injuries were caused by foreign students whose numbers should be reduced. Xenophobia had been introduced into medical judgement. Semmelweis, the foreigner, watched his students reduced from 42 to 20, with foreigners almost completely excluded. He also watched his statistics. Mortality in his wards at first dropped, and then rose to frightening heights. By April 1847 it had reached I 8 per cent. During this period Semmelweis had one of the deep fits of depression which he experienced at different times throughout his life. His needed little to trigger its peaks and troughs. On this occasion, however, there was a ready excuse if one was needed. Throughout the clinic Semmel— weis could sense a deep feeling of contempt among his patients and even among the domestic staff for the medical staff. The laymen were con- vinced that the medics were themselves in some way responsible for the appalling deathrate. Semmelweis himself stood among the accused. He looked for obvious reasons which might support the patients’ accusations, but there were none. In desperation, when he noticed a difference in the method of delivery used in the two divisions, he ordered that his own delivery ward should adopt a new method. He wrote: Like a drowning man clutching at a straw, I gave up the dorsal position in labour, which was customary in the first clinic, and because the lateral position was that adopted in the second clinic. I do not believe that the dorsal position was so disadvantageous compared with the lateral position as to cause the higher mortality. He was right. It made no difference whether women were delivered on their backs or on their sides. In the first division clinic they died at an unchanging, appalling rate. So far Semmelweis had succeeded only in stirring up antipathy to- wards himself, by emphasising a problem which reflected the short- comings of his superior. He had challenged orthodoxy, but had not re- placed its techniques with anything preferable. It cannot have come as a complete surprise to Semmelweis when, in October 1846, Klein de- clined to renew his assistantship, but offered a provisional appointment instead. Semmelweis, touchy and haughty, was offended. He brooded over his future, left Vienna, and half-heartedly took up a study of English with a view to going to Dublin to investigate puerperal fever there. But by February of i 847 his old post was again vacant and he was reappointed. Back in Vienna in a refreshed frame of mind, he had been walking the wards for only a few hours when the news reached him that one of the 33 MICROBES AND MEN 1W7 34 professors he admired most in the Medical School’s faculty, Kolletschka, was dead. While carrying out a post—mortem a pupil’s knife had slipped and pierced Kolletschka’s finger. He had died his painful death within a few days of an infection setting in. The symptoms were described to Semmelweis, who reacted in his typical hypomanic fashion: In the excited condition in which I then was, it rushed into my mind with irresistible clearness that the disease from which Kolletschka had died was identical with that from which I had seen so many hundreds of lying-in women die . . . Day and night the vision of Kolletschka’s malady haunted me, and with ever increasing conviction I recognised the identity of the disease. In fact he only partly understood Kolletschka’s death. Semmelweis’s theory was that the knife had infected him with ‘cadaveric particles’: minute decayed pieces of flesh from the dead body. At' this stage the important question, what are ‘cadaveric particles’ P, did not occur to Semmelweis. He was simply concerned with preventing them reaching the open wounds of the genital organs of a woman after childbirth. It was not now difficult for him to think up a reason how they got there. Obstetric students in the first clinic frequently moved from autopsies being carried out in the post-mortem room which joined directly onto the clinic’s delivery ward, to the examination of women in labour. They went through an apologetic hand-washing procedure before moving from death to birth, but it was well known that the stench of a dead body clung to the hands for hours after washing with ordinary soap and water. The particles, Semmelweis realised, were carried to a women’s sexual organs by students’ and teachers’ dirty fingers. Semmelweis now insisted that his students wash their hands in chlorine water before they began any examination in the first clinic. He had invented an antiseptic procedure. The first students to wash their hands in chlorine water did so in May 1.871. The solution had an acid smell, was unpleasant to work with, and was expensive. Semmelweis soon substituted chlorinated lime which he rightly believed would have the same effect as chlorine water. The result was a sensational success. In the seven remaining months of 1847 Semmelweis reduced mortality to 3 per cent. The 1846 level had been I I per cent. In the midwives’ clinic mortality was 27 per cent. In 1848, for the first time in its history, mortality in the teaching clinic fell below that in the midwives’. Semmelweis was elated and, on the peak of one of his hypomanic phases, rigorously insisted that every student, teacher and medical visitor who wanted to carry out an examination of any sort should wash ATTEMPTS AT DISINFECTION his hands in chlorinated lime on entering the labour ward, then use soap and water between examinations. . . In the short term, particularly in the eyes of Semmelweis’s reaction- ary seniors, there was no reason to assume that this newfangled and messy procedure was other than another piece of mumbo-Jumbo, coinciding with a lull in the virulence of the disease. There was every indication that this was so, shortly after a pregnant woman who was suffering from a cancer of the cervix (the neck of the womb) was brought to the labour ward in October 1847. She was put in bed number i. The hand-washing ritual was followed by all who entered the ward, under the priest-like supervision of the obsessive Hungarian doctor. Never- theless, in spite of these precautions, in deeply-felt'hqrror, Semmelweis watched eleven of the twelve women in the ward die of puerperal fever. He was convinced that the position of the woman’s bed and the fact that she was first in order of examination was critical in the spread of the disease. He was also still convinced that an examining finger had carried it. If this was so, then it must be the case that the infective particles, whatever they were, could come from the living matter of the human body; in this case a cancerous woman. The dead bodies of the-post- mortem room were evidently not the only source. To prevent-this sort of carnage happening again, Semmelweis insisted on the dismfecting chlorinated lime-wash being used between patients. Soap and water would not do. . But within a month another tragedy was played out in the same labour ward. Semmelweis needed to experience it in order to give a fine focus to his theory. A second sick woman was admitted into the labour ward. She had a bad ulcer in her left knee joint. The sore was open and running and its smell filled the delivery room. The woman s genital organs, however, were in no way infected and there seemed no reasor; Vvhy she should not have a safe delivery. Yet again, however, m Splij 0 every care in the hand-washing procedure, the ward was deCimate . Semmelweis’s conclusion was that, ‘The air of the labour room, loaded with the putrid matter, found its way into the gaping genitals just at the completion of labour, and onward into the caVity of the uterus where the putrid matter was absorbed, andpuerperal fever was the consequence’. From then on he kept any badly infected cases out of ' abour ward. hls'I’he statistics of mortality for the months which followed were un biguous, and in the year following Semmelweis’s experiences With the wo infected women, mortality fell to 1'3 per cent. nlike Henle, Semmelweis did not really care what the ‘decomposed 35 MICROBES AND MEN animal-organic matter’ was which was carrying the disease through his wards. But he deeply cared about putting his theory to the test and he was able to bring extraordinarily effective methods of disease—preven- tion into operation. In his depressed periods he also carried a deep sense of guilt at his long ignorance: ‘God only knows the number of women I have consigned prematurely to the grave.’ Besides this he had the consummate knack of making others feel guilty: his professor in par- ticular. The statistics which Semmelweis dredged up from the past showed unmistakably how puerperal fever mortality had increased dramatically in the year Klein took charge of the department. Klein’s predecessor had taught midwifery on a model of the human body, Klein himself used dead bodies from the labour ward. The inference was clear. Students’ fingers — and Klein’s fingers — had carried childbed fever back into the labour ward. Klein was one of the woman-slaughterers. This was only one of a series of factors which put Semmelweis in conflict with those who were able to make decisions on his academic future in Vienna. One of these decisions was to reject his application for promotion. But even before the first serious abrasions with his depart- ment’s superiors, Semmelweis showed signs of a persecution complex somewhere beneath the surface of his thin skin. His response to the reluctance even to set up a simple investigation of his results was to take deep offence and to react irrationally. He refused an invitation to address the Vienna Medical Society on his work. This could have been Semmelweis’s opportunity to put his conclu- sions on early record. Instead, a few of the friends who were accustomed to the quirks in his personality took it on themselves to publicise his work. Semmelweis was more than fortunate in the quality of three of the young professors at the Medical School. Rokitanski, Hebra and Skoda, who all eventually won international reputations for themselves, im- mediately gave him their support. Skoda, at the Vienna Academy of Sciences in 1849, described Semmelweis’s work as ‘one of the most important discoveries in the domain of medicine’. Skoda’s opinion was no more than just, but Semmelweis took none of the steps to make sure that its importance was communicated. He reacted to Skoda and Hebra’s good intentions with the ingratitude typical of his personality, blaming them for laying too much emphasis on contagion by ‘cadaveric particles’ and not on the rest of his theory. When Semmelweis did at last address the Vienna Medical Society in May 1850 with an account of the work he knew to be unorthodox and anti-establishment he, again typically, saw the criticisms of his work as personal attacks on himself. SEMMELWEIS LEAVES VIENNA When his second application for promotion was heard and granted, but without the full teaching privileges he ought to have been able to expect after six years’ apprenticeship, Semmelweis broke with the Vienna Medical School. He stormed out of the city, back to his own country without even a word of goodbye to the friends who had tried to promote the ideas he himself has so inadequately promoted. Hurt by the conspicuous ingratitude, Skoda never spoke again to Semmelweis. The abnormality in Semmelweis’s character was unalterable, and so was his single-mindedness. Once back in Hungary he took the post of unpaid senior physician in the Obstetric Clinic of a Pesth hospital, re- producing the theory and practice in childbed fever preventive tech- niques. He called it his ‘doctrine’ and, still without publishing fully, he furthered its cause as enthusiastically as he had in Vienna, collecting just as much antagonism and reaction in the process as he had in Austria. Just as Semmelweis’s psychopathology caused his personal inade- quacies, it was responsible for his prominent streak of scientific creativity. The creative energy he threw into his stream of work and activity is typical of many manic depressives. The pattern protected against the threat of depression and promised creative results from which could be won esteem and approval. But in Hungary Semmelweis was never to produce the originality of thought and approach which had marked his few years in Austria. Tragically too, he was now separated from the mainstream of European scientific thought into which, once injected, his ideas and his influence might have spread. During these years of exile in his own country, Semmelweis became fatter, more florid and balder. A family life — at 38 he married a girl of I 8 ~ might at first have given him a more stable pattern of existence, but he was still quick-tempered and needed to be soothed in his outbursts. And there were early unpredictable tragedies in his married life, which carried the mark of that irony which inevitably is attached to some part of the lives of all those who made contributions to the germ theory of disease. Semmelweis, who had spent so much of his life depressed by the deaths in his wards of mothers and children, saw his first child born a hydrocephalic. It was dead within forty-eight hours. A year later a second child was born, only to die within months, of peritonitis. Semmelweis was accustomed to death, but these two in particular cannot have contributed to the stability of his personality. Over the years his friends watched his quirks turn into serious character defects. For years he maintained that he loathed the idea of putting his work on paper, and the only account of his work was still that in the recorded minutes for 1850 of the Vienna Medical Society. When ten years after 37 MICROBES AND MEN his last really original work in Vienna, he decided to take up his pen, words flowed from it in torrents. In 1857 he began to organise the statistics he had collected over thirteen years and set them down with his obstetrical observations and emotional experiences. It took him three years to write his Aetiology, Conception and Prophylaxis of Child- bed Fever. It was a rambling, repetitive, polemical and egotistical work, over-amply emphasising his misrepresentation and persecution; its 543 pages were loaded with such phrases as, “Fate has selected me as the champion of the truth . . . a duty laid upon me which I cannot refuse to perform’. The work had been completed in a state of high excitement, with Semmelweis furiously writing and rewriting chapters, then packing them off to the printer without correction. When Aetiology was finally published, it produced no reaction whatever. Semmelweis’s simple theory was that puerperal fever is caused by the transmission of organic particles to the open wound of a freshly delivered woman. Yet he failed to place his ideas in the common current of nineteenth-century scientific thought. And when, too late, he attempted to publish, his simple idea was so verbosely expressed as to defy attention. Semmelweis had translated a whole sentence in the vast scientific hieroglyph, but had failed to put it in sequence. His inability to communicate unmistakably what he had done condemned his work to sterility and thereby lost him his claim to scientific creativity. When the book which had taken three years to complete failed to produce the response he craved from the medical press, Semmelweis clung desperately to his pen as his saviour. Now he began to dash ofl long emotional open letters either to those he felt might have influence, or to those who opposed him. Their contents were bitter, irrational and accusatory. One professor of midwifery in Vienna took the brunt of his attack: ‘In this period of ten years at least 1924. patients lost their lives from avoidable infection . . . In this massacre you, Herr Professor, have participated’. By the middle of 186 5 Semmelweis’s behaviour had become so eccentric in public and private that it was clear he was suffering from mental illness. His wife consulted one of his colleagues from the Medical Society where, even in lectures, Semmelweis was becoming an em- barrassment. A consortium of his medical colleagues gathered to recommend treatment. What they proposed should be done to him — blood letting and cold-water dousing — was the sort of irrational treat- ment his methods should now have been helping to eliminate from medical procedures. A LAST IRONY Eventually he was taken back to Vienna. There one of the few re- maining friends from his early years in the city, Ferdinand Hebra, invented some reason to persuade the prematurely aged Semmelweis to enter the gates of a mental institution. I In the asylum a medical examination showed that Semmelweis had an injury to a finger on his right hand. It was believed to have been accidentally inflicted during his last obstetric operation. The wound appeared gangrenous. The last irony was particularly bitter. He died, as Kolletschka had done, of a puerperal-like infection, and in the same way that had made Semmelweis himself realise the mechanism of the infection. He was taken back to the Vienna General Hospital for the first time in fifteen years — in a coffin. There an autopsy showed extensive organic brain damage. 39 ...
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