Physician Heal Thy Self

In 1847, Jakob Kolletschka, a close friend of Hungarian doctor, Ignaz Semmelweis, cut his finger while he was doing an autopsy.  Kolletschka soon died of symptoms like those of puerperal fever.





 "There is not a corner in Britain where this formidable disease has not made many mourners,” John Mackintosh, an Edinburgh, Scotland "man-midwife" wrote of puerperal or "childbed" fever in the 1820s.


This bacterial disease of the upper genital tract typically began within the first three days after childbirth with abdominal pain, fever and respiratory difficulty, and very often ended with the new mother's death.


Medical writers had been remarking on childbed fever at least since Hippocrates, but in the early modern era, it began to attract attention for a number of reasons. For one, it began to appear in epidemics, with very high mortality rates. For another, accounts of outbreaks were written about and published.

 There were terrible epidemics of puerperal fever in the German city of Leipzig in 1652 and 1665, at the Hôtel Dieu in Paris, France, in 1745 and 1746, and at the British Lying-In Hospital in London, England, in 1760.


In 1847, one of every six women whose babies were delivered by the medical students and supervising doctors at Allgemeine Krankenhaus (General Hospital) in Vienna died of puerperal fever.



Dr. Semmelweis



The death rate consumed Dr. Semmelweis. He could not figure it out.


A nearby obstetric hospital, run by midwives, lost only two percent of its patients to fever.

 Not only was the incidence of this disease in women delivered by hospital midwives dramatically lower but puerperal fever was quite rare when mothers had their babies born at home.

 While a few physicians (most notably Alexander Gordon and Oliver Wendell Holmes) realized that childbed fever was a contagious process,  it was Ignáz Semmelweis who identified the nature of the problem as stemming from the failure of obstetricians and medical students to wash their hands and change their clothing, especially after performing autopsies or doing surgery.

Semelweiss concluded that some unknown "cadaveric material" caused childbed fever.


No one had connected germs with disease yet. The first hint of that connection would come from England six years later and Joseph Lister would not demonstrate how to kill germs for another 18 years.

People, in the 1800s, found their way to the surgical ward of a hospital by following the smell of rotting flesh. Doctors saw no need to wash their hands between patients or after autopsies.


In fact, an apron covered in layers of gore was thought to show how important and busy a doctor was. And instruments, of course, weren't washed between patients either.


On a hunch, Semmelweis set up a policy. Doctors must wash their hands in a chlorine solution when they leave the cadavers and surgery and before examining any woman in labor.

 Mortality from puerperal fever promptly dropped to two percent.

 But instead of reporting his success at a meeting, Semmelweis said nothing. Finally, a friend published two papers on the method. By then, Semmelweis had started washing medical instruments as well as hands.

As outside interest grew, Semmelweis's silence became understandable . The hospital director felt his leadership had been criticized. He was furious. He blocked Semmelweis's promotion. The situation got worse. Viennese doctors turned on him.

 Finally, he went back to Budapest. There he brought his methods to a far more primitive hospital. He cut death by puerperal fever to less than one percent. He did more. He systematically isolated causes of death. He autopsied victims. He set up control groups. He studied statistics.

 He lectured publicly about his results in 1850, however, the reception by the medical community was cold, if not hostile. His observations went against the current scientific opinion of the time, which blamed diseases on an imbalance of the basic "humours" in the body.

 It was also argued that even if his findings were correct, washing one's hands each time before treating a pregnant woman, as Semmelweis advised, would be too much work. Nor were doctors eager to admit that they had caused so many deaths.


Semmelweis spent 14 years developing his ideas and lobbying for their acceptance, culminating in a book he wrote in 1861.


The medical establishment gave it poor reviews. Semmelweis grew angry and polemical. He hurt his own cause with rage and frustration.

 In 1865 he suffered a mental breakdown. Friends committed him to a mental institution.

There – at the age of 47 -- he cut his finger.

 In days, he was dead...... of the very infection that killed his friend Kolletschka...... and from which he had saved thousands of mothers.


That same year Joseph Lister began spraying a carbolic acid solution during surgery to kill germs. In the end, it was Lister who gave this hero his due. He said, "Without Semmelweis, my achievements would be nothing."