Appendix 62a - Semmelweis

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]


"You medical people will have more lives to answer for in the other world than even we generals." - Napoleon Bonaparte

Dry Skin and Dead Patients

One hundred thousand people die every year in the US from "nosocomial" infections - meaning infections they contracted in the hospital.[726] "On that day in 1996 when the Valu-Jet plane crashed in the Florida Everglades, killing more than 110 people," writes the president of a consumer group, "at least 220 people died from infections acquired in the hospital."[727] Many of these deaths are completely preventable.

From the New England Journal of Medicine:

Hand washing is considered the single most important procedure in preventing nosocomial infections... [but] compliance of healthcare workers with recommended hand washing practices remains unacceptably low....

We found that, on the average, hospital personnel washed their hands after contact with [intensive care unit] patients less than half the time. Physicians were among the worst offenders.[728]

Top two excuses doctors use for not washing hands? Dry skin and being too busy. Even when they doctors do wash their hands, studies show that they wash for an average of 9 seconds.[729]

Delusions

A recent Australian study of doctor hand washing in - of all places - a pediatric intensive care unit. Only 12% of doctors washed their hands after patient contact. What if an educational program with in-service teaching rounds, poster displays, specific requests to hand wash and performance feedback is offered? The hand washing rate rises to 17%.

A sample of doctors working in the pediatric ICU were asked how much they thought they washed their hands. The average self-estimate of their own hand washing rate was 73%, with individual responses ranging from 50% to 95%. These doctors were singled out and followed. Their actual hand washing rate? Nine percent.[730]

From the accompanying editorial:

It seems a terrible indictment of doctors that practices and protocols must be developed to take the place of something as simple... as hand washing. Perhaps an even bigger concern for current medical practice, and one which should lead us all to do some soul searching, is that careful and caring doctors can be extraordinarily self-delusional about their behavior....[731]

Ignaz Phillip Semmelweis

From the Proceedings of the Royal Society of Medicine:

Many men have been endowed with clear intellects and hearts full of love for their fellow men, with the enthusiasm of humanity, and they have been enabled to achieve some signal service for the human race in their day and generation; but in the whole history of medicine there is only one Semmelweis in the magnitude of his services to Mankind, and in the depths of his sufferings from contemporary jealous stupidity and ingratitude.[732]

The year is 1846. The scene is the Viennese General Hospital, the largest of its kind in the world. Semmelweis gets a job as obstetrical assistant.[733]

Semmelweis notices that three times as many women are dying at the hands of the medical students than at the hands of the midwifery students from puerperal fever, commonly known at the time as, "the black death of the childbed."[734] "In the medical school division the mortality from puerperal fever was so terrifying that this division became notorious," Semmelweis describes. "There were heart rendering scenes when [pregnant] patients knelt down, wringing their hands, to beg for a transfer [to the midwifery division]...."

Why the discrepancy? The food and ventilation was the same in both divisions. If anything, surgical skill was better in the medical school and overcrowding less. The idea at the time was that the excess mortality was due to the emotional strain of being examined by male students, since the midwives were all female. So the elders of the Medical School met in council and proceeded to exclude the foreign students from the hospital on the ground that they were, "rougher in their examination than the Viennese." Death rates didn't change.

Before Lister, before Pasteur, Semmelweis made the connection between the autopsies the medical students were doing and the, "examining finger which introduces the cadaveric particles." In May 1847 he required every medical student to wash his hands with a chlorine solution before making an examination and the death rate plummeted. For the first time in the history of the Vienna Hospital, the mortality rate at the medical school fell below that of the school of midwives.[735]

Publish and Perish[736]

Knighted, no doubt, for the discovery of the century? Hardly. Historians believe his doctrine was unpalatable to colleagues since it implied that the obstetricians were the cause of death. He shared this knowledge with his superiors. From the Proceedings of the Royal Society of Medicine: "The suggestion was unheard of! Indeed, it was sheer impertinence to suggest that the Accoucheur to the Imperial household should carry contagion upon his hands." Semmelweis was summarily dismissed.[737]

So he lectured, he wrote papers; he continued to be ridiculed. Doctors regarded antisepsis as a poor joke. His successor in Vienna publicly stated that the doctrine was, "discredited and universally rejected." Semmelweis wrote a book, The Cause, Nature, and Prevention of Puerperal Fever, expecting it to save thousands of lives, but it was ignored.[738]

So he turned from academics to polemics. He started to publish open letters to midwifery professors. "Your teaching... is based on the dead bodies of... women slaughtered through ignorance. If... you continue to teach your students and midwives that puerperal fever is an ordinary epidemic disease, I proclaim you before God and the world to be an assassin...."[739]

By the summer of 1865 he had taken to the streets of Budapest thrusting circulars into the hands of startled pedestrians. "The peril of childbed fever menaces your life! Beware of doctors for they will kill you.... Unless everything that touches you is washed with soap and water and then chlorine solution, you will die and your child with you!"[740]

Semmelweis, at the age of 47, the father of three young children was committed to an insane asylum in Vienna. He attempted to escape, but was forcibly restrained by several guards, secured in a straight jacket, and confined in a darkened cell. The asylum guards beat him severely.

Quoting from the Bulletin of the History of Medicine, "He was not in the asylum for long. Thirteen days after admission he was dead." From the autopsy report: "It is obvious that these horrible injuries were... the consequences of brutal beating, tying down, trampling underfoot."[741]

Bloodletting was another effective way doctors killed people - Appendix 62b.

 


 

[726] Inlander, CB. Medicine on Trial New York: Pantheon Books, 1989:124.

[727] Inlander, CB. This Won't Hurt Allentown: People's Medical Society, 1998.

[728] Albert, RK and F Condie. "Hand-Washing Patterns in Medical Intensive-Care Units." New England Journal of Medicine 304(1981):1465-1466.

[729] Boyce, JM. "It Is Time for Action: Improving Hand Hygiene in Hospitals." Annals of Internal Medicine 130(1999):153-155.

[730] Tibballs, J. "Teaching Medical Staff to Handwash." Medical Journal of Australia 164(1996):395.

[731] Pritchard, RC and RF Raper. "Doctors and Handwashing." Medical Journal of Australia 164(1996):389-390.

[732] Elek, SD. "Semmelweis and the Oath of Hippocrates." Proceedings of the Royal Society of Medicine 59(1966):346-352.

[733] Ibid.

[734] Lamm, RD. "Marginal Medicine." Journal of the American Medical Association 280(1998):931-933.

[735] Elek, SD. "Semmelweis and the Oath of Hippocrates." Proceedings of the Royal Society of Medicine 59(1966):346-352.

[736] Mitford, J. The American Way of Birth New York: NAL/Dutton, 1993:29.

[737] Elek, SD. "Semmelweis and the Oath of Hippocrates." Proceedings of the Royal Society of Medicine 59(1966):346-352.

[738] Carter, KS, S Abbott and JL Siebach. "Five Documents Relating to the Final Illness and Death of Ignaz Semmelweis." Bulletin of the History of Medicine 69(1995):255-270.

[739] Elek, SD. Proceedings of the Royal Society of Medicine 59(1966):346-352.

[740] Ibid.

[741] Carter, KS, S Abbott and JL Siebach. "Five Documents Relating to the Final Illness and Death of Ignaz Semmelweis." Bulletin of the History of Medicine 69(1995):255-270.

 


 

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