- Email: [email protected]
Ignaz Philipp Semmelweis
i’iti.:\ I:.YI’I\.I~ VEI)I(:IN~: 3, 574-580
(1974)
A Corner IGNAz
of History
PHILIPP
SEMMELWEI~
FIG. 1. Ignaz Philipp
Semmelweis
1818-1865.
One of the most fascinating chapters in the history of preventive medicine is the story of how Ignaz Semmelweis proved that puerperal fever (childbed fever), which caused many unnecessary deaths in the major teaching hospitals of Europe, was man-made and, therefore, was largely preventable by man. In spite of the evidence assembled by Semmelweis in the late 1840’s, his concept of prevention was not accepted by most of his peers in his own time. Although he did not have to fight vested commercial interests, the autocratic university professors in Vienna proved to be formidable opponents, unlikely to change their minds about established theories on the origin of childbed fever, especially when challenged by a young Hungarian assistant professor who lacked the diplomatic skills of persuasion. For Semmelweis and his colleagues at the Lying-in Hospital in Vienna, the normal hospital practice of the day meant that patients were examined by the physician and his students after they had performed an autopsy or an examination of a patient with an infected wound, and their only hygiene before ex574 Copyright 0 1974 by Academic Press, Inc. All rights of reproduction in any form reserved.
A CORNER
OF
575
HISTORY
Die Aetiologie, der BegriiT lllld dir
Prol>hglaxis dr.
Kindbettfiebera
Pest, Wien und Leipzig.
FIG. 2. Title
page of The Etiology, Concept and Prophyhis
of Childbed Fewer (1861).
amining the women in labor consisted of washing with soap and water. Later in life, he was to regret bitterly the death toll he unwittingly caused by this daily sequence of events, and his own death in 1865 from the same infection incurred while performing an autopsy provides a grim footnote. Semmelweis had astutely observed that deaths from childbed fever were much more frequent in the hospital ward attended by physicians and students than in the one attended by midwives. Through a long, diligent process, he examined and discarded each current theory about the origin of the infection and in 1847 he came to the conclusion that, rather than being of epidemic origin, the infection was transmitted to healthy patients by the physicians and medical students themselves, as a direct result of their constant contact with cadavers and already infected patients. Unfortunately, Semmelweis had an aversion to writing up his data and thereby informing a wider audience. In fact, his only early published material on these data comes from his presentation to the Medical Society of Vienna in May, June, and July of 1850, where they are part of the recorded proceedings. In addition, the essence of his findings was presented by Ferdinand Hebra in 1847-1848, F. H. C. Routh in 1848, and Carl Hailer and Joseph Skoda in 1848. His ideas met with great resistance and his position as assistant professor in gynecology was not renewed. His attempt to obtain an assistantship in ob-
576
A CORNER
OF Tabelle
hbtlreilung
ftir
HISTORY Nr. 1.
.4erzte.
hbtheilong
fiir
241’2 26.59 278 2956 3241 3754
86 202 164 6n fi6 105
Hebammeu
:. s JlIllI
WI $e -2 2% -2 <
--L 1841 1342 1343 1344 1845 1346
:34x6 3237 3060 3157 :3492 4010
237 513 274 260 241 459
Summa
2004?
1989
77 15H Pi.9 x.2 6H 11.4 /
9.92
li791
691
3.Ll 75 5.9 2.3 2.03 27 1
3.38
FIG. 3. Table I, showing the difference in death rates in two groups of postpartum attended by physicians (left) and those attended by midwives (right).
women, those
stetrics was also denied. After a third attempt, he received an assistantship in theoretical obstetrics which placed severe restrictions on the scope of his teaching. Unable to accept such limitations, he returned to Budapest in 1850 and took a position lecturing in obstetrics at St. Rochus Hospital. Although he published, in Hungarian, an overview of his ideas about the etiology of childbed fever in 1858, it was not until 1861 (Fig. 2) that his major treatise on the Etiology, Concept and Prophylaxis of Childbed Fever appeared, in German. In reviewing this classical work, one is impressed with the detailed statistical tables (63 such tables were included) which form the basis for his conclusion that washing with chlorinated water prior to the examination of pregnant women would lead to a marked reduction in the death rate from childbed fever. The first table of Semmelweis’ paper (Fig. 3) contained the initial clue to the etiology of this disease, namely, that the death rate among women in the department attended by physicians and students was significantly higher than on the service where they were attended by midwives. In the Viennese clinic, statistics were kept on a monthly basis and Table 3 (Fig. 4) shows the death rates for the various months from 1841 to 1846, while Table 16 (Fig. 5) shows the percentages of deaths recorded in 1848 after the introduction of washing with chlorinated water. Semmelweis’ treatise is full of statistical detail with minute descriptions of the various aspects of his investigations. It also included a detailed description of his experiments with rabbits, beginning March 22,1847, showing that they died from infection after being brushed with exudate obtained from autopsy material. Even though the pathology findings were similar to those described for his patients, this evidence was not accepted by his adversaries who claimed he used too high a dose. One aspect of his efforts is of particular interest to those who have ever attempted to reprimand scientific and medical colleagues in print for their lack
Tabelle Wr. III. 6liuik
Acrzte
fiir
1641 Jiineer . Fehrusr Miirz April .
.
Ri 1H 12 4
201 1YU ;;;
10 16 3
236 2xl fehlt
2; 53
“3.5
Mai
Juni Joli. , . August. September Dctoher.... Kovember December
254 23Y 2ii ST,
.
:!
'-1-w i.,
4 i.l ’ .a;
o.:,
5.#M
::YJ 1.9; ll.M) 2:! ,*
1842 Jinuer Febrnar MIrz . . . April Mai Juni . Juli. August. September October. Ziovrmber December .
:3Oi
311 264 2.u 310
64 3X 27 26 10
2iB
231 216 223 242 E
:: 55 41 71 48 75
"o.,, I”.,, 10 21 lo.:, 3 .+z ha PO.;,, 25.,,
18.i.
~.,a ?L, Sl.,,
1813 JPnner Febroar . :. mrz . . . ‘4;ff : : . Juni : : . : Jnli . Angnst September October.... November . December 1844 Jiioner . Februar
FIG. 4. Table
III.
Monthly
272 263 ‘266 285 Mb: lY6 lY1 19.3 22 1 250 252 236
244 2.57
5p 42 3 :34 1.3 H ’ 3 h 18 19
37 29
1% 15.w 12.,, I 1.‘%, ho :,?M 1 7.5 &I 17..%, i.,, &
15.1, '1.9.
Krz April Jlai .Iwi .Juli.
56
: : : :
.4upast.
3M 30 ?!I Mo1I $9
24.3 248 “4.3 “I,6
September October. Sorember December
4; 4;
Ii.,, Ii
14
3 ,,I”
6
:! ,,; f li
,!T’ 3 x ?i
27
:’ 42
:’ :i 2’ 1’ I,‘, II).,,,
I*45 Jiitmer Fehroar !&irz April #ai I I : I .Juni .Iuli I I I : dugust. September O&her Sownher December 1x46 Jiinner Fehruar M&m ;!Ip! Juoi : : : : : Juli August. September October. Sovemher December W4i Jiinner Febrnar Miirz .4pril Mai : 1:
death rates in the clinic Tabelle Nr. XVI.
:g !!)‘I 3;tJ 2% 2x1 "4.j 51 :‘:+i ig+ %:I 267
23 13 I3 II 1:s 20 13 Y E 2Y “8
i.;., 5 II 4 I-, 41, J.,., i.,, Ii,! H.,. IO:;, I4.., K..,, ‘04,
36 29.3 311 253 305 2% 282 f;:’ 54
III 53 JR 4x 41 ;; H!l :X4 3x .A? lb:
I%,., ‘h lb.,, $7 10:: ;:;.I y “, ‘4 <” I4..,. ‘fy ((
10
A.,, i.!#> ‘S” ’L '2 1.
IYi
2Yx
311 412 .305 312 2Y4
attended
lfi 5i 36
by physicians,
1841-1847.
578
A CORNER
OF
HISTORY
Dr. J. Spaeth, profefforber ~eCrt6lji~fean her6. 6. 3o~eftdiabemis in mien,
HofrathDr. F. 11;.Scanzoni,
FIG. 6. Cover of open letter to Doctors
Spaeth and Scanzoni.
of acceptance of given scientific data or concepts. In Semmelweis’ case, he used the technique of published open letters. Figure 6 shows the cover of the reprint of his 1861 open letter to Dr. Spaeth and Dr. Scanzoni. The final paragraphs of this letter (Fig. 7), freely translated, read as follows: “Your teaching, Herr Professor, is based on the corpses of pregnant women, murdered by ignorance, and since I have decided to make an end to this killing as much as it is within my power, I am asking you the following: only two positions are possible-either you hold my concept is wrong or it is correct. A third alternative does not exist.” “If you consider my concepts wrong, I ask you to tell me the reasons why you consider them as such. Though I have used 103 printed pages in my publication to correct all the errors and falsities with respect to childbed fever, it apparently has not been properly understood by you. Should my reasons not be sufficient for you or should you have new doubts, I ask you to discuss these publicly since there are many others besides you who require a proper lesson with respect to the concept of childbed fever. Should you regard my concepts as correct, I ask you to declare yourself as such publicly, not to give me satisfaction, but to convince your students who deliver the corpses to you outside your clinic, as a confirmation of your concept, so that these students may finally learn the truth. However, should you, Herr Professor, without having negated my concept, continue to write in favor of the epidemic aspect of childbed fever or have others write in this regard, should you without having contradicted my concept continue to educate your students in the epidemic concept of this disease, so I
A CORNER
OF
579
HISTORY
9$ce Qeljte@err$wfrt~tbbafirt auf ben L’eit$en, 0118Untuiflen~it ermorbeter 98bdytexinen, unb naebem i4 bar uaer#itterlidjen &ntfd$ufraefaf%babe, hem ‘DloCbPn , f0 lDeitebin meiner%I# hgt, tin @4lbcdtI mu4en, (0 tid$e i4, an Gie , #err &fro@, folgenbe Qufforberung: &U finb nut dmei$blle m6glii$. tutmebcr@Iten @iemcine@ekefin falft$, eberbir baRenmeinewn fiir ma@-;eiu b&t& gibt rb nimt. qSaIteneie meine Begrefiic far@,fo furberei4 bie biermit auf, mir bie @riinbemitdutfieilen,marum Gie me-he8ebrefilr faIfk$BaIten. w babe#uar iu meiaerwft Cberdnbbette @eber103 Drudfeiten oermeubet,blOeurn alIe i@ 3rrtbiimer uub %$$ungen, oon tuelc$en Gie in ‘Be~ug auf ba6Winbbett@eber gefanqenge$altentverbm,au mi. bedegen;fdten S@nenmemeOrilnbe sie& geniigen, ober babe:1Ge mue Lhueifel,fo forbercic$@Sebiernit auf, mir fdhc fiffentlidj mitptf$eiIen; ii+JlucrbcB$nen 6ffentli4 bie nSt$iecbeIe@ungert$eiIeu,meil e8aueer 9f)nennod,bie[e Brbt, bie einer dek@ung in Betttff be8WinbbettfielMbentitbigen.@&en 5ie meineLdre fiir ~aabr,fo forberei4 bie $iermitauf, bal) BRentIi$, o~ne8ikf~aIt au trfhiren, niigt urn mic eine @Jettug, tbuung JU aerfc$o(fen,fonbernurn Sbre @$iIer unb Ed$eriaen, bie 3l,tnen au$erboIbbe5Bbeblr)(wfbbie Berhen$ur Beftdtigungibrer BeoreIieftrn, ba %h@ $tit aqufirlyea. Wlten 6ie ober,9err #ofrat$, obne meineCebrewibedegtc baben,fortfabren,fir bit &bre be& epibemi[l$tnRinbbettfieberlJU fhreiben, unb fireiben gu Inffen. GoUtenQie aber,@err@ofrat$,obne meinc Be&e mibedegt@I$aben,fortfo$rt+n,3&e @@ii. b uub Gd$eriaen itr ber9ebrebtbepibemijdjen d?inb hcfffiebcr4dll eqie@en, jo erfltire ic$%e uor Oott unb be ?!leItfir einen9Xhrber,unh bie,,@efcficMc be8Rid* bettfieberl” wirbe gegen@ieni@tutqere(&fein, tuw felbe Gir, fiir bal Berbienftber Orftegemefcn au itin, bet fid~meinerlebenrrttenbea Eebremihrrfe81, ak meblcinijdyl ?kro Deretuigen tuilrbe.” FIG. 7. Final paragraphs
of open letter to Doctors
Spaeth and SC:anzoni
declare you before God and the world as a murderer and the history of childbed fever would not be unjust if you, because of your efforts as the first to have fought against my life-saving concepts, were to go down in history as a medical Nero.”
His neglect in placing his data before the public in published form for more than 10 years after first finding a solution to a major medical problem of his day is, of course, difficult to understand as is his great abhorrence of writing. One may wonder whether his efforts would have been more readily accepted if he had published his data in 1848 and 1849. One might also wonder whether, in the long run, more diplomatic ways of convincing his opponents would have served him and his cause better. Judging Semmelweis’ contribution to the history of infectious diseases, one
580
A CORNER
OF
HISTORY
needs to realize that all of this work was done at a time when bacteriology had not been discovered and that it was another 50 years before Pasteur succeeded in identifying the streptococcal agent, the actual cause of childbed fever. Like Snow who recommended preventive measures against cholera without having identified the causative agent, Semmelweis deserves the credit for having helped to show the way to prevent a major illness without knowing the specific cause. His keen observation, careful presentation of statistical data, and his use of animal experiments, viewed in the context of his time, deserve, indeed, the accolades that history had accorded him. Both in terms of scientific technique and the manner in which his data came to be presented to society, there is much to be learned from the long and courageous struggle against an overwhelming tide of scientific and educational resistance which formed an integral part of the life of Semmelweis.
(1974)
A Corner IGNAz
of History
PHILIPP
SEMMELWEI~
FIG. 1. Ignaz Philipp
Semmelweis
1818-1865.
One of the most fascinating chapters in the history of preventive medicine is the story of how Ignaz Semmelweis proved that puerperal fever (childbed fever), which caused many unnecessary deaths in the major teaching hospitals of Europe, was man-made and, therefore, was largely preventable by man. In spite of the evidence assembled by Semmelweis in the late 1840’s, his concept of prevention was not accepted by most of his peers in his own time. Although he did not have to fight vested commercial interests, the autocratic university professors in Vienna proved to be formidable opponents, unlikely to change their minds about established theories on the origin of childbed fever, especially when challenged by a young Hungarian assistant professor who lacked the diplomatic skills of persuasion. For Semmelweis and his colleagues at the Lying-in Hospital in Vienna, the normal hospital practice of the day meant that patients were examined by the physician and his students after they had performed an autopsy or an examination of a patient with an infected wound, and their only hygiene before ex574 Copyright 0 1974 by Academic Press, Inc. All rights of reproduction in any form reserved.
A CORNER
OF
575
HISTORY
Die Aetiologie, der BegriiT lllld dir
Prol>hglaxis dr.
Kindbettfiebera
Pest, Wien und Leipzig.
FIG. 2. Title
page of The Etiology, Concept and Prophyhis
of Childbed Fewer (1861).
amining the women in labor consisted of washing with soap and water. Later in life, he was to regret bitterly the death toll he unwittingly caused by this daily sequence of events, and his own death in 1865 from the same infection incurred while performing an autopsy provides a grim footnote. Semmelweis had astutely observed that deaths from childbed fever were much more frequent in the hospital ward attended by physicians and students than in the one attended by midwives. Through a long, diligent process, he examined and discarded each current theory about the origin of the infection and in 1847 he came to the conclusion that, rather than being of epidemic origin, the infection was transmitted to healthy patients by the physicians and medical students themselves, as a direct result of their constant contact with cadavers and already infected patients. Unfortunately, Semmelweis had an aversion to writing up his data and thereby informing a wider audience. In fact, his only early published material on these data comes from his presentation to the Medical Society of Vienna in May, June, and July of 1850, where they are part of the recorded proceedings. In addition, the essence of his findings was presented by Ferdinand Hebra in 1847-1848, F. H. C. Routh in 1848, and Carl Hailer and Joseph Skoda in 1848. His ideas met with great resistance and his position as assistant professor in gynecology was not renewed. His attempt to obtain an assistantship in ob-
576
A CORNER
OF Tabelle
hbtlreilung
ftir
HISTORY Nr. 1.
.4erzte.
hbtheilong
fiir
241’2 26.59 278 2956 3241 3754
86 202 164 6n fi6 105
Hebammeu
:. s JlIllI
WI $e -2 2% -2 <
--L 1841 1342 1343 1344 1845 1346
:34x6 3237 3060 3157 :3492 4010
237 513 274 260 241 459
Summa
2004?
1989
77 15H Pi.9 x.2 6H 11.4 /
9.92
li791
691
3.Ll 75 5.9 2.3 2.03 27 1
3.38
FIG. 3. Table I, showing the difference in death rates in two groups of postpartum attended by physicians (left) and those attended by midwives (right).
women, those
stetrics was also denied. After a third attempt, he received an assistantship in theoretical obstetrics which placed severe restrictions on the scope of his teaching. Unable to accept such limitations, he returned to Budapest in 1850 and took a position lecturing in obstetrics at St. Rochus Hospital. Although he published, in Hungarian, an overview of his ideas about the etiology of childbed fever in 1858, it was not until 1861 (Fig. 2) that his major treatise on the Etiology, Concept and Prophylaxis of Childbed Fever appeared, in German. In reviewing this classical work, one is impressed with the detailed statistical tables (63 such tables were included) which form the basis for his conclusion that washing with chlorinated water prior to the examination of pregnant women would lead to a marked reduction in the death rate from childbed fever. The first table of Semmelweis’ paper (Fig. 3) contained the initial clue to the etiology of this disease, namely, that the death rate among women in the department attended by physicians and students was significantly higher than on the service where they were attended by midwives. In the Viennese clinic, statistics were kept on a monthly basis and Table 3 (Fig. 4) shows the death rates for the various months from 1841 to 1846, while Table 16 (Fig. 5) shows the percentages of deaths recorded in 1848 after the introduction of washing with chlorinated water. Semmelweis’ treatise is full of statistical detail with minute descriptions of the various aspects of his investigations. It also included a detailed description of his experiments with rabbits, beginning March 22,1847, showing that they died from infection after being brushed with exudate obtained from autopsy material. Even though the pathology findings were similar to those described for his patients, this evidence was not accepted by his adversaries who claimed he used too high a dose. One aspect of his efforts is of particular interest to those who have ever attempted to reprimand scientific and medical colleagues in print for their lack
Tabelle Wr. III. 6liuik
Acrzte
fiir
1641 Jiineer . Fehrusr Miirz April .
.
Ri 1H 12 4
201 1YU ;;;
10 16 3
236 2xl fehlt
2; 53
“3.5
Mai
Juni Joli. , . August. September Dctoher.... Kovember December
254 23Y 2ii ST,
.
:!
'-1-w i.,
4 i.l ’ .a;
o.:,
5.#M
::YJ 1.9; ll.M) 2:! ,*
1842 Jinuer Febrnar MIrz . . . April Mai Juni . Juli. August. September October. Ziovrmber December .
:3Oi
311 264 2.u 310
64 3X 27 26 10
2iB
231 216 223 242 E
:: 55 41 71 48 75
"o.,, I”.,, 10 21 lo.:, 3 .+z ha PO.;,, 25.,,
18.i.
~.,a ?L, Sl.,,
1813 JPnner Febroar . :. mrz . . . ‘4;ff : : . Juni : : . : Jnli . Angnst September October.... November . December 1844 Jiioner . Februar
FIG. 4. Table
III.
Monthly
272 263 ‘266 285 Mb: lY6 lY1 19.3 22 1 250 252 236
244 2.57
5p 42 3 :34 1.3 H ’ 3 h 18 19
37 29
1% 15.w 12.,, I 1.‘%, ho :,?M 1 7.5 &I 17..%, i.,, &
15.1, '1.9.
Krz April Jlai .Iwi .Juli.
56
: : : :
.4upast.
3M 30 ?!I Mo1I $9
24.3 248 “4.3 “I,6
September October. Sorember December
4; 4;
Ii.,, Ii
14
3 ,,I”
6
:! ,,; f li
,!T’ 3 x ?i
27
:’ 42
:’ :i 2’ 1’ I,‘, II).,,,
I*45 Jiitmer Fehroar !&irz April #ai I I : I .Juni .Iuli I I I : dugust. September O&her Sownher December 1x46 Jiinner Fehruar M&m ;!Ip! Juoi : : : : : Juli August. September October. Sovemher December W4i Jiinner Febrnar Miirz .4pril Mai : 1:
death rates in the clinic Tabelle Nr. XVI.
:g !!)‘I 3;tJ 2% 2x1 "4.j 51 :‘:+i ig+ %:I 267
23 13 I3 II 1:s 20 13 Y E 2Y “8
i.;., 5 II 4 I-, 41, J.,., i.,, Ii,! H.,. IO:;, I4.., K..,, ‘04,
36 29.3 311 253 305 2% 282 f;:’ 54
III 53 JR 4x 41 ;; H!l :X4 3x .A? lb:
I%,., ‘h lb.,, $7 10:: ;:;.I y “, ‘4 <” I4..,. ‘fy ((
10
A.,, i.!#> ‘S” ’L '2 1.
IYi
2Yx
311 412 .305 312 2Y4
attended
lfi 5i 36
by physicians,
1841-1847.
578
A CORNER
OF
HISTORY
Dr. J. Spaeth, profefforber ~eCrt6lji~fean her6. 6. 3o~eftdiabemis in mien,
HofrathDr. F. 11;.Scanzoni,
FIG. 6. Cover of open letter to Doctors
Spaeth and Scanzoni.
of acceptance of given scientific data or concepts. In Semmelweis’ case, he used the technique of published open letters. Figure 6 shows the cover of the reprint of his 1861 open letter to Dr. Spaeth and Dr. Scanzoni. The final paragraphs of this letter (Fig. 7), freely translated, read as follows: “Your teaching, Herr Professor, is based on the corpses of pregnant women, murdered by ignorance, and since I have decided to make an end to this killing as much as it is within my power, I am asking you the following: only two positions are possible-either you hold my concept is wrong or it is correct. A third alternative does not exist.” “If you consider my concepts wrong, I ask you to tell me the reasons why you consider them as such. Though I have used 103 printed pages in my publication to correct all the errors and falsities with respect to childbed fever, it apparently has not been properly understood by you. Should my reasons not be sufficient for you or should you have new doubts, I ask you to discuss these publicly since there are many others besides you who require a proper lesson with respect to the concept of childbed fever. Should you regard my concepts as correct, I ask you to declare yourself as such publicly, not to give me satisfaction, but to convince your students who deliver the corpses to you outside your clinic, as a confirmation of your concept, so that these students may finally learn the truth. However, should you, Herr Professor, without having negated my concept, continue to write in favor of the epidemic aspect of childbed fever or have others write in this regard, should you without having contradicted my concept continue to educate your students in the epidemic concept of this disease, so I
A CORNER
OF
579
HISTORY
9$ce Qeljte@err$wfrt~tbbafirt auf ben L’eit$en, 0118Untuiflen~it ermorbeter 98bdytexinen, unb naebem i4 bar uaer#itterlidjen &ntfd$ufraefaf%babe, hem ‘DloCbPn , f0 lDeitebin meiner%I# hgt, tin @4lbcdtI mu4en, (0 tid$e i4, an Gie , #err &fro@, folgenbe Qufforberung: &U finb nut dmei$blle m6glii$. tutmebcr@Iten @iemcine@ekefin falft$, eberbir baRenmeinewn fiir ma@-;eiu b&t& gibt rb nimt. qSaIteneie meine Begrefiic far@,fo furberei4 bie biermit auf, mir bie @riinbemitdutfieilen,marum Gie me-he8ebrefilr faIfk$BaIten. w babe#uar iu meiaerwft Cberdnbbette @eber103 Drudfeiten oermeubet,blOeurn alIe i@ 3rrtbiimer uub %$$ungen, oon tuelc$en Gie in ‘Be~ug auf ba6Winbbett@eber gefanqenge$altentverbm,au mi. bedegen;fdten S@nenmemeOrilnbe sie& geniigen, ober babe:1Ge mue Lhueifel,fo forbercic$@Sebiernit auf, mir fdhc fiffentlidj mitptf$eiIen; ii+JlucrbcB$nen 6ffentli4 bie nSt$iecbeIe@ungert$eiIeu,meil e8aueer 9f)nennod,bie[e Brbt, bie einer dek@ung in Betttff be8WinbbettfielMbentitbigen.@&en 5ie meineLdre fiir ~aabr,fo forberei4 bie $iermitauf, bal) BRentIi$, o~ne8ikf~aIt au trfhiren, niigt urn mic eine @Jettug, tbuung JU aerfc$o(fen,fonbernurn Sbre @$iIer unb Ed$eriaen, bie 3l,tnen au$erboIbbe5Bbeblr)(wfbbie Berhen$ur Beftdtigungibrer BeoreIieftrn, ba %h@ $tit aqufirlyea. Wlten 6ie ober,9err #ofrat$, obne meineCebrewibedegtc baben,fortfabren,fir bit &bre be& epibemi[l$tnRinbbettfieberlJU fhreiben, unb fireiben gu Inffen. GoUtenQie aber,@err@ofrat$,obne meinc Be&e mibedegt@I$aben,fortfo$rt+n,3&e @@ii. b uub Gd$eriaen itr ber9ebrebtbepibemijdjen d?inb hcfffiebcr4dll eqie@en, jo erfltire ic$%e uor Oott unb be ?!leItfir einen9Xhrber,unh bie,,@efcficMc be8Rid* bettfieberl” wirbe gegen@ieni@tutqere(&fein, tuw felbe Gir, fiir bal Berbienftber Orftegemefcn au itin, bet fid~meinerlebenrrttenbea Eebremihrrfe81, ak meblcinijdyl ?kro Deretuigen tuilrbe.” FIG. 7. Final paragraphs
of open letter to Doctors
Spaeth and SC:anzoni
declare you before God and the world as a murderer and the history of childbed fever would not be unjust if you, because of your efforts as the first to have fought against my life-saving concepts, were to go down in history as a medical Nero.”
His neglect in placing his data before the public in published form for more than 10 years after first finding a solution to a major medical problem of his day is, of course, difficult to understand as is his great abhorrence of writing. One may wonder whether his efforts would have been more readily accepted if he had published his data in 1848 and 1849. One might also wonder whether, in the long run, more diplomatic ways of convincing his opponents would have served him and his cause better. Judging Semmelweis’ contribution to the history of infectious diseases, one
580
A CORNER
OF
HISTORY
needs to realize that all of this work was done at a time when bacteriology had not been discovered and that it was another 50 years before Pasteur succeeded in identifying the streptococcal agent, the actual cause of childbed fever. Like Snow who recommended preventive measures against cholera without having identified the causative agent, Semmelweis deserves the credit for having helped to show the way to prevent a major illness without knowing the specific cause. His keen observation, careful presentation of statistical data, and his use of animal experiments, viewed in the context of his time, deserve, indeed, the accolades that history had accorded him. Both in terms of scientific technique and the manner in which his data came to be presented to society, there is much to be learned from the long and courageous struggle against an overwhelming tide of scientific and educational resistance which formed an integral part of the life of Semmelweis.