(1 Jul 1818 - 13 Aug 1865)
PATHFINDERS IN MEDICINE
Semmelweis, the Obstetrician.
By Victor Robinson
from Medical Review of Reviews (1912)
The great Lying-in Hospital of Vienna is divided into two sections: the first obstetric clinic is for medical students, and the second for midwife-pupils.
The medical profession has often been accused of over-drugging, but the Vienna School of the nineteenth century had no materia medica. This school produced no therapeutists: it forgot that a physician should sometimes cure. “Doctor, what medicine shall I take?” asked the invalid who had been treated merely as an object of scientific investigation. “Oh,” exclaimed the Viennese medicus, as if surprised at the question, “that is immaterial.” If the sufferer still insisted on treatment, he was given a standard prescription which the apothecary read as follows: “Rx—A little bitter-almond water mixed with considerable common water, sweetened and fortified with syrup.”
Skoda was enthusiastic in making diagnoses, and Rokitansky in performing autopsies—and if the diagnosis and the autopsy agreed, the patient was not supposed to complain. The dissecting-room was their temple, where they devoutly prayed to be admitted to the inner mysteries of diseased organs. The cadaver was considered the noblest work of nature. The subject of pathologic anatomy was immensely enriched, but little was done to heal the sick or save the dying. “Our ancestors,” said Professor Dietl, “laid much stress on the success of their treatment of the sick; we, however, on the result of our investigations. Our tendency is purely scientific. The physician should be judged by the extent of his knowledge and not by the number of his cures. It is the investigator, not the healer, that is to be appreciated in the physician.”
The students whom we see in the First Clinic have just come from postmortem examinations, and are waiting for an instructor to take them to the obstetric cases. They have washed their hands with a squirt of water, and are now drying these organs by blowing on them, waving them in the air, or sticking them in their pockets.
“Oho, Marcus, how would you like to have a sweetheart like that?” asks a future accoucheur, indicating a woman with a meteoric abdomen.
“Why, Franz, that looks like the girl you were walking with last night.’’
“Oh, you old beggar! I was with your own sister the whole evening.”
“You lie! Lilly said she was going [p.233] out with a gentleman, so it couldn’t have been you.”
“I swear that I and no other—but Heavens! how the Fraulein can drink! Tokayer—a bottle; Pfaffstättner—a bottle; Gumpoldskirchener—a bottle. I have no money left. Loan me a few gulden, will you?”
“So you can make my sister drunk? Why don’t you take the girl to church?”
“Stop that squabbling about Fraulein Lilly, fellows; here comes—”
from painting for Medical Review of Reviews
The teacher enters the clinic, but the amused smirks of the students have already been succeeded by studious looks. Their instructor is Professor Klein’s assistant; he answers to the German name of Dr. Semmelweis, but he is a true Magyar, born in Budapest, and he speaks German with an accent and writes it with a hitch. Altho he is getting bald, he is still in his twenties: only a few years ago he lived and laughed in the Josefstadt—the Latin-Quarter of Vienna. He is genial, sympathetic, soft-hearted; the quintessence of goodness is revealed in his open smile.
He leads the way thru the wards, pointing out the interesting cases, and directing physical examinations to be made.
Suddenly he stops; his brow contracts on the bridge of his nose. Before him lies a young mother exhibiting the symptoms of puerperal fever. He remembers her—three days ago he delivered her of a healthy infant. Parent and child seemed to be doing well, but now the curse of the lying-in hospital smites them. Unlike Jules Clement, Semmelweis is not accoucheur to Mlle. la Valliere, or any other royal mistress, but every servant-girl entrusted to his care he treats as tenderly as if she were a queen upon whom rested the hopes of a dynasty. For a moment he forgets his students and gazes with compassion at the stricken woman. A cold wave sweeps along her spinal cord, her pulse gallops, her skin is hot and dry, her breathing short and hurried, her countenance sunken and anxious, and at night she mutters in a lethal delirium. She is sick, and next week she will be dead.
The Assistant dismisses the students from his clinic, but he cannot banish the subject from his mind. He goes out, hurries along the Haupt-Allée, past the superb chestnut trees, the epauleted officers, the prancing horses, the beautiful ladies.
He walks unheeding, while all the time his ear-drums half burst from the loud queries that ring thru his head: Why do they die? What is childbed fever? How does it enter the lying-in chamber?
He has read all the books he could find on the subject, and the various theories of distinguished obstetricians flit thru his mind: “It is due to the milk,” says Boer. “It is epidemic,” announces Klein. “It is caused by lochial suppression,” thinks Smellie. “Miasma is responsible for it,” declares Cruveilhier. “It is a gastric-bilious disturbance,” writes Denman. “Its etiology is found in peritonitis,” argues Baudelocque. “Erysipelas of the bowels is the predisposing factor,” opines Gordon.
The conflicting notions fill Dr. Semmelweis with despair. Who knows which is the correct solution, or if any are true? We grope in darkness; all is chaos and doubt; nothing is certain —except that the number of women who die in childbirth is appalling. In [p.234] the holiest hour of her life the woman is beaten down by an unknown hand. And the physicians who should save her, stand helplessly by—-discussing etiology.
The young doctor thinks and thinks. He is a favorite of Rokitansky, and in the early morning, before his duties in the hospital begin, he examines and operates on the females who died from puerperal fever, or any diseases peculiar to women. But nothing that he has ever observed can furnish an inkling of the truth.
What mystery of medicine is this which carries off women without a determinable cause? Pregnancy is not a nine months’ disease; it is natural, and healthy puerperants should not succumb. And here is the strange part of it all: the maternity hospital is divided into two divisions: the first for medical students, and the second for midwives. The conditions are identical in each, and yet so many more die in the first division than in the second. The first clinic has long had a bad reputation, and therefore the second ward is always more crowded, and yet the mortality continues to be higher in the first. Why should this be?
Fear of the first division is claimed to have something to do with the matter. But a psychic state can never produce such anatomical changes as are seen in puerperal fever.
They say the women are ashamed to undergo parturition in presence of the men, and therefore die from modesty. But how can a condition of mind cause a gangrenous endometrium?
They speak of epidemic influences. But why should an epidemic spare one clinic and attack another, when both are under the same roof? Besides, when the fever rages at its worst in
the hospital, the women delivered in their homes are not affected more than usual. An epidemic is not limited by walls: cholera spreads over a wide area.
It is said that so many of the women die because they are unmarried and have been seduced. But this cannot explain the difference in the mortality of the two divisions, since exactly the same class of patients are admitted to both clinics. Moreover, nature never feels outraged because the mother does not possess a marriage-ring.
It is argued that the medical students examine the women in a rougher manner than do the midwives, and thus cause injury which results in death. But certainly a uterus enlarged by a fetus can tolerate the most ungentle index finger.
They say the ventilation is wrong, but the same method of allowing air to enter is employed in both divisions.
It is all nonsense to talk about the diet, the warming, the washing. The same caterer supplies food to both divisions: the same washerwomen clean the linen of the first and second clinic.
The women surprised by labor in the streets, who give birth to children on door-steps and under arch-ways, tho the day be cold or the night stormy, are not attacked by puerperal fever. Why, women of the country, gored open and delivered of their seed by the horns of maddened bulls, have a better chance of life than the pregnant female who comes to lie in the First Obstetric Clinic of Vienna’s famous Maternity Hospital.
Thus musing, the distracted Assistant finds he has walked far out—to the Central Cemetery, where reposes the illustrious dust of Beethoven and Mozart and Gluck and Schubert. [p.235] But Semmelweis is not in a mood for melody. The subtle and resistless onset of puerperal fever, the vacant chair by the desolated fireside, the straight road from the marriage-bed to the dead-house, the husband undone and a baby for a salaried wet-nurse,— these are the discords which afflict the sensitive Hungarian who has taken the vow of Hippocrates.
He has reached the environs of Vienna. In the distance, seeming to come from the left bank of the Danube, in the direction of the battlefield of Wagram, he hears the note of a church-bell. He starts disagreeably at the sound. He has heard that doleful tone too often of late. At the Clinic, when the end draws near, and the priest bears the last sacrament to her who bids the world farewell, a bell is rung to mark the passing of a soul. And this frequent, solemn tolling jars with strange effect the nerves of the doctor.
He turns homeward: the problem yet unsolved, still in the grip of a hideous malady. Everywhere is endless confusion; only this much proven: they die, they die, they die. Again the bell clangs: it is an exhortation, O Semmelweis! to be clear of vision and find the source of childbed fever, so the mothers of the race may conceive in safety, and breasts ripe for nursing will not shrivel till the love-fruit takes its fill.
In the early spring of 1847,—the same year that Oliver Wendell Holmes became Professor of Anatomy at Harvard—Semmelweis went for a short vacation to Venice, but unlike Byron, he did not lean back in a gondola with voluptuous languor, while a black-eyed Venetian girl opposite read the tales of Boccaccio.
On the Twentieth of March he returned to Vienna, and a few hours later was at his post, prepared to resume his duties with renewed ardor. But the first news he heard was the sad fate of Kolletschka, a friend whom he highly esteemed. Kolletschka was Professor of Medical Jurisprudence, and while performing a post-mortem examination in a medico-legal case, was accidentally pricked on the finger by the knife of a pupil. Thru the tiny stab-wound the poison from the scalpel’s tip entered, and inflammation ran wild in the Professor’s body: lymphangitis, phlebitis, peritonitis, pleuritis, meningitis. Blood-vessel and lymph-channel conveyed the infection to his eyes, and Kolletschka was sightless and lifeless before Semmelweis returned from feeding the pigeons that fly below the golden horses of St. Mark.
As Semmelweis listened to the details of the case, to him as to Porphyro on a sweeter occasion, “a thought came like a full-blown rose, flushing his brow, and in his pained heart made purple riot.” Lymphangitis, phlebitis, peritonitis, pleuritis, meningitis,— these were the symptoms observed in women who perished of puerperal fever. Semmelweis saw that Kolletschka and the puerperal women died from an identical cause—from septic infection, from poisoned cadaveric material absorbed by the vascular system. Puerperal fever was not a malady unique in nature—it was simply a form of pyemia!
Now it became clear why the mortality of the first obstetric clinic was so much higher than the second: the instruction of the midwives did not include work on the cadaver; therefore they did not often come into contact with decomposing organic matter. But pathologic anatomy was all the [p.236] rage in Vienna, and the medical student had an overdose of dissection. From the dead-house they came to the labor-ward, and with hands to which the cadaveric particles still adhered, poison lurking behind every fingernail, they examined the pregnant, parturient, and puerperal women. And the gaping genitals freshly wounded by travail, the denuded surface of the vagina, the fissures about the fourchette, the lacerations near the mouth of the womb, easily sucked up the noxious virus that spelled disaster and death.
A little later Semmelweis discovered that not only decomposing cadaveric matter, but that putrid matter derived from living organisms, and even the atmosphere when overloaded with foul exhalations, may produce the dreaded septicemia. After this, the students who came to the First Clinic found a new rule: before touching a woman they must disinfect their hands with a solution of chlorinated lime. This was the introduction of antisepsis into obstetrics. Immediately the slaughtering of the mothers was lessened, and soon—for the first time in the history of the Vienna Lying-in Hospital—the mortality in the First Division fell below that of the Second Division. A chunk of chloride of lime upsetting a hundred theories, accomplished this miracle. Now to proclaim the Doctrine to the whole world!
Semmelweis had reason to congratulate himself: the next day the three greatest men in Vienna were his disciples. Skoda referred to his discovery as one of the most important in the domain of medicine. Rokitansky at once accepted his new etiology of puerperal fever. Lest it be deemed strange that a man whose days were spent in the dissecting-room should be so alive to new ideas, we must say that Rokitansky kept sweet and sane by memorizing Kant and marrying a singer. Hebra, who knew so much about itch that we call him the Father of Modern Dermatology, was editor of the Journal of the Medical Society of Vienna, and wrote a couple of articles in which he linked the name of Semmelweis with that of Edward Jenner. In return for the compliment, Semmelweis acted as accoucheur in Frau Hebra’s next confinement, and his skilled and sterilized hands delivered the good woman in safety.
But not many were as clear-headed as this triumvirate, and misoneism,— that insidious inertia of the mind which makes mankind averse to innovation,—soon asserted itself in clinic, hospital and lecture-room. Semmelweis awoke and found himself famous—and hated.
At this period, however, something happened in Europe which caused even Semmelweis to forget puerperal fever. A nobler fever attacked Mother Earth —the fever of 1848. This was the year in which barricades rose like magic to the sound of the singing of the Marseillaise; the year of Mazzini and the Roman Republic; the year of Garibaldi and his red-shirts; the year of flying popes and abdicating emperors; the year of overturned thrones and angry peoples; the year when the workingman’s pike was aimed at the monarch’s scepter; the year of endless courage and divine defiance; the year of young blood and new life.
Knout-cursed Russia did not tug at her chains, but every other nation leaped up in fiery revolt. Of course, Austria was all turmoil, for Austria, the lengthened shadow of Metternich, was the chief oppressor of western Europe. The university students of [p.237] Vienna, cursing the prince’s cruelty, broke into Metternich’s home, and drove the old monster over the continent.
Professors and pupils, physicians and lawyers, formed an Academic Legion. Ferdinand Hebra, tho more accustomed to dermatologic eruptions than to political ones, enrolled as a member. Ernest Krackowizer, the first person in Vienna on whom the anesthetic properties of chloroform were tried, unsheathed his sword for freedom. And when the reactionary Professor Klein walked thru his clinic, whom should he see arrayed in the uniform of the revolutionary Legion, but his assistant, Dr. Ignaz Philipp Semmelweis. He could hardly recognize him at first because of the broad hat with the waving plume. And what was it he held in his hand—a scalpel or a sword? Hippocrates was supplanted by Louis Kossuth.
In Berlin the worthiest sons of Æsculapius acted in the same way. Rudolph Virchow was deprived of his posts by the Prussian authorities, and another turn of the fickle wheel of fortune might have snuffed out his life. Physicians have not yet discovered the drug that ensures perpetual youth, and few who warmed their hearts in the sacred blaze of 1848, are now alive. Yet we all know one physician who was then in prison for liberty’s sake, and still lives and practices his profession, and has recently become the President of the American Medical Association: Ave Magister, Abraham Jacobi!
Magyarland, under the brilliant leadership of Kossuth, was gaining its independence. But the strong Czar poured his armies into Austria, and a hundred thousand armed Russians trampled out Hungary’s freedom. The flame of rebellion flickered low, and 1849 was the year of reaction. The barricades were razed to the ground, the Marseillaise was “sung no more, the aspirations were quenched, the monarchs returned, a host of revolutionaries—those who escaped death and dungeons—flocked to England and America, while several who were not too deeply compromised sought to resume their former positions.
Semmelweis came back to the Obstetric Clinic, and found a new proof of the truth of his doctrine: during the month of March, 1848, such excitement had prevailed in Vienna, that the parturient women in the lying-in hospital were practically neglected, and that was the only month in which not a single death or sickness occurred.
Semmelweis and his companions decided to carry on their propaganda, not thru pamphlets or the press, but [p.238] by private letters addressed to various teachers of midwifery.
Professor Michaelis of Kiel, whose work on the Obliquely Contracted Pelvis is still famous, received one of these letters and was impressed by the contents. Michaelis, a conscientious man, was much worried over the prevalence of puerperal fever in his clinic. In fact, not being able to cope with the situation, he found it necessary to close the hospital for a time. He now introduced Semmelweis’s method of chlorine disinfection, watching results, and the outcome was this: no more puerperal fever. Michaelis was profoundly grateful, and regarded Semmelweis as a benefactor of the human race.
A scourge abolished! The excellent professor hummed in satisfaction, but a shooting pain broke off the song on the penult of a word. His niece, his beloved niece—what dreams she had when she felt her babe move within her—already in anticipation she saw her child climb to distinguished heights—how anxious she was to sew a coverlet with which to warm the little stranger on his first appearance—and she had trusted her uncle—so innocently she had looked up in his face and put her doubly-precious life in his hands—and with these same hands he had murdered her —with these stained hands he had conveyed puerperal fever to her, and her dreams were done—she wrapped the sheets of the childbed around her as a snowy shroud, and said Good-by, and died. The warm-hearted Michaelis recoiled at the unlivable horror of the thing. Something sticky seemed to cling to his fingers. These fingers killed her, and she did not even reproach him. But how the keen voice of remorse breathed hot into his ear. Michaelis rushed from his house. His darkened eyes saw nothing, but he heard a train with snorting breath rumble over the parallel rails. He advanced feverishly, threw himself upon the trackway, and when the locomotive passed there was only a book on The Contracted Pelvis to keep alive the name and fame of Professor G. A. Michaelis of Kiel. So the gospel of Semmelweis was sanctified by a martyr’s blood.
Semmelweis was likewise forced to admit that he himself had been the harbinger of death in many households: “When an assistant took special interest in pathologic anatomy, and made many post-mortem examinations, the mortality was high. Consequently must I here make my confession that God only knows the number of women whom I have consigned prematurely to the grave. I have occupied myself with the cadaver to an extent reached by few obstetricians. However painful and depressing the recognition may be, there is no advantage in concealment; if the misfortune is not to remain permanent, .the truth must be brought home to all concerned.”
Correspondence was also entered into with Simpson of Edinburgh, who introduced anesthesia into obstetrics the same year that Semmelweis introduced antisepsis. Simpson read the letter in haste, and replied with a Scotch accent: He knew without being told-how filthy the maternity hospitals in Germany and Austria were; he knew that the high mortality was due to the criminal carelessness of placing a healthy lying-in woman on the same bedclothes and linen in which a parturient woman had just died; if [p.239] Semmelweis and his friends would take the trouble to read British obstetric literature they would see that Englishmen had long been aware of the contagious character of puerperal disease and had employed chlorine disinfection for its prevention.
From the above it will be seen that Professor Simpson confused the English theory of the specific contagiousness of puerperal fever—a disease communicated by the sick puerperant to the healthy one, or transmitted by the physician who has confined a woman suffering from the malady—with the Semmelweis doctrine of its causation by the absorption of putrid matter from a living organism or cadaver, producing a pyemic blood-dissolution.
It will be recalled that these English opinions were copied and adopted in 1843 by Oliver Wendell Holmes, in his immortal essay, “The Contagiousness of Puerperal Fever.” Yet in Siebold’s standard History of Obstetrics there is no mention of Dr. Holmes. Such accidents seem liable to occur: Baker Brown actually wrote an historical sketch of Ovariotomy without referring to Ephraim McDowell. It is true Holmes did not devote much time to puerperal sepsis. He wrote his one essay on the subject, and set it adrift in a quarterly medical magazine which suspended publication within a year. But the man and his work could not perish—especially as the eminent Professor Meigs denounced him with the same virulence that he opposed Simpson’s use of chloroform in labor. There is no passage in medical literature more frequently quoted than Holmes’ concluding appeal: “The woman about to become a mother, or with new-born infant upon her bosom, should be the object of trembling care and sympathy wherever she bears her tender burden, or stretches her aching limbs. The very outcast of the streets has pity upon her sister in degradation, when the seal of promised maternity is impressed upon her. The remorseless vengeance of the law, brought down upon its victims by a machinery as sure as destiny, is arrested in its fall at a word which reveals her transient claim for mercy. The solemn prayer of the liturgy singles out her sorrows from the multiplied trials of life, to plead for her in the hour of peril. God forbid that any member of the profession to which she trusts her life, doubly precious at that eventful period, should hazard it negligently, unadvisedly, or selfishly.”
A closer examination of the subject convinced Simpson that the English and the Semmelweis etiology were not identical, and since he was J. Y. Simpson, he acknowledged his mistake. From that time on, aided by his well-known assistant, Matthews Duncan, he preached the truth regarding puerperal sepsis, and it was due chiefly to the efforts of his school that British obstetrics outstripped and long outranked the continental tokology.
About this period, an honor was conferred upon Semmelweis. Dr. Karl Haller, an influential man, a director and senior physician of the General Hospital, suggested that Semmelweis be invited to address the Vienna Medical Society on his experience with puerperal fever. The motion was adopted, but Semmelweis voted in the negative. In truth, he had never spoken to an audience, and the mere thought of it gave him stage-fright— an evil which a solution of chlorine could not remove. Finally he was prevailed upon to appear, and he [p.240] produced an excellent impression. The discussion that followed was certainly pleasing to Semmelweis. Rokitansky, who presided, spoke in his favor; brave Chiari—son-in-law of Klein—voiced his approval; Helm and Arneth called the young discoverer a benefactor, while Skoda, Hebra, and Haller applauded.
It was a great triumph for the humble assistant, but it aroused his enemies to action. Rosas cursed him; Klein frowned heavily when he met him; Scanzoni—the snake of midwifery who rattled his fangs also at Simpson—poured venom at him; Bamberger attacked him; Kiwisch insulted him; Lumpe laughed at him; Seyfert spat at him.
By this time Semmelweis’s assistantship had expired, and he applied for an extension of two years more, like his predecessor in the First Clinic and his colleague in the Second Clinic had successfully done. But the authorities were against Semmelweis. It was not forgotten that he had served in the Academic Legion. The stupid Klein took his revenge; his pursed-up lips meant, “I want to be rid of you.” Semmelwies then petitioned to be appointed Privat-Dozent of Midwifery. After a rather long wait—from March, 1849, till October, 1850—he received the position, but with galling restrictions; he could not grant certificates of attendance like other dozenten, and he could not demonstrate on the cadaver, only on the manikin. Semmelweis was an emotional man. He was a scientist, but with the artistic temperament. He was terribly enraged, and made up his mind to shake the dust of Vienna from his feet. He acted unreasonably, and did not call upon Rokitansky; he did not bid farewell to Hebra; he did not shake hands with Skoda. He simply packed up his belongings, and started for Budapest. Ignaz Semmelweis is a type that Tragedy loves to mark as her own: intense, impractical, uncompromising. Too unworldly to look after his personal interests, too honest to make terms with popular falsehood, he was predestined for the road of bitterness, and the crown of thorns awaited him.
Twelve years ago, as a pleasant youth of nineteen, Semmelweis had left Budapest to enter the University of Vienna. Now he came back to his birthplace, immortal but unsuccessful. His home-coming was not a happy one. His parents were dead; his brothers, who had taken their share in the revolution of 1848, were refugees; there remained to him only one brother, who was a parson, and one sister, who was married.
The sight of houses and landmarks intimately known in former days brought back a thousand recollections of boyhood, and he could not but smile that so many trivial and even silly incidents should crowd upon his memory. After all, he was not sorry to leave Vienna, and he whistled a snatch from Petöfi, but stopped in amazement to look at the majestic Suspension Bridge which had been completed the year before by the English engineers, Tiernay and Adam Clark. Then he strolled reminiscently thru the street where his father had kept a shop.
Semmelweis felt a subtle sympathy for his country, which, like himself, had been conquered by the powers of darkness: stabbed by Windischgratz, hanged by Haynau, knouted by Nicholas. Only a year before Semmelweis returned to Budapest, Louis Batthyani, the distinguished Hungarian patriot, had been caught there, court-martialed, and shot. The prison-odor [p.241] still clung to Balassa, the professor of surgery. Semmelweis did not really escape Vienna: all over Hungary’s capital the superfluous men known as state-agents eavesdropped and peeped; spies—nasty, sneaky, crawling, slimy creatures, forever pilloried by the grim pen of Maxim Gorky.
The Hungarian Academy of Sciences was closed by pleasure of the law, and the Medical Society of Pest could not meet unless a policeman was present. Semmelweis sighed—what else was there to do? He claimed he did not know how to write, so he could not find solace in the ink-bottle. But be seemed to experiment on the value of doing nothing. He who had been indefatigable became the apostle of apathy, the lord of laziness, a very prince of procrastination.
But such a state of affairs could not last long: Professor Klein did not send Semmelweis money to live upon. Semmelweies had his choice: either make an honest living as a respectable member of organized society, or join a roving gypsy-band and pitch a tent and swing a kettle on any hillside—in which occupation he would have been as comfortable as a frog in acetic acid.
When Rogers saw Lord Brougham ride off one morning, he remarked, “There go Solon, Lycurgus, Demosthenes, Archimedes, Sir Isaac Newton, Lord Chesterfield, and a great many more all in one post-chaise.” A similar compliment could not be paid to Semmelweis. He was not a versatile man. He knew his branch of medicine, and nothing more. In fact, he was a man of one idea—but it was a great idea.
Semmelweis now petitioned to be appointed director of the Obstetric Division of the St. Rochus Hospital, a cheerful institution, with windows suggestively overlooking the cemetery. His application was successful, and as soon as he entered he introduced chlorine disinfection. The mortality at the hospital decreased so swiftly and surely that the fame of Dr. Semmelweis spread thruout Budapest. It boomed too his private practice; his office now contained more than one patient at a time.
Thus matters went on for about five years; then Hofrath Birly, the incumbent of the chair of midwifery in the university, was elegised by his friends, and wreaths were placed upon his coffin. A professorship—fortunately —is not hereditary, and the question arose: Who will succeed old Birly? [p.242] It is pleasant to record that, in July, 1855, Ignaz Semmelweis was appointed Professor of Theoretical and Practical Midwifery in the University of Pest.
There is no tonic in any Pharmacopeia equal to the elixir of success. Success—it is iron, mother’s salve, digitalis, capsicum plaster, catarrh snuff, Godfrey’s cordial, Hoffman’s anodyne, Seidlitz powder, brandy and hasheesh all in one. Success purifies the blood, it draws the tip of the chin in, it throws back the shoulders, it straightens the spinal column, it gives color to the cheeks, and brings lustre to the eye. The Herr Imperial Royal Professor Semmelweis walked with a jaunty air. He was enthusiastic, and determined to make Budapest the medical Mecca of the world.
When an affectionate bachelor finds himself living on Easy Street, he is apt to speculate in the matrimonial market, especially if a sweet girl like Marie Weidenhofer—overlooking his lack of manners and admiring his wealth of character—seems to be fond of him. Ignaz was a bald-headed professor of thirty-eight; Marie was a charming fraulein of eighteen, but they now promised to love each other as long as they lived, and never to quarrel, or cause each other jealousy. How it happened that a shy man like Semmelweis took advantage of the psychological moment is more than we can presume to explain. The best we can do is to quote from Lillian Bell, who exposes all the secrets of sex: “Proposing,” claims this lady, “requires a sort of plunge; a burst of courage; a bravery which must be pumped up for the occasion, and that sort of thing your shy man is used to. He cannot even ask a girl to take a walk with him without perspiring under his hatband, so he is accustomed to being afraid and going home without having done it and then longing for it in secret, and finally, goaded to desperation, of making a bolt for it. That is the history of his daily emotional life.”
It is fortunate that Semmelweis could now find consolation at home, for the school-year 1857-8 was a frightful one: four per centum of the women in his Lying-in Hospital died from puerperal fever. How Carl Braun and Scanzoni would jeer at him! What was the cause of this dreadful slaughter? When Semmelweis had first assumed charge of the obstetric clinic, he found that the women lay “upon filthy sheets which actually stank of decomposed blood and lochia.” Enraged at the circumstance, he pulled the unclean linen from the beds, gathered it into a pile, and rushed to von Tandler, the official in charge. “Smell!” shouted Semmelweis, shoving the foul bundle under his nose. After this practical appeal to the olfactory organ of the Statthaltereirath, the laundry contractor was requested to wash the soiled linen before returning it. So the Lying-in Hospital now had clean sheets, chlorine disinfection of course was employed, and yet here was a mortality of 4 per cent. What evil agency was at work, destroying lives with an invisible hand? Semmelweis did not sleep till he discovered the cause: a careless nurse. Either some students had bribed her to disobey the professor, or she herself had no interest in his hobby, because she made it a rule never to go to the trouble of changing sheets, even in the bed in which a patient died from puerperal fever. An expensive idiosyncrasy: it cost 18 out of 449 lying-in women their lives. Semmelweis discharged the culprit [p.243] whose treachery had brought about the four per centum mortality. A nurse trained in his own prophylaxis—it was enough to make a man go mad.
Semmelweis indeed had reason to be unhappy. His Doctrine made little headway. He could not lift the boulder of prejudice that lay in the path of medical progress.
Primerose and Riolan attacked Harvey’s discovery, but denial of the circulation of the blood never injured anyone’s health. Regardless of what men thought, the heart forced the ruddy life-fluid into the mighty aorta, which spread it all over the body, where it came to great venous trunks and emptied into the auricle, flowing into the lower ventricle, whose systole pumped it into the lungs, whence it passed a vast meshwork of capillaries, gave up its carbon dioxide in exchange for oxygen, turning from dark purple to bright scarlet, entered the pulmonary veins, which carried it back to its starting-point, and thus completed the circuit—just as it does to-day when we know all about it. Many did not accept Newton’s law of gravitation, but this stupidity was not followed by symptoms of pyemia. Dr. Ohm was considered unbalanced, but failure to comprehend the unit of electrical resistance did not result in phlebitis. Galvani was ridiculed as the frog’s dancing-master, but inability to appreciate the value of galvinism never caused lymphangitis. Cuvier vanquished Lamarck and Hilaire, scoffed at the idea of fossil man, and pitched the bones out of the window in a rage. Scientific progress was thus hindered, and the doctrine of Evolution delayed for a generation, but no man died from metastases because he failed to greet the monkeys in the zoological garden as his long-lost cousins.
But to hold erroneous views on the etiology of puerperal fever meant that thousands of wrongly-trained practitioners and midwives went yearly forth to spread disease and death; it meant that countless hosts of mothers were wantonly massacred in state-supported murder-dens. “To be laid on the confinement bed,” said Fritsch, “was the same as to be delivered to the hangman.”
As late as 1860-3, Achilles Rose was a student at the University of Jena, and he records that during that period no lying-in woman left the institution alive. “All died,” he writes, “from puerperal fever. Disinfection, of the hands, insisted upon by Semmelweis, had not received any consideration, even by such an eminent man as Professor Schultze.”
But an intellectual giant—besides whom the eminent Prof. Schultze was insignificant—saw no good in Semmelweis. To claim that Virchow is one of the greatest sons of Hippocrates is unnecessary, because it is undisputed. But there was this difference between the Greek and the German: the latter had limitations. His opposition to Semmelweis was by no means his only sin. When William Detmold opened an intracranial abscess, Virchow’s Archiv had a paragraph about the “American swindle.” When Haeckel desired that Evolution be included in the curricula of the public schools, Virchow took the contrary view—with vehemence. Virchow claimed there was an essential difference between the skull of primitive man and the ape, arguing that no human being had an orbital stricture as pronounced as is found in the Pithecanthropus. The words were hardly out of his mouth when Nehring found a skull of a Brazilian Indian in the [p.244] Sambaquis of Santos, in which the stricture was deeper than in many of the apes. And then how puerile was Virchow’s warning, “Darwinism leads to Socialism!” Since when has it been the duty of the scientist to worry what anything leads to? It is the function of the scientist to find the fact and accept the conclusion, be it saccharin or gall. It may be unpleasant to contemplate that man is a freak of nature, and will ultimately disappear from the earth, but if such be the facts, then scientists must announce them, or cease to lay claim to the title of truthseekers. Virchow’s admonition deserves to be placed by the side of Agassiz’s complaint, “Darwinism seems to dethrone God, and replace him by a blind force called the law of evolution.” Virchow’s attitude towards Darwinism was so unfair, that the ever-gentle Darwin, who could rarely be provoked to retort, wrote to Haeckel, “Virchow’s conduct is shameful, and I trust he will one day feel the shame of it.” But Virchow evidently did not repent, for as late as 1894, at the Anthropological Congress in Vienna, he said, “a man might just as well have descended from a sheep or an elephant as from an ape.” Virchow, in later years, liked to speak of “the point where science makes its compromise with the church.” Perhaps this is the reason why Virchow is thrice quoted with approval in J. J. Walsh’s The Popes and Science, an alleged medico-historical volume, recommended by Archbishop Farley and dedicated to Pius X. on Our Lady’s Day. Shall we say of Virchow as Nietzsche said of Wagner: “He succumbs at the cross of Jesus Christ?” But Father Time has amusing little tricks of his own: yesterday, Rudolph Virchow, the scientific founder of cellular pathology, rejected Darwinism, and to-day the Jesuits themselves are accepting it!
Semmelweis now saw that he must do what he had long declared he could not do—write a book. “I cannot write,” he told his devoted friend Markusovsky, who continually urged him. “I have a congenital aversion to all that is called writing.” But the groans of the lying-in women dying of childbed fever caused by the pupils that Carl Braun and Scanzoni sent out into the world, thrust the pen into unwilling fingers.
One day in 1860 Dr. Hirschler was strolling along the streets, when he was seized by an excited individual who insisted that he come to his home at once. Dr. Hirschler complied with the urgent demand, and no sooner did the friends seat themselves than the host opened a drawer, pulled out a huge manuscript, and began: “My Doctrine is not established in order that the book expounding it may moulder in the dust of a library: my Doctrine has a mission, and that is to bring blessings into practical social life. My Doctrine is produced in order that it may be disseminated by teachers of midwifery, until all who practise medicine, down to the last village doctor and the last village midwife, may act according to its principles; my Doctrine is produced in order to banish the terror from the lying-in hospitals, to preserve the wife to the husband, the mother to the child.”
So Hirschler learnt that Semmelweis had at last completed his book: The Etiology, Nature, and Prophylaxis of Puerperal Fever. Semmelweis had underrated his literary ability: he could write. His book is one of the medical masterpieces of the nineteenth century, for the first [p.245] requisite of art is sincerity. As far as its scientific value is concerned, no praise can be too high: page after page could stand, without revision, in the most modern treatise on the topic. Arnold Lea’s Puerperal Sepsis, just off the press and fresh from the bindery, does not antiquate Semmelweis’s work—it supplements it.
But the book did not sell. And the lecture-rooms still re-echoed with ancient nonsense about epidemic puerperal fever, while the examining finger and the operating hand still committed murder. Semmelweis called his discovery “the puerperal sun which arose in Vienna in 1847,” but its ravs were dimmed by Breisky mist and obscured by Carl Braun clouds.
Semmelweis was a disappointed man. He became bitter, irritable, old. Sometimes when he smiled to his wife, she saw how weary he was. But Semmelweis had learnt the lure of writing, and the pen was now his constant companion. And this instrument which he had hitherto feared became in his hands a burning lash and a flaming sword.
In Disraeli’s Quarrels of Authors, there is no controversy more fierce than Semmelweis’s Open Letters to Professors of Midwifery. In these letters we do not recognize the gentle man of earlier days; we see instead an exasperated antagonist, desperate, emotional, fanatical, furious. “My Doctrine,” he writes to Scanzoni, “is based on my experience. Your teaching, Herr Hofrath, is based on the dead bodies of lying-in women slaughtered thru ignorance; and I have formed the unshakable resolution to put an end to this murderous work as far as lies in my power. If, Herr Hofrath, without controverting my teachings, or giving reasons for assuming them erroneous, you continue to teach your students the doctrine of epidemic puerperal fever, I denounce you before God and the world as a murderer, and the History of Puerperal Fever will not do you an injustice when, for the service of having been the first to oppose my life-saving Lehre, it perpetuates your name as a medical Nero.”
These terrible Open Letters only amused the professors. “Have you been scorched by the puerperal sun?” asked one. “The Hungarian crank is simply crazy,” said another.
No longer able to control himself, Semmehveis stopped laborers and business-men on the streets, and tried to make them listen to his Doctrine. They tapped their foreheads significantly, and passed on. It was not these people, however, that caused Fritsch’s epigram: “There is a dark chapter in the history of midwifery, and it is headed—Semmelweis.”
During a meal, Semmelweis behaved strangely, and when Marie looked into his eyes she saw that reason had left him. She ran to his friend, the editor of Orvosi Hetilap. “Nonsense,” said the good Markusovsky, “nonsense, I assure you. He is excited; can you blame him? He will be all right tomorrow. I will come to see him. There is no cause for worry.” But Ludwig Markusovsky knew he lied, for he himself had sickening suspicions.
A few days later it was no longer possible to conceal the circumstances, and it was decided to remove Semmelweis to a lunatic asylum in Vienna, where he would be under the care of Dr. Riedel, the eminent alienist. On the last day in July—his birth-month —in 1865, when he was forty-seven years of age, the journey was begun. Some friends and relatives, his wife and infant child, accompanied the invalid. By means of a stratagem, Ferdinand Hebra induced him to enter the asylum. Fifteen years ago, Semmelweis had left Vienna—angry; now he was brought back—mad. Perhaps he had often dreamed of returning, but hardly, like this.
Within a day or two it was discovered that Semmelweis had a wound in his finger*, the result of his last gynecological operation. Gangrene set in, cellulitis developed along the arm, metastases followed, and soon Semmelweis lay in the dead-house, ready for a post-mortem examination. Just as Laennec died of phthisis, the disease which he had studied above all others, so Semmelweis fell a victim of pyemia, which he had discovered to be identical with puerperal fever, and which he sought to exterminate by antisepsis.
Nothing but the small cold worm
Fretteth thine enshrouded form—
Let them rave.
Light and shadow ever wander
O’er the green that folds thy grave—
Let them rave.
But they rave no more. His grave had hardly closed when Pasteur and Lister began to make a microscopic bacterium reveal its deadly secret, and then all the world knew that Semmelweis had been right since 1847, and a magnificent monument was raised to his memory. The great obstetrician is seen in full, holding his book under his arm; on the step of the pedestal sits a woman, with her infant in her arms, gazing reverently at her benefactor. “I stood to-day with uncovered head by the monument of Semmelweis,” writes Dr. W. J. Robinson, from the International Medical Congress at Budapest; “it is very beautiful, and is kept green and is well taken care of by a special watchman.” Ah, if they had been as tender to the man as they are to his statue, his career would have been happier.
Yet it is well that Semmelweis has been thus honored, and tho that marble mausoleum at Budapest may crumble in the course of centuries, there is one monument to the beloved physician which shall endure as long as the human female bears children: Motherhood is safer because Ignaz Semmelweis lived and worked.
* Webmaster note: For a century, this ironic cause of death was widely repeated. However, from his research for a bioographical book about Semmelweis, author Sherwin Nuland, a surgeon, draws different conclusions from the available facts. He suggests Semmelweis had suffered his decline in health due to early-onset Alzheimer's disease. Furthermore, from examining autopsy reports and X-rays of Semmelweis's remains, Nuland implicated institutional brutality. Quite possibly, while confined at the asylum, Nuland concludes, Semmelweiss may have been abused—beaten, bruised and wounded by the attendants there. The true cause of Semmelweis's demise may have been the infection of these new wounds. Ref: Sherwin B. Nuland, The Doctors' Plague: Germs, Childbed Fever, and the Strange Story of Ignác Semmelweis (2003).