by Marguerite Vigliani, MD; Gale Eaton
Ignatz Semmelweis was appalled. The Vienna hospital where he worked was world famous for its obstetrics department,1 but women would rather give birth outside on the street. It was safer.2 Inside, more of them died of childbed fever, especially if they were put in First Clinic. The two maternity wards or clinics accepted patients on alternate days, but whenever their babies arrived, mothers begged to be put in Second Clinic. The death rate there was lower.3
Childbed (or puerperal) fever was a bacterial infection common in nineteenth-century hospitals and even after doctor-assisted home births. It tore through the reproductive systems and blood streams of women exhausted by childbirth. In America, oliver Wendell Holmes Sr. announced in 1843 that the disease was carried on the unwashed hands and clothes of doctors, but he was largely ignored.4
In 1847, Semmelweis came to the same conclusion. As assistant to Professor Johann Klein, he was put in charge of First Clinic and found the patients were right about it. His ward’s 1841-1846 death rate was 9.92 percent, compared to 3.88 percent in Second Clinic.5 Was it because of miasma? No. The two clinics were under the same roof and shared an anteroom; all patients breathed the same air. Overcrowding? No. Second Clinic was more crowded. Semmelweis ruled out one hypothesis after another.6
A chart shows yearly puerperal fever mortality rates from two clinics.
Women admitted to the Vienna General Hospital’s First Clinic, where babies were delivered by medical students, were more likely to die in childbed than women in the Second Clinic, staffed by midwives—but why?
Source: From 'A Story of Medicine in 50 Discoveries', by Marguerite Vigliani, MD and Gale Eaton (Tilbury House, 2015)
Reluctantly, he concluded that sickness was being carried to First Clinic from the morgue. Up until 1840, the two clinics were alike in both staffing and death rates. After 1840, medical students trained in First Clinic and midwives in Second. Medical students did autopsies; midwives did not.
Then one of Semmelweis’s friends died after cutting himself with a scalpel during an autopsy. He had all the symptoms of puerperal fever. Semmelweis reasoned that some particle from the cadaver had transmitted the disease to his friend—and particles from cadavers, on the hands of professors, assistants, and students, could be transmitting it to patients.7 In May he began requiring everyone to wash their hands, not just with soap and water but with chlorinated lime. The mortality rate in the First Clinic dropped from 7.82% for the first half of 1847 to 3.04% for the second half.
Two incidents persuaded him that the fever could be spread by discharges from living tissue as well as corpses. In october, a woman with a discharging uterine cancer lay in the bed where rounds always began; of twelve women delivering on the ward just then, eleven died. Semmelweis made everyone wash with chlorine after examining patients with infected discharges. But in November, a woman with an oozing knee somehow infected the whole ward. Semmelweis did not believe her infection was spread on attendants’ hands; he thought it must have been airborne, and childbirth made her neighbors tragically vulnerable to it. From then on, he isolated patients with discharging wounds.8
Although Semmelweis cut hospital mortality rates, he failed to influence medical opinion. He was a bad communicator, tactless, undiplomatic, and reluctant to publish or lecture.9 He wrote angry letters to prominent obstetricians, denouncing them as murderers because they would not wash their hands. They were annoyed.
A chart shows puerperal fever mortality rates from 1784-1849 for the Wien maternity clinic and the Dublin maternity hospital.
In his 1861 book, Semmelweis compared the rates of fatal childbed fever in Dublin and Vienna maternity clinics, 1784 – 1849. Vienna rates spiked after the 1823 introduction of pathological anatomy at the teaching hospital, but dropped with the 1847 introduction of chlorine hand washing.
Source: From 'A Story of Medicine in 50 Discoveries', by Marguerite Vigliani, MD and Gale Eaton (Tilbury House, 2015)
Besides, they believed in established theories: infection was caused by contagion and miasma. Semmelweis argued that childbed fever was not contagious. Smallpox was contagious; exposure to it caused “only smallpox and no other disease.” Childbed fever could “be caused in healthy patients through other diseases.” And it was not miasmatic; it was transmitted by “decaying animal-organic matter,” airborne or not.10
History supported Semmelweis. In 1867 James Y. Simpson reviewed more than 1,800,000 deliveries and found that mothers died in 3.4 percent of hospital births but only 0.47 percent of home births. His report was bitterly attacked, but Lister’s antisepsis and Pasteur’s germ theory soon gave doctors new ways to explain and control infections. Things improved.
From 'A Story of Medicine in 50 Discoveries', by Marguerite Vigliani, MD and Gale Eaton (Tilbury House, 2015)
Question
Use the passage to answer the question.
Drag each item to the correct location to compare the two clinics.
(1 point)
Put responses in the correct input to answer the question. Select a response, navigate to the desired input and insert the response. Responses can be selected and inserted using the space bar, enter key, left mouse button or touchpad. Responses can also be moved by dragging with a mouse.
First Clinic Second Clinic
answer choices-medical students who did autopsies worked there,less crowded,9.92 death rate,midwaves worked there,more crowded,3.38 death rate
1 answer
To compare the two clinics based on the passage, the correct placements are as follows:
First Clinic:
Second Clinic:
(Note: Please check the specific death rate for Second Clinic; the passage mentions a 3.88% death rate, so adjust accordingly if needed.)
