An Ode to Semmelweis

Medical Museums

I graduated nursing school last year and as a flashback to that time in history, I’m dedicating the month of October to my fascination with all things nursing, medical, and otherwise health related.

First up in my orgy of medical museums and such is the Semmelweis Museum in Budapest, Hungary.   I feel bad for Semmelweis.  He made a major medical discovery, yet couldn’t explain it, so all his colleagues mocked him mercilessly, and then he died… a broken man.  Only to have his discovery proven right a few short years later.  He is one of the reasons we do a 2-minute scrub prior to entering surgical delivery rooms.

Here it is:  my ode to Semmelweis and his discovery of germs…

It’s a tiny little thing; it’s hardly ever seen.

But once inside, it can turn you  green.

Germs are many; treatments are few

For many years no one knew

What they were or their effects

Sickness was caused by air or a hex

Then Semmelweis figured it out

“Wash your hands” he wanted to shout.

But no one listened; no one cared

And no one cared how patients fared

A crusade against the little beasts he undertook

He gave speeches; he wrote a book

When he died he was outcast

But twenty years later, a hero he was–at last

Today entire classes are taught how to wash their hands

To wash away beasts tinier than a grain of sand

Semmelweis is the hero; he’s the man

Except to the microbes; talk of him in banned

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Semme;weis’ father’s apothacary shop

Semmelweis was a Hungarian doctor teaching medicine in Vienna. He noticed that the [male medical] students moved between the dissection room and the delivery room without washing their hands and their patients had a death rate of over 30%. [Oh, the infection control police at the hospital would be horrified] while the midwives’ patients, who didn’t do dissections, had a death rate of only about 2%. On a hunch, he set up a policy.  Effective immediately, doctors must wash their hands in a chlorine solution when they leave the cadavers.  Mortality from puerperal fever [aka childbirth fever] promptly drops to three percent and further drops to 1% after physicians began cleaning instruments in the same solution they washed their hands.

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The museum is also a medical history museum

Now here’s the part of the story where things grow strange. Instead of reporting his success at a meeting, Semmelweis tells his boss, but his boss orders him to ‘stand down’. Semmelweis says nothing. Finally, a friend publishes two papers on the method. By now, Semmelweis has started washing medical instruments as well as hands.

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The hospital director feels his leadership has been criticized [by Semmelweis]. He’s furious. Livid. Beyond angry. He blocks Semmelweis’s promotion. The situation gets worse. Viennese doctors turn on this Hungarian immigrant. They run him out of town. Finally, he goes back  home to Budapest.  He is an outcast among the “civilized” Austrian medical community. He brings his hand washing methods to a far more primitive hospital. He cuts death by puerperal fever to less than one percent. He does more. He systematically isolates causes of death. He autopsies victims. He sets up control groups. He studies statistics.  His has it all figured out.

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Requisite skull with a hole in it

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Finally, in 1861, he writes a book on his methods. The establishment gives it poor reviews. Semmelweis grows angry and polemical. He hurts his own cause with rage and frustration.  He calls his colleagues idiots and ignoramuses.  He bashes their stupidity. He turned every conversation to the topic of child-bed fever.

After a number of unfavorable foreign reviews of his 1861 book, Semmelweis lashed out against his critics in a series of Open Letters.  They were addressed to various prominent European obstetricians, including Spath, Scanzonia, Siebold, and to “all obstetricians”. They were full of bitterness, desperation, and fury and were “highly polemical and superlatively offensive” at times denouncing his critics as irresponsible murderers.  He also called upon Siebold to arrange a meeting of German obstetricians somewhere in Germany to provide a forum for discussions on puerperal fever where he would stay “until all have been converted to his theory.”

By mid-1865, his public behavior became irritating and embarrassing to his associates. He also began to drink heavily; he spent progressively more time away from his family, sometimes in the company of prostitutes.  His wife noticed changes in his sexual behavior. On July 13, 1865 the Semmelweis family visited friends, and during the visit Semmelweis’s behavior seemed particularly inappropriate.  Later in 1865 he suffers a mental breakdown. Friends commit him to a mental institution. Semmelweis surmised what was happening and tried to leave. He was severely beaten by several guards.  He was put in straitjacket and confined to a darkened cell. Apart from the straitjacket, treatments at the mental institution included dousing with cold water and administering castor oil. He died after two weeks, on August 13, 1865, aged 47, from a  gangrenous  wound caused by the beating. His autopsy revealed extensive internal injuries, the cause of death  pyemia–the very thing he spent his life trying to eradicate.

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Semmelweis was buried in Vienna on August 15, 1865. Only a few people attended the service.  Brief announcements of his death appeared in a few medical periodicals in Vienna and Budapest. Although the rules of the Hungarian Association of Physicians and Natural Scientists specified that a commemorative address be delivered in honor of a member who had died in the preceding year, there was no address for Semmelweis; his death was never even mentioned.

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A memorial to Semmelweis, savior of women and children

That same year Joseph Lister [the person whom Listerine is named after] begins spraying a carbolic acid solution during surgery to kill germs. In the end, it’s Lister who gives our unhappy hero his due. He says, “Without Semmelweis, my achievements would be nothing.”

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The anatomical Venus mad of wax… see I do see art from time to time

PS:  I don’t write poetry often; there is probably a reason for that

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