The Childbed Fever Mystery and the Meaning of Medical Journalism

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A Note on Semmelweis’s Animal Experiments and Their Historical Significance

This article seeks to establish what animal experiments Semmelweis conducted, and when and why he conducted them, because the Semmelweis literature contains conflicting claims about these topics or has ignored them altogether. Semmelweis first conducted animal experiments between 22 March and 20 August 1849 with Rokitansky’s assistant, Georg Maria Lautner, because his chief, Johann Klein, did not accept that by merely reducing the mortality rate from childbed fever with chlorine hand-disinfection, Semmelweis had proved his theory of the cause of childbed fever. However, Skoda concluded that the Lautner experiments did not resolve the doubts about Semmelweis’s theory they were intended to resolve, and, therefore, asked the Academy of Sciences to award Semmelweis a grant to conduct further and more varied experiments with the physiologist, Ernst Ritter von Brücke. These additional experiments were conducted in the spring and summer of 1850, but yielded only ambiguous results, and led Brücke to conclude that questions about Semmelweis’s theory could only be resolved by clinical observations, not animal experiments. This article discusses the reasoning behind these animal experiments, and Skoda’s and Brücke’s responses to them, and argues that their responses to the experiments caused Semmelweis to delay publishing his research until he had collected sufficient clinical evidence to prove his theory.

Why Semmelweis's doctrine was rejected: evidence from the first publication of his results by Friedrich Wieger, and an editorial commenting on the results

We present English translations of two French documents to show that the main reason for the rejection of Semmelweis's theory of the cause of childbed (puerperal) fever was because his proof relied on the post hoc ergo propter hoc fallacy, and not because Joseph Skoda referred only to cadaveric particles as the cause in his lecture to the Academy of Science on Semmelweis's discovery. Friedrich Wieger (1821–1890), an obstetrician from Strasbourg, published an accurate account of Semmelweis's theory six months before Skoda's lecture, and reported a case in which the causative agent originated from a source other than cadavers. Wieger also presented data showing that chlorine hand disinfection reduced the annual maternal mortality rate from childbed fever (MMR) from more than 7 per cent for the years 1840–1846 to 1.27 per cent in 1848, the first full year in which chlorine hand disinfection was practised. But an editorial in the Gazette médicale de Paris rejected the data as proof of the effectiveness of chlorine hand disinfection, stating that the fact that the MMR fell after chlorine hand disinfection was implemented did not mean that this innovation had caused the MMR to fall. This previously unrecognized objection to Semmelweis's proof was also the reason why Semmelweis's chief rejected Semmelweis's evidence.

**19** Chap 3.d

In the spring of 1784, wounds and bruises, even trivial ones, led to the death of many patients, and at the same time Barker reports that women were dying of puerperal or childbed fever, even after normal pregnancies and deliveries. This was an epidemic Barker had never before experienced. He describes the clinical picture, his treatments, outcomes, and dissections, what books and journals he read, and how he communicated with other New England physicians asking for help dealing with this devastating epidemic that would inexplicably resolve within a year, never to recur except sporadically.

The Tragic Hero of Childbed Fever

The situation in the Vienna hospital in the mid-1840s was certainly grim. The hospital offered medical care to indigent mothers, but in one maternity ward women faced a ghastly one-in-ten chance of dying from childbed fever (today’s puerperal sepsis, a bacterial infection). Could nothing be done? Enter Ignaz Semmelweis (Figure 24.1), who, so popular stories typically tell us, “notices that [the attending medical] students move between the dissection room and the delivery room without washing their hands.” The students offering care are themselves infecting the patients with putrid matter from cadavers! Semmelweis institutes handwashing, and the mortality rate soon drops by an impressive 90%. However, “despite the dramatic reduction in the mortality rate in Semmelweis’ ward, his colleagues and the greater medical community greeted his findings with hostility or dismissal.” Semmelweis’s hypothesis “was largely ignored, rejected or ridiculed. He was dismissed from the hospital and harassed by the medical community in Vienna, which eventually forced him to move to Budapest.” Further injustice seemed to follow. “Despite various publications of results where handwashing reduced mortality to below 1%, Semmelweis’s observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands and Semmelweis could offer no acceptable scientific explanation for his findings.” “The years of controversy and repeated rejection of his work by the medical community caused him to suffer a mental breakdown. Semmelweis died in 1865 in an Austrian mental institution. Some believe that his own death was ironically caused by puerperal sepsis,” the very disease he had tried to prevent. “Semmelweis saved the lives of countless women and their newborn children. He showed how a statistical approach to the problems of medicine could demolish popular but mystical theories of disease. His work prepared the way for Pasteur’s elucidation of germ theory. He turned obstetrics into a respectable science. And he revealed how professional eminence and authority could breed crass stupidity and bitter jealousy.”