Ignace Philippe Semmelweis
Ignace-Philippe Semmelweiss (July 1st 1818 - August 13rd 1865) is a doctor who worked for the Hygiène. It showed the utility of the washing of the hands after the Dissection of a corpse, before carrying out a Accouchement. It also showed that the washing of the hands decreased death by Septicémie of the women after the Accouchement (see Fièvre puerpérale). Until there the obstetricians in vain tried to include/understand from which the fevers puerpérales came by making many Autopsie S, to avoid all these unjust deaths. For those which were finally convinced by the ideas of Semmelweis, it was a terrible blow: it proved that themselves transmitted the disease involuntarily.
Beginnings
Fifth child of a prosperous grocer of German origin , Ignace Semmelweis was born in Tabán, which was then Czech the old working trading of Buda. He studied initially with the Catholic Gymnasium of Buda, then, of 1835 to 1837, continued his studies at the University of Pest, where he obtained a license in right. His/her father wished that it proceed in this way to become military lawyer with the service of the Austrian administration , and it thus went to Vienna to the autumn 1837 to be registered with the Faculty of Law. Shortly after its arrival, it assisted, at the hospital of this city, the Autopsie of a dead woman of fever puerpérale, which decided its vocation. It was registered then at the medical college, without apparent opposition of his parents.There affected by the mocking remarks of his/her Austrian comrades, who made fun of his accent Hungarian, Semmelweis turned over to Pest at the conclusion of its first year and continued its academic works of 1839 to 1841. But, disappointed by the antiquated conditions which reigned in this university, it turned over this year to Austria, being registered with what under the name of Second Medical school of Vienna was going to be known. This establishment combined the study in laboratory and the practice with the bedside of the patient, and became one of the major centers of study of medicine during the second part of the 19th century. During its two last years, it had among its professors Carl von Rokitansky, Joseph Škoda and Ferdinand von Hebra, with which it tied close links. Semmelweis supported its thesis bearing on the Botanique at the beginning of 1844, and, its diploma obtained, it remained in Vienna to again follow a two months course in practical Obstétrique, speciality for which it accepted a Maîtrise. It supplemented its surgical formation and spent almost fifteen months (of October 1844 in February 1846) to study with Škoda the methods of diagnosis and the Statistiques. After which he became doctor attending the first service of obstetrics of the General hospital of Vienna, where the hospital teaching of the university exempted.
Discovered importance of the Hygiene
It is there that Semmelweis started to study the causes of the Fièvre puerpérale, in spite of the resistance of its superiors which believed impossible to prevent it, allotting it to containment, promiscuity, the bad ventilation or the beginning of the Lactation. In July 1846, Semmelweis was named senior registrar in this same service, directed then by the professor Johann Klein (1788-1856). Among its many tasks, the most pressing problem which arose for him was the rate of 13 % of mortality maternal and néonatale due to the fever puerpérale. The fact was known, and many women preferred to be confined in the street rather than to be led there. Curiously, the second service, directed by professor Barcht, had, for the same disease, a death rate of 2 % only, whereas these two services were located in the same hospital and employed the same techniques. The only difference was the personnel which worked there: the first was useful, as that was known as higher, with the instruction of the medical students, while the second had been selected in 1839 for the formation of the midwives.Semmelweis put forth several assumptions, which were successively refuted by its observations and/or its experiments: he considered that of a epidemic, that of a putrid atmosphere (what seemed most judicious in the medical design of the time), then that of a food mode or different care. He went even until thinking that the medical acts carried out by the students (who worked in this first private clinic) were of bad quality, or that the position during the childbirth, different in the two places, influenced the number of deaths.
It is into 1847 that the death of his/her friend Jakob Kolletschka, professor of Anatomie, opened the eyes to him: Kolletschka died of an infection after being wounded accidentally with the finger with a lancet, during the dissection of a corpse. Its clean Autopsie revealed a pathology identical to that of the dead women of the fever puerpérale. Semmelweis immediately saw the relationship between the contamination by the corpses and the fever puerpérale, and he studied in a detailed way the statistics of mortality in the two obstetric clinics. He concludes from it that it was him and the students who, since the room of autopsy, brought on their hands the particles of contamination to the patients that they looked after in the first private clinic. At the time, the theory of the microbial diseases had not been formulated yet, this is why Semmelweiss concludes that it was an unknown cadaveric substance which caused the fever puerpérale. It prescribed then, in May 1847, the use of a solution of Hypochlorite of calcium for the washing of the hands between the work of autopsy and the examination of the patients; death rate fell of 12 % with 2.4 %, result comparable with that of the second private clinic.
He asked that this washing with hypochlorite was extended to the whole of the examinations which put the doctors in contact with organic matter in decomposition. Death rate fell then still, to reach 1,3 %.
Rejection by the medical institution
In spite of such a spectacular result, Semmelweis refused to officially communicate its method with the erudite circles of Vienna. It did not want to either explain it on paper, and it is Ferdinand von Hebra which, finally, wrote two articles explaining the etiology fever puerpérale, and highly recommending the use of the calcium hypochlorite as preventive. But, although foreign doctors and the principal members of the School Viennese had been impressed by this obvious discovery, the articles were not able to attract a broad support to him. Its observations went against the opinion which prevailed then in the scientists, which (among other such extravagant causes) allotted the diseases to an imbalance in the body of “four fundamental moods”, a theory known under the name of dyscrasy. One went until supporting that, its discoveries would be they exact, each time to wash the hands before dealing with expectant mother, as Semmelweis required it, would be really too work. And then the doctors did not want any to acknowledge which they were responsible for so many deaths.There were also questions of Idéologie which prevented at the time the medical institution from recognizing and to implement the discovery of Semmelweis. One of them was that this thesis seemed to rest on no scientific basis, since one could give no justification of it. The scientific explanation came only a few decades later when Pasteur, Lister and other pioneers develops the microbial theory of the disease. Another ideological problem was that the ideas of Semmelweis appeared to be based on a religious design of the death, which forced the doctors to purify the hands after the autopsies; all that felt the “monk”, the “superstitious one” in the intellectual environment which dominated at the time in the scientific circles and which resulted directly from the age of the Lumières.
In 1848, Ignace Semmelweis extended the use of his prophylactic protocol while making clean all the instruments coming into contact with the parturients, and it showed, thanks to the statistics, that it had succeeded in almost completely eliminating the fever puerpérale from the room of hospital, which led Skoda to want to create an official commission to examine and make public these results. This proposal, in the final analysis, was disallowed by the Ministry for the State education for political reasons of quarrels within the university and of the governmental bureaucracy, between the beaten liberal of 1848 and the conservatives lately with the capacity. Irritated by the favorable reports/ratios which indirectly called into question its convictions and its acts, Johann Klein refused to renew the nomination of Semmelweis in its service of obstetrics in March 1849. Without letting itself dismount, this last presented its candidature for a post of professor not remunerated (Privatdozent) in obstetrics, but its past of liberal militant was undoubtedly one of the reasons which made that its candidature was deferred. To show the validity of its clinical conclusions, Semmelweis began experiments with animals, assisted physiologist Ernst Brücke and with the agreement of the Academy of Science of Vienna.
As that was known as higher, the first report of discovered of Semmelweis was published by professor Ferdinand Hebra in December 1847 in the Zeitschrift DER kaiserlich-königlichen Gesellschaft der Ärzte zu Wien , followed by an additional talk of the same doctor in April 1848. In October 1849, Skoda made a speech on this subject with the Imperial and Royal Academy of Sciences. Unfortunately Semmelweis had neglected to correct papers of his/her two friends, and the errors which they made could let believe that it supported that the fever puerpérale was only caused by an infectious virus. One however succeeds in finally convincing Semmelweis which it was to present itself its discovery On the origin of the fever puerpérale at the medical community of Vienna. May 15th, 1850, it gave a conference in front of the Association of the Doctors in Vienna under the presidency of Rokitansky, speech followed by a second on June 18th, 1850. Next in October, it accepted its nomination of Privatdozent in obstetrics, until it waited since more than one year, but the governmental decree stipulated that it was to teach with a mannequin, condition which appeared to him somewhat humiliating. Confronted with financial problems, and perhaps also discouraged, it left Vienna for Pest abruptly, without same to have warned his closest friends. This hasty decision destroyed its chances to convince the scepticists Viennese little by little, whereas it had the support of partisans devoted such as Rokitansky, Skoda, Hebra and other colleagues still.
In Hungary, Semmelweis was charged to direct the maternity of the Saint-Roch Hospital in Pest of 1851 to 1857. Its policy of washing of the hands and the material lowered to it to 0,85 % death rate due to the fever puerpérale, and its ideas were soon accepted in all Hungary, after a governmental decree had ordered that its prophylactic methods were applied everywhere. It Maria, had five children and constituted important private customers. It occupied pulpit of the theoretical and practical obstetrics at the University of Pest in July 1855 and refused, in 1857, the offer that one made him of a pulpit of obstetrics to Zurich. Vienna, however, remained to him always completely hostile.
In 1861, Semmelweis ends finally up publishing its discovery (14 years later) in a book, Die Ätiologie, der Begriff und die Prophylaxis of Kindbettfiebers . A certain number of unfavourable criticisms, appeared abroad about its book, led it to break out against its adversaries in a series of open letters, written in the years 1861-1862, which hardly supported the acceptance of its ideas. With a conference of doctors and biologists German, the majority of the speakers rejected his doctrines and, among them, Rudolf Virchow.
The refusal of the medical community to recognize this discovery condemned to a tragic death and useless thousands of young mothers, but in fact in the final analysis the ideas of Semmelweis triumphed. One quotes his case sometimes as the example of a situation where scientific progress was slowed down by the inertia of the professionals well in place.
In July 1865, Semmelweis was victim of what seemed to be a nervous breakdown, although some modern historians believe that symptoms that it presented show that it was reached of a beginning of Maladie of Alzheimer or of senile insanity. After a voyage to Vienna that his/her friends and his/her parents imposed to him, it was interned in a psychiatric asylum, the Niederösterreichische Landesirrenanstalt in Wien Döbling, where it died, two weeks later only. Traditionally, one speaks about a generalized poisoning of blood, similar to that of the fever puerpérale, which it would have contracted while being wounded with a finger, during an operation. An article of H.O. Lancaster, published in the Newspaper off Medical Biography , contradicts this assertion: One wrote much on Semmelweis, but the authentic history of its death, on August 13rd, 1865, had to wait until 1979, to be confirmed by S.B. Nuland. After a few years, where its mental health had worsened, Semmelweis was entrusted to a private asylum of Vienna. There it became violent at the point to be made beat by the personnel of asylum; so that he died of his wounds fifteen days later. It was to ring the knell of these theatrical explanations according to which it would have been wounded and infected during an autopsy, which would have been, if that had been exact, a marvellous case of irony grecque.
On the death of Ignaz Semmelweis, KC Carter, S Abbott and JL Seibach bring back five documents of which the report/ratio of autopsy practiced by Karl Kitansky (or one of its assistants) which proves that I. Semmelweis is deceased continuations of ill treatments undergone during its internment which are at the origin of a septicaemia with many infectious hearths surface - gangrene on the level of the major one of right hand, which deep - " pyopneumothorax" and metastatic infectious hearth of the left kidney.
It is only after the death of Semmelweis that the theory of the bacterial diseases was elaborate, and one now sees in him a pioneer of measurements of antisepsy and prevention of the infections nosocomiales.
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