"When I look back upon the past, I can only dispel the sadness which falls upon me by gazing into that happy future when the infection will be banished . . . The conviction that such a time must inevitably sooner or later arrive will cheer my dying hour." - Ignaz Semmelweis
Breakthrough Moment
Semmelweis’ good friend and colleague Professor Kolletshka accidentally stabbed himself in the hand with a scalpel being used during an autopsy. The professor fell sick and died just a few days later. Semmelwies, upon hearing the news, closely examined his friend’s post mortem report, which described Kolletshka’s swollen abdomen, high fever, and multiple absesses. Semmelweis reasoned that the professor died of septicemia, or blood poisoning, from the cadaveric particles from the scalpel. The doctor described this vital breakthrough moment and recalled that, “My mind, in this excited state, registered with irresistible clarity the identity of the disease Kolletchka had died of, and the disease I had seen cause the death of so many hundreds of women in childbed.” For the doctor, it was an astonishing and unbelievable moment of clarity and understanding. His friend’s death, though tragic in nature, finally revealed to him the source of the devastating disease. It also explained why the women delivered by physicians were several times more likely to die of puerperal fever than the women delivered by midwives—midwives did not perform autopsies. Semmelweis not only unlocked the mystery of the source of the disease, but he reasoned its transmission as well.
"If therefore, in the case of Professor Kolletshka general sepsis [blood contamination] arose from the inoculation of cadaver
particles, then puerperal fever must originate from the same source. Now it was only necessary to decide from where and by what
means the putrid cadaver particles were introduced into the delivery cases. The fact of the matter is that the transmitting source of
those cadaver particles was to be found in the hands of the students and attending physicians....puerperal fever was nothing more
or less than cadaveric blood poisoning."
"If therefore, in the case of Professor Kolletshka general sepsis [blood contamination] arose from the inoculation of cadaver
particles, then puerperal fever must originate from the same source. Now it was only necessary to decide from where and by what
means the putrid cadaver particles were introduced into the delivery cases. The fact of the matter is that the transmitting source of
those cadaver particles was to be found in the hands of the students and attending physicians....puerperal fever was nothing more
or less than cadaveric blood poisoning."
Prevention and Reform
![Picture](/uploads/9/1/3/2/9132342/367050337.jpg?316)
Once Semmelweis discovered the source and transmission of puerperal fever, he took direct action to prevent the disease from reaching the delivery rooms. The horrible stench of the cadaveric particles remained on the hands of the autopsy physicians and was often destroyed using a chlorine solution. Semmelweis reasoned that the chlorine would be the ideal substance to use as an antiseptic in his new technique. He then filled a large bowl with a chlorine solution and several hand brushes at the entrance to the maternity ward. A sign posted near the bowl required all physicians and students to wash and scrub their hands in the solution before entering the area and touching a woman in labor. Although the solution was later changed to a less expensive chloride of lime solution, the changes in death rates were immediate and drastic. In only a short time, the number of incidents of puerperal fever in the obstetrics ward plummeted. This early form of antiseptic procedure prevented the cadaveric particles from entering the wards and the women stopped dying of blood poisoning. In the last seven months of 1847, only 56 of the 1,841 women that delivered in the First Division died. This meant that the mortality rate fell from over 33% to 3%. These figures were finally comparable to those of the Second Division, where women were delivered by midwives. In 1848, the first full year of the program, the First Division had a death rate of 1.2% which was practically comparable to that of the Second Division's death rate of 1.3%. Although Semmelweis could not explain why this method of sanitation worked, he was excited and relieved to see that this new procedure was effective.
During 184, Semmelweis gradually widened his prophylaxis and antiseptic techniques to include all instruments coming in contact with patients in labor. Semmelweis later gained employment at the St. Rochus Hospital in Budapest, Hungary. The hospital was in a state of utter disarray when he arrived and the mortality rate from puerperal fever was alarming. He applied his new procedure there and in a short time, the death rate in the maternity units dropped drastically. Semmelweis also noticed that women with other infections or diseases, such as a knee infection in one case, could pass the disease onto the other women in their area. The nurses and physicians that attended these women would not wash their hands between patients and carried bacteria from one to another. As one woman would infect another, he reasoned that the source of the bacteria did not matter, so long as it was an absorption of decomposed "particles".
During 184, Semmelweis gradually widened his prophylaxis and antiseptic techniques to include all instruments coming in contact with patients in labor. Semmelweis later gained employment at the St. Rochus Hospital in Budapest, Hungary. The hospital was in a state of utter disarray when he arrived and the mortality rate from puerperal fever was alarming. He applied his new procedure there and in a short time, the death rate in the maternity units dropped drastically. Semmelweis also noticed that women with other infections or diseases, such as a knee infection in one case, could pass the disease onto the other women in their area. The nurses and physicians that attended these women would not wash their hands between patients and carried bacteria from one to another. As one woman would infect another, he reasoned that the source of the bacteria did not matter, so long as it was an absorption of decomposed "particles".
![Picture](/uploads/9/1/3/2/9132342/622243511.png?519)
The graph demonstrates the drastic effect that the new hand washing techniques had on the obstetrical wards. The monthly mortality rates from puerperal fever averaged around 15 deaths before any sanitation techniques were implemented in the wards. However, shortly after the use of the chlorine or chloride of lime wash came into use, the mortality rates plummeted, averaging less than five deaths per month.