1) Was Ignaz Phillip Semmelweis the first to identify or a pioneer in identifying, the importance of hygiene in these cases?
A. Ignaz Semmelweis was not the first to emphasize the significance of hand decontamination but he was the first from Europe who demonstrated the importance through statistical numbers. There were others prior to him such as Antoine Germain Labarraque who provided evidence for the role of hand decontamination reducing maternal mortality and puerperal fever.
The significance of hand washing in patient care was conceptualized in the early 19th century. Labarraque provided the first evidence that hand decontamination can markedly reduce the incidence of puerperal fever and maternal mortality. Hand hygiene: Back to the basics of infection control
B. There were also other doctors across the Atlantic such as Oliver Wendell Holmes who at least six years before Ignaz Semmelweis recognized the importance of hand decontamination.
It should not be forgotten that Holmes' essay was published six years before Semmelweis undertook his remarkable studies in 1849. Unfortunately the essay appeared in a new and little known journal which “failed” shortly afterwards. Probably Holmes' message would have been overlooked had it not been vigorously attacked and ridiculed a few years later by two leading Philadelphian obstetricians, Charles Meigs and Hugh Hodge. Oliver Wendell Holmes (1809–1894) and his essay on puerperal fever
But even Oliver Wendell Holmes was not the first doctor to advise precautions against transmitting contagious diseases.
Holmes was not the first doctor to conclude puerperal fever was contagious. In his research, he discovered doctors as far back as 1795 advising precautions against transmitting the disease. In his preface to the reprinted version of his paper, Holmes focused his famed eloquence on Hodge and Meigs, who were teaching future doctors that the disease was not contagious. "If I am right, let the doctrines which lead to professional homicide be no longer taught from the chairs of those two great institutions,'' Holmes wrote. "If there is voluntary blindness, any interested oversight, any culpable negligence, even, in such a matter, and the facts shall reach the public ear; the pestilence-carrier of the lying-in chamber must look to God for pardon, for man will never forgive him." How Oliver Wendell Holmes helped conquer the 'black death of childbed'
2) Whether Ignaz Semmelweis claims were rejected by the establishment at the time or ignored/shunned?
A. The doctrine of Semmelweis initially received very little response from the medical community of the time.
The letters sent by the friends of Semmelweis to the professors of midwifery in various universities, clinics, and schools for midwifery in the Continent of Europe and Great Britain, received very little response, and the article by Hebra appeared to have attracted no attention from those official teachers whom it ought to have compelled into immediate action. Meanwhile the
foreign visitors had all left Vienna to avoid the political revolution. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
Diverse opinion existed until 1863.
We see then that a clear divergency of opinion still existed so late as 1863. Among the witnesses perhaps the most influential was Virchow, and within a year he was frankly to accept the Semmelweis pathology, simultaneously with Spath of Vienna. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
However, later the doctrine was accepted by the medical community and even compared to Edward Jenner's famous germ theory.
While all medical circles were discussing the value of the Semmelweis discovery, and taking part indirectly in the feud among the professors of the Faculty of Medicine, Dr. Karl Haller brought the subject before the Medical
Society in February, 1849. They were entitled to conclude that the method of chlorine disinfection introduced by Dr. Semmelweis had an important influence in producing the more favourable conditions in this Clinic. Dr. Haller concluded by proposing that Dr. Semmelweis should be invited to give an address on his
experiences to the Medical Society. This remarkably flattering proposal was at once adopted, although every member present must have known that the acceptance
of such a resolution was equivalent to a vote of censure on Profesor Klein. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
Hebra was the first to compare the beneficent discovery of Semmelweis with that of Jenner. Semmelweis accepted the comparison as just and appropriate, and introduced it repeatedly in later years when defending his Lehre. There was no exaggeration in favour of Semmelweis in the comparison : Hebra's expression has
been amply justified since it was first employed. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
B. Supporters: Ignaz Semmelweis was not ignored and shunned since he had supporters such as medical professors, Dr. Arneth, Hebra editor of the Journal of the Medical Society of Vienna and a great diagnostician named Skoda having significant influence at Prague and Wiirzburg. Skoda was considered to be the greatest supporter of the doctrine of Semmelweis among his peers. Some of his peers certainly approved his correct analysis which is further detailed below.
The most ardent supporters of the Semmelweis Doctrine were the three professors who had befriended him from the first, with Dr. Haller, senior physician at the General Hospital, the group of men in fact who had drawn the attention of the world to the Vienna School of Medicine, and attracted to their class-rooms in the General Hospital students and young graduates from all parts of Europe. Skoda became the most strenuous and outspoken supporter of Semmelweis, and he may have gone just a little too far in his advocacy for the best interests of his protege. Kussmaul pronounced the operation course of mid- wifery, conducted by Semmelweis, as simply admirable ; and he appears to have been much impressed with what he witnessed of the work of the Vienna Lying-in Hospital. To Hebra, who was at that time editor of the Journal of the Medical Society of Vienna, the Doctrine appeared to be now sufficiently matured for public notice. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
There were also young foreign graduate doctors who were influenced by the doctrine of the silent Semmelweis which is further detailed below.
The columns of the Austrian, Hungarian, and German medical journals were available to him for publication, and it was now, and not ten years later, that he was in duty bound to seize the opportunity of proclaiming his Doctrine. But he remained practically silent, and he and a group of young friends, chiefly foreign graduates who had been attracted to Vienna by the opportunities of clinical study, resorted to the comparatively futile methods of spoken word and private letter in order to spread the doctrine. Among these visitors were Dr. F. H. C. Routh, of London, Dr. Stendrichs of Amsterdam, Kussmaul of Heidelberg, a former assistant of the now venerable Naegele, Schwarz the young friend of Michaelis of Kiel, and Wieger of Strassburg. So these young graduates, who had learned the Semmelweis Doctrine at first hand, and enthusiastically accepted it as a new evangel, divided Europe among them, and each undertook to write to his former professor or to some influential obstetrician of his own country. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
Dr. Routh from England, Professor Michaelis of Kiel, Tilanus of Amsterdam, Dr. Hebra, and Dr. Karl Haller were open supporters of the Semmelweis doctrine.
Dr. Routh was the first Englishman to proclaim the Semmelweis doctrine in England. He read a paper at a meeting of the Medico-Chirurgical Society entitled : " On the Causes of the Endemic Puerperal Fever of Vienna," and it was published in the Medico-Chirurgical Transactions, Vol. xxxii (1849). The second answer to Semmelweis came through Schwarz from Professor Michaelis of Kiel, known to English readers chiefly by his work on the "Obliquely Contracted Pelvis," quoted by all our modern makers of text-books on midwifery. Hebra was the first to compare the beneficent discovery of Semmelweis with that of Jenner. Haller was amongst the warmest and most influential supporters of Semmelweis. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
Former opponents such as Carl Braun, Virchow, Professor E. Martin and people such as Chiari who ignored his theory also became future supporters.
It was declared by the opponents of Semmelweis that Chiari had given up the infective theory, but this was not the case ; the Semmelweis doctrine had no more sturdy and consistent supporter from first to last than Chiari. Thus we see that Kiwisch had actually adopted the Semmelweis prophylaxis, though he still argued against it on theoretical grounds; and though he must have read
the Hebra articles and the report of the addresses delivered by Semmelweis at the Vienna Medical Society the year before, he joins in perpetuating the error and misrepresentation that Semmelweis attributed the infection of lying-in women only to cadaveric poison. " The reader will see with astonishment that Carl Braun who so brilliantly combated the hypothesis of cadaveric infection, who so triumphantly vindicated . . the unlimited power of epidemic influences : that the same Carl Braun now assigns a place in the conception of puerperal fever even to decomposed animal matter not to epidemic influences. Oh, logic." Virchow's adoption of the doctrine of Semmelweis was declared in 1864, but his support came too late to comfort the unhappy author. It will be observed that the reference to E. Martin is conceived in the most forbearing terms ever used by Semmelweis, for, as we shall see, E. Martin was the most reasonable of opponents, and was among the first in North Germany to appreciate the importance of the Semmelweis Lehre. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
Markusovszky a close friend of Semmelweis also wrote a powerful article as a reply to the opponent of Semmelweis doctrine called Breisky in the Hungarian language.
Markusovszky took upon himself the task of replying to Breisky in the "Orvosi Hetilap," and consequently language, remained unknown to Western Europe for
many years, until it was translated and published by Bruck. Breisky remained practically unanswered. The powerful article of Markusovszky, written in the Hungarian Such is in essentials the far-seeing and sagacious article of Markusovszky's on the objections to the Semmelweis discovery. It was friendly, but it required courage and patience with his friend, who was sadly excited and unreasonable in his reception of the truth contained in the article. He appears to have even believed for a time that Markusovszky, his most loyal friend and most influential supporter, had gone over to the camp of the enemy. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
Semmelweis then grew bitter with himself and left Vienna in 1851 without informing anybody including his most staunch supporter Skoda.
The insulting condition attached to the nomination aroused a feeling of bitterness in Semmelweis which grew and rankled. "His patience was at an end; his anger rose beyond the bounds of reason, and evidently remembering only the persecution of enemies and forgetting what had been done for him for years by a circle of loyal and devoted friends and supporters, he formed the rash and irrevocable resolution to leave Vienna, which he loved so well, and to return to Pesth, where he was now a stranger." So he went off without a word of
farewell to any one of his professional friends, not even to Skoda, who had done him so much disinterested service, and had made so many enemies in his generous struggle to estabhsh the doctrine of which he was among the first
to recognise the truth. Skoda, as was to be expected, was deeply hurt by the
ingratitude and folly of Semmelweis. He said nothing, but for him Semmelweis ceased henceforth to exist. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
He was also even appointed as Professor later in 1855 which should mean that he was not entirely ignored or shunned by his peers.
So in July, 1855, Semmelweis was appointed Professor of Theoretical and Practical Midwifery in the University of Pesth. This appointment crowned his ambition, and it seemed to work a transformation in his character. His
ambition flamed up once more, and the old energy and enthusiasm of the Assistantship period in Vienna revived. He had a trying task before him ; the means of teaching both at the University and the Hospital had become derelict by the neglect of years, and it required all the energy and enthusiastic devotion of even Semmelweis to create something like a modified efficiency. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
C. Criticism/opposition: Professor Klein, Carl Braun, Herr Hofrath, Dr. V. Siebold, Hecker of Munich, Dr. J. Spath, Dr. F.W. Scanzoni, Dr. Eduard Carp, KiwiscH of Wiirzburg, Prof. Bamberger of Wiirzburg, Professor Birly, Dr. Boer and Dr. Lumpe were the chief opponents of the doctrine of Semmelweis.
Within a year of the publication of the Etiologie he could restrain himself no longer, and he burst out upon his chief antagonists in the Open Letters. In these letters we find nothing that is new concerning puerperal fever : there is more emotion than ratiocination. They are perhaps best considered as the cry
of painful disappointment, almost of despair, of the philanthropist, rather than of the scientific obstetrician. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
It is also felt that Semmelweis himself was his own enemy.
But he was in a sense his worst enemy himself. He had plenty of time at his disposal ; he had collected material concerning his discovery, and everything. appeared to demand from him some public exposition of his doctrine; but nothing would induce him to address the Medical Society which had given him an invitation so flattering to a young man in his position. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
- The cause of the illness which ultimately led to the death of Semmelweis is attributed to cellulitis.
One of the medical staff soon discovered an injury to a finger of the
right hand, which had probably resulted from one of the last gynaecological operations, and had been overlooked. The wound had become gangrenous, and had perforated and disintegrated a joint. Cellulitis spread along the
arm, and after the formation of metastases, the final aspect of the disease became that of pyo-pneumo-thorax, to which the sufferer succumbed on the 13th of August. The autopsy revealed extensive organic disease of the brain. Whether it was the cause or the consequence of the alternating periods of depression and excitement in an emotional type of man, is a question which we must be content to leave unanswered. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine
TL;DR: Semmelweis had both supporters and opponents for his doctrine of chlorine disinfection and most certainly not ignored or shunned for his beliefs.
If he had possessed the self-consciousness and personal ambition of some of
his antagonists and spread the evangel with the persistency and vehemence of the opposition, he might have seen the triumph of his teaching in his own lifetime, and, like Edward Jenner, earned some of the fruits of success. But he was absolutely devoid of the qualities which express themselves in self-seeking and personal ambition, and hence it was that he did not see the happy time for
which he longed. Semmelweis: His Life and his Doctrine: A Chapter in the History of Medicine