Anthony Valerio's Books
Excerpt from SEMMELWEIS, the Women's Doctor by Anthony Valerio
Part III: BREAKTHROUGH
"Destiny chose me to be a missionary of truth as to the means that must be taken to avoid and to combat the puerperal scourge."—Dr. Ignaz Semmelweis
Semmelweis saw all that is worth in women, and newborns.—A.V.
He did not go to Dublin and investigate and learn from its great maternity hospital, because after serving the last four months of 1846, his replacement, Dr. Breit, was named professor of obstetrics at the University of Tübingen. Semmelweis picked up at the imperial hospital where he had left off those four months earlier. Certainly, Klein did not welcome him back, but his teachers and mentors Drs. Skoda and Rokitansky had gained influence with the education minister and at court. After all, in addition to first-rate obstetricians to insure their divine rights, the royal family and courtesans needed top-notch internists and surgeons. The great physicians and teachers campaigned for Semmelweis's return as Assistant of Obstetrics, and that is what happened.
Life is about people so Semmelweis shifted emphasis from the two lying-in clinics' similarities and differences to the human aspect. To the personnel of the two clinics: students and attending physicians who examined and delivered in the First clinic, midwives in the Second.
"Deaths in the First Clinic were not caused by epidemic influences but by endemic and yet unknown factors," Semmelweis wrote about this exact time.
A statistic from 1842 to the present spring day in 1847 that captured his attention was that maternity hospitals that were not teaching hospitals, as was his, or that trained only midwives, which his was not, had a lower mortality rate. This fact was as true in Strasbourg as it was in Vienna. Also, a colleague shared an observation to which Semmelweis listened: "The fewer deaths in Bartsch's (the Second) pavilion is due to the clumsiness of the medical students examining and delivering in the First. This must be the real cause of the fatal inflammation."
Medical students and visiting physicians examined the women in the First Clinic, from the time they arrived, throughout labor and delivery.
An experiment strikes him! Exchange the midwives of the Second Clinic with the students of the First! He received permission to make the switch, most likely through Joseph Skoda's influence. Now midwives examined and delivered in the First Clinic while medical students did same in the Second. Again Semmelweis waits…two weeks…a month… Finally, results! From June through December (1847), of the 1,841 deliveries in the First Clinic, 56 new mothers died. The mortality rate of 3% is comparable to the death rate of the Second Clinic!
Death followed the students!
He considers a few variables. The practices of midwives have no contact with cadavers. They do not bloody their hands. They do not go from Dissection to Delivery. They practice on the Phantom instead of on a cadaver. Another variable concerns the women who deliver on the street. They and their babies manage to escape death by the Fever.
"To me," he wrote, "it appeared logical that patients who experienced street births would become ill at least as frequently as those who delivered in the clinic....What protected those who delivered outside the clinic from these destructive unknown endemic influences?"
He'd found the answer. Medical students did not attend to the pregnant women on the street.
"The fact is," he wrote to Lajos, "I am searching in our own clinic and we need to look nowhere else."
He scrutinizes these medical students, foreign and native, their comings and goings, their habits. Waits outside Autopsy, watches silently, anonymously. He must be a clandestine observer. He must have them not make the slightest change in their routines. Perform autopsies on recently deceased new mothers, bloodied hands reaching into the genitals reeking and oozing with puss and ochor, then wash their hands with soap and water cursorily, which some skip, then they descend as if to hell to his clinic, the First. From a dark corner, he watches students examine pregnant women with hands washed hastily. Then he goes to Clinic #2 and observes hands of midwives untarnished with the byproducts of Autopsy.
After an autopsy of his own, and after he washes his own hands with soap and water, he brings his hands to his nose. Inhale! Again, breathe in! There it is, that ever-present odor of cadaveric particles which had greeted him on his first day at Vienna Hospital and lingered throughout school, those two years operating beside Rokintansky, and played around his nostrils while he slept. It shot out to the priest who passed with his tinkling bell and then rushed back in to his bed. The odor of the process of mortal death was the natural odor of his wing of the hospital, certainly the Dead Room, Autopsy, Dissection. After an hour, Dr. Semmelweis inhales again. Still there! A second hour--the malodor lingers, sometimes for a longer time, sometimes shorter. If this is so, it also has not left the hands of medical students and attending physicians of the First Clinic, as well as those of attendants of all the maternity clinics around the world who first work on cadavers. He tells Lajos:
"Cadaveric particles can be detected by their odor! They transfer from the corpse to the hands and remain despite soap and water washings. Then these same hands examine a woman approaching term and then deliver. In the end, dear friend, it is not the students who cause the Fever. It can be anyone, including myself--you, her, him and him--whoever carries cadaveric particles on the hands!" "Deodorize the hands," he says at this time. "The whole problem is there."
Semmelweis smelled germs fifty years before Pasteur saw them.
Hardly into the second year of his Assistantship, Dr. Ignaz Philipp Semmelweis laid the foundation on which to discover the causes of puerperal fever--and infection in general!
dedicated to my editor now diseased Corlies "Cork" Smith, executive editor, Harcourt/Brace/Jovanovitch when we did this book together. Salute old friend!
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A powerful, funny novel. Preceded The Sopranos & Analyze This -
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