Kapronczay Károly szerk.: Orvostörténeti Közlemények 194-195. (Budapest, 2006)

TANULMÁNYOK — ARTICLES - HÄNNINEN, O. - FARAGÓ, Mária - MONOS, Emil: Semmelweis ' Discovery and Its Finnish Follow-Up

SEMMELWEIS' DISCOVERY AND ITS FINNISH FOLLOW-UP OTTO HANN IN EN-EM IL MONOS-MÁRIA FARAGÓ The short history of discovery made by Semmelweis Ignác Semmelweis (1818-1865 was born in Buda, now the western part of Budapest. He studied medicine alternatively in Vienna and Pest, then took his doctor's degree on May 21, 1844 in Vienna. He started his work as assistant physician at professor Johann Klein's obstetric clinic in the Viennese General Hospital (Allgemeines Krankenhaus) in 1846 (see e.g. 1, 6, 11,20). Semmelweis recognized a striking difference between the puerperal mortality rates in the two departments of the same hospital. In 1845 the maternal mortality rates in the First and the Second Clinic of Obstetrics were 11.5 %, and 2.7%, respectively. A special commission established by the government studied the possible cause of the high mortality rate. Professor Klein explained it by poor facilities of his department. Both clinics, however, were quite similarly supplied. Results of careful statistical analysis performed by Semmelweis unambiguously proved that the year 1845 was not just an exception. Moreover, findings based on the autopsy of newborns showed that sepsis was the cause of both fetal and maternal deaths. In 1846, the director of the clinic unexpectedly fired Semmelweis. Returning back after a short stay in Venice, Semmelweis learned that his friend professor of forensic medicine Jakob K. Kolletschka (1803-1847) had died from sepsis after a finger-cut, which he got during an autopsy. Semmelweis recognized from the documents that the signs of the mortal disease of his friend and of the mothers dying in puerperal fever were similar. Since same symptoms were observed in adults - both men and women, and in newborns, Semmelweis concluded that mothers delivering at the First Clinic apparently died due to certain (then unknown) agents, transmitted by doctors and medical students from the autopsy unit of the teaching hospital. In the Second Clinic midwives took care of mothers, and they usually escaped this morbid disease, which was so common in the nearby clinic. Semmelweis also noticed that after autopsy normai hand-washing with soap failed to remove the odor, it did disappeared only if chlorine water was used. Now professor Klein gave permission to Semmelweis - who again had got a job contract for two years - to introduce such hand-washing in patient examination and in attending deliveries. This procedure dramatically reduced the mortality rate to one fifth (1,6, 11,20). In 1847 Semmelweis postulated that puerperal fever was due to particles from cadavers, pus, and other putrefying organic materials. During patient examination or delivery the female genitals were exposed to these substances that could enter the blood stream of the unfortunate person (11).