Antall József szerk.: Orvostörténeti közlemények 55-56. (Budapest, 1970)

TANULMÁNYOK - Mádai Lajos: Semmelweis és a statisztikai tudomány (angol nyelvű közlemény)

Analysing the data of the mentioned table Semmelweis found that in the 1st clinic the relative frequency of maternal mortality in the years 1841—1846 was three times as big as the mortality of the 2nd (midwifery) clinic. "That was the first observation", wrote Semmelweis," which raised the first doubts in me on the infectious nature of puerperal fever" (6). The considerable difference between the mortality conditions of the two maternity clinics became a foundation stone in his further aetiological researches. I feel that I must strongly emphasize the importance of this basic statistical conception and perception as the figures of the regular statistical reports of the clinic had been available to the professors of the two maternity clinics, to Semmelweis's predecessors, the earlier assistants, and to the director of the Allgemeines Krankenhaus; they were submitted even to the competent ministry. Semmelweis mentions in his Aetiology that previous to his activity the cause of the excessively high mortality in the ill-famed 1st maternity clinic had been investigated on several occasions by a ministerial committee. Both professor Klein and the committees attributed the fluctuation in the frequency of illness and death brought about by puerperal fever to the outbreak of an epidemic (7). The cautious clinical observation of seemingly unimportant events and the checking of all possible hypotheses played an essential role in his complex research methods on the aetiology of puerperal fever. One of such hypotheses was the effect of fear, worry on the women's part due to the frequent illnesses and deaths. The sound of the bell when the priest called on the dying mothers every day added to the dramatic atmosphere of the wards. The elimination of that physic factor: the discontinuance of the ringing of the bell did not put an end to the further illnesses and deaths, there was no causual relation between the two symptoms, something Semmelweis had been convinced of, but thought necessary to check. He noticed that those women at whom the length of the dilation at the first parturition was 24, 36, 48 or more hours, generally became ill in puerperal fever and died as a consequence. The same phenomenon, however, was not recognizable in the other clinic in the case of first parturations. His observations that in his clinic puerperal fever was most uncommon in the case of premature births was another important additional element in his aetiological research. "Everything was questionable, everything was insoluble", wrote Semmelweis, "everything was in doubt, only the high number of the dead was an unquestionable reality." (8). On the basis of this first table and with matchless diligence Semmelweis implemented a very extensive collection of data followed by their thorough processing. By the help of statistical analyses he challenged and refuted the hypotheses in the epidemic nature of the disease one after the other, as these atmospheric, miasmatic, etc. factors could never produce as favourable conditions in the 1st clinic as existed in the 2nd. Among the statistical methods of Semmelweis I should like to dwell on the importance of long term dynamic sets, which are not without value from the point of view of science history either. Collecting the statistical figures bearing