Ignaz Philipp Semmelweis ( German: [? 'na: ts' z? ml? va? s] ; Hungarian: Semmelweis Ignà ¢ ¡c FÃÆ'¼lÃÆ'¶p ; July 1, 1818 - August 13, 1865) is an ethnic Hungarian physicist Ancestor -German, now known as the earliest pioneer of antiseptic procedures. Described as "mother's savior," Semmelweis found that the incidence of puerperal fever (also known as "puerperal fever") can be drastically cut by the use of hand disinfection in obstetric clinics. Puerperal fever is common in hospitals in the mid-19th century and is often fatal. Semmelweis proposed the practice of washing hands with chlorinated lime solution in 1847 while working at the First Obstetric Clinic at Vienna General Hospital, where the doctor's ward had three deaths of the midwife ward. He published a book of his findings in Etiology, Concept and Prophylaxis Childbed Fever .
Despite numerous publications of results where handwashing reduced mortality to below 1%, Semmelweis's observations contradicted the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Semmelweis can not offer acceptable scientific explanations for his findings, and some doctors are offended by the suggestion that they should wash their hands. The Semmelweis practice gained widespread acceptance just a few years after his death, when Louis Pasteur confirmed the germ theory and Joseph Lister, acting on French microbiological research, practiced and operated, using hygienic methods, with great success. In 1865, Semmelweis committed itself to asylum, where he died at the age of 47 after being beaten by guards, just 14 days after he was promised.
Video Ignaz Semmelweis
Family and early life
Ignaz Semmelweis was born on July 1, 1818 in TabÃÆ'¡n, Buda neighborhood, Hungary, today part of Budapest. He is the fifth child of ten prosperous merchant families in József Semmelweis and TerÃÆ'Â © z MÃÆ'¼ller.
His father is a German ethnic born in Kismarton, then part of Hungary, now Eisenstadt, Austria. He obtained permission to set up a shop in Buda in 1806 and, in the same year, opened a wholesale business for spices and general consumer goods. The company is named zum WeiÃÆ'Ÿen Elefanten (in White Elephant) at Meindl-Haus in TabÃÆ'¡n (today 1-3, AprÃÆ'³d Street, Semmelweis Museum of Medical History). In 1810, he was a wealthy man and married to TerÃÆ'Â © z MÃÆ'¼ller, daughter of builder (vehicle) builder FÃÆ'¼lÃÆ'¶p MÃÆ'¼ller.
Ignaz Semmelweis began studying law at the University of Vienna in the autumn of 1837, but the following year, for reasons unknown, he turned to medicine. He was awarded a doctorate in medicine in 1844. Later, after failing to get an appointment at the clinic for internal medicine, Semmelweis decided to specialize in obstetrics. His teachers include Carl von Rokitansky, Joseph? Koda and Ferdinand von Hebra.
Maps Ignaz Semmelweis
Kadafair poisoning theory
Semmelweis was appointed assistant to Professor Johann Klein at the First Obstetric Clinic at the Vienna General Hospital on July 1, 1846. The current comparable position in the United States hospital would be "the main occupant." His job is to examine patients every morning in preparation for a professor round, supervising difficult delivery, teaching obstetric students and becoming a "scribe" of notes.
Maternity institutions are established throughout Europe to address the problem of killing unlawful children. They are established as a free institution and offer care for babies, which makes them attractive to women who can not afford, including prostitutes. In return for free services, women will be subject to training doctors and midwives. Two maternity clinics are in Vienna hospital. The First Clinic has an average maternal mortality rate of about 10% due to puerperal fever. The Second Clinic Rate is much lower, averaging less than 4%. This fact is known outside the hospital. The two clinics are treated on alternate days, but the woman begs to be admitted to the Second Clinic, because of the bad reputation of the First Clinic. Semmelweis describes desperate women pleading to their knees to avoid being accepted at the First Clinic. Some women even prefer to give birth on the streets, pretending to have a sudden birth on the way to the hospital (a practice known as street birth), which means they will still be eligible for childcare benefits without having been treated in the clinic. Semmelweis is puzzled that puerperal fever is uncommon among women who give birth on the streets. "To me, it seems logical that patients who experience birth on the streets will become ill at least as often as those who deliver at the clinic. [...] What protects those who deliver beyond the clinic from this endangered, destructive endemic effect? "
Semmelweis is very disturbed because the First Clinic has a much higher death rate because of puerperal fever than the Second Clinic. It "makes me so miserable that life looks worthless". Both clinics use almost identical techniques, and Semmelweis begins a very thorough process to eliminate all possible differences, including even religious practice. The only major difference is the people who work there. The First Clinic is a teaching service for medical students, while the Second Clinic was chosen in 1841 for midwife instruction only.
He excluded "jostling" as the cause, because the Second Clinic was always more crowded and his death lower. He removes climate as the cause because the climate is the same. The breakthrough occurred in 1847, following the death of his best friend, Jakob Kolletschka, who inadvertently stabbed the scalpel of the student during a post mortem examination. Autopsy Kolletschka shows a pathology similar to a woman who died of puerperal fever. Semmelweis immediately suggested a link between cadaveric contamination and puerperal fever.
He concluded that he and his medical students were bringing "poor particles" in their hands from the autopsy room to the patient they examined at the First Obstetric Clinic. This explains why the student midwife in the Second Clinic, who was not involved in the autopsy and had no contact with the corpse, saw a much lower death rate.
The germ theory has not been accepted in Vienna. Thus, Semmelweis concludes some unknown "carcass material" causing puerperal fever. He applied the policy of using chlorinated lime solution (calcium hypochlorite) to wash hands between autopsy work and patient examination. He did this because he discovered that this chlorinated solution works best to remove the stench from infected autopsy tissues, and thus may destroy "toxic" or contaminate "cadaveric" substances that are hypothetically transmitted by this material.
The result is the death rate at the First Clinic dropped by 90%, and then comparable to that in the Second Clinic. The death rate in April 1847 was 18.3%. After washing hands instituted in mid-May, the rates in June were 2.2%, 1.2% July, 1.9.9 August and, for the first time since the introduction of anatomical orientation, the mortality rate was zero in the next two months. this invention.
Efforts to reduce child fever
The Semmelweist hypothesis, that there is only one cause, that the most important is cleanliness, is extreme at the time, and largely ignored, rejected, or mocked. He was discharged from the hospital for political reasons and harassed by the medical community in Vienna, who was eventually forced to move to Budapest.
Semmelweis was angered by the indifference of the medical profession and began writing open and increasingly angry letters to leading European gynecologists, sometimes denouncing them as irresponsible killers. His contemporaries, including his wife, believed he was losing his senses, and in 1865, nearly twenty years after his breakthrough, he committed himself to asylum. He died there septicemia only 14 days later, probably because of being beaten by guards. The Semmelweis exercise gained wide acceptance only a few years after his death, when Louis Pasteur developed the germ theory of disease, offering a theoretical explanation for Semmelweis findings. He is considered a pioneer of antiseptic procedures.
Conflict with established medical opinion
The Semmelweis observation contradicts the established scientific and medical opinions of the time. The theory of disease is strongly influenced by the idea of ​​a basic imbalance of "four humor" in the body, a theory known as dyscrasia, whose primary treatment is blood contamination. The medical text at the time stressed that each case of the disease is unique, the result of personal imbalance, and the main difficulty of the medical profession is to establish the unique situation of each patient, case by case.
Findings from the autopsy of deceased women also show many confusing physical signs, emphasizing the belief that puerperal fever is not just one, but many diseases are different but not identifiable.
The rejection of Semmelweis's empirical observations is often traced to the persevering belief, the psychological tendency of attachment to discredited beliefs. In addition, some scientific historians have argued that resistance to the breaking contribution of unknown scientists is common and "is one of the most powerful blocks for the advancement of science."
As a result, his ideas were rejected by the medical community. Other subtle factors may also play a role. Some doctors, for example, feel offended by the suggestion that they should wash their hands, feeling that their social status as men is inconsistent with the idea that their hands can be unclean.
The results of Semmelweis had no scientific explanation at the time. It became possible only a few decades later, when Louis Pasteur, Joseph Lister, and others developed the germ theory of disease.
During 1848, Semmelweis expanded the scope of its washing protocol, to include all instruments in contact with patients in labor, and used a time series of mortality rates to document its success in eliminating puerperal fever from hospital wards.
Excessive publication of results and first signs of trouble
Towards the end of 1847, the stories of Semmelweis's work began to spread throughout Europe. Semmelweis and his students wrote letters to the directors of several prominent maternity clinics describing their last observations. Ferdinand von Hebra, editor of Austria's leading medical journal, announces the discovery of Semmelweis in the 1847 and April 1848 medical journals. Hebra claims that the work of Semmelweis has a practical meaning that is comparable to the introduction of the introduction of cow worm by Edward Jenner to prevent smallpox.
In late 1848, one of the former Semmelweis students wrote a lecture explaining the work of Semmelweis. The lecture was presented to the Royal Medical and Surgical Society in London and published in The Lancet, a leading medical journal. A few months later, another Semmelweis student published a similar essay in a French magazine.
When reports of dramatic declines in mortality rates in Vienna were circulated throughout Europe, Semmelweis has reason to hope that chlorine washing will be widely adopted, saving tens of thousands of lives. Initial responses to his work also provide clear signs of coming problems. Some doctors obviously misinterpreted his claim. James Young Simpson, for example, saw no difference between Semmelweis's innovative findings and the British idea suggested by Oliver Wendell Holmes in 1843 that the puerperal fever is contagious (ie that infected people can transmit the infection to others). Indeed, the initial response to Semmelweis's findings is that he says there is nothing new .
In fact, Semmelweis warns against all decaying organic matter, not just against the specific transmission that comes from victims of childhood fever itself. This misconception, and others like that, occurs partly because Semmelweis's work is only known through the former reports written by his colleagues and students. At this crucial stage, Semmelweis himself did not publish anything. This and similar misconceptions will continue to obscure the discussion of his work throughout this century.
Some accounts emphasize that Semmelweis refused to communicate his method officially to the educated Viennese, nor to explain it on paper.
Political turmoil and dismissal from Vienna hospital
In 1848, a series of tumultuous revolutions swept over Europe. The political turmoil that took place will affect Semmelweis's career. In Vienna on 13 March 1848 students demonstrated support for the promotion of civil rights, including trials by jury and freedom of expression. The demonstration was led by medical students and young faculty members and joined with workers from the suburbs. Two days later in Hungary, demonstrations and uprisings led to the Hungarian Revolution of 1848 and full-scale war against the Habsburgs ruling the Austrian Empire. In Vienna, the March demonstrations were followed by months of general unrest.
There is no evidence to suggest that Semmelweis was personally involved in the events of 1848. Some of his brothers were punished for active participation in the Hungarian independence movement, and Hungarian-born Semmelweis may sympathize with the cause. Semmelweis's boss, professor Johann Klein, was an Austrian conservative, perhaps anxious with the independence movement and concerned about another revolution of 1848 in the Habsburg region. Klein may not believe in Semmelweis.
By the time Semmelweis would end, Carl Braun also applied for an "assistant" position at First Clinic, probably at Klein's own invitation. Semmelweis and Braun are the only two applicants for the post. His predecessor Semmelweis, Franz Breit, has been granted a two-year extension. Semmelweis application for expansion supported by Joseph? Koda and Carl von Rokitansky and by most of the medical faculty, but Klein chose Braun for that position. Semmelweis was forced to leave the midwifery clinic when his term ended on March 20, 1849.
On the day when his term ended, Semmelweis petitioned the Vienna authorities to be registered as an obstetrician. A guide is a private lecturer who teaches students and who has access to some university facilities. Initially, due to Klein's opposition, the request of Semmelweis was rejected. He signed up again, but had to wait until October 10, 1850 (over 18 months), before finally being appointed as a 'theoretical' obstetrician. These conditions deny him access to the cadaver and limit him to teaching students only by using leather-made dolls. A few days after being informed of his appointment, Semmelweis left Vienna unexpectedly and returned to Pest. He seems to leave without saying goodbye to his former friends and colleagues, a move that may have offended them. According to his own account, he left Vienna because he "was unable to endure further frustration in dealing with Vienna's medical establishment".
Life in Budapest
During 1848-1849, some 70,000 troops from the Habsburg-controlled Austrian Empire thwarted the Hungarian independence movement, executing or imprisoning their leaders and in the process of destroying parts of Pest. Semmelweis, having arrived from Habsburg Vienna in 1850, did not seem to be warmly welcomed at Pest.
On May 20, 1851, Semmelweis took the relatively insignificant, unpaid, and honorary head-doctor position in the midwifery ward at Szent RÃÆ'³kus Hospital in Pest. He held that position for six years, until June 1857. Children's fever was rampant in the clinic; on a visit in 1850, right after returning to Pest, Semmelweis discovered a new corpse, another patient who was in great pain, and four suffered serious illness. After taking over in 1851, Semmelweis almost eliminated the disease. During 1851-1855, only eight patients died of puerperal fever of 933 births (0.85%).
Despite the impressive results, the Semmelweis idea was not accepted by other obstetricians in Budapest. Professor of midwifery at Pest University, Ede FlÃÆ'³riÃÆ'¡n Birly, has never adopted the Semmelweis method. He continues to believe that puerperal fever is caused by bowel impairment. Therefore, extensive cleaning is the preferred treatment.
After Birly died in 1854, Semmelweis applied for the position. So did Carl Braun - enemy and successor of Semmelweis as Johann Klein's assistant in Vienna - and Braun received more votes from his Hungarian counterparts than Semmelweis. Semmelweis was finally appointed in 1855, but only because the Viennese authorities rejected the Hungarian desire, since Braun did not speak Hungarian. As a midwifery professor, Semmelweis performs chlorine leaching at the University's Pest maternity clinic. Again, the results are very impressive.
Semmelweis refused an offer in 1857 to become professor of obstetrics at the University of Zurich. In the same year, Semmelweis married MÃÆ'¡ria Weidenhofer (1837-1910), 19 years younger and daughter of a successful trader at Pest. They have five children:
- AntÃÆ'³nia Tici (1864 - 1942) will have a child of his own.
- MÃÆ'¡ria (1859 - 1860) died at the age of four months.
- Ignae (1858 - 1858) died shortly after birth.
- Margit MÃÆ'¡ci (1861 - 1928) will remain unmarried.
- BÃÆ'Ã… © la (1862 - 1885) committed suicide at the age of 23 (probably because of gambling debts).
Response by the medical community
Semmelweis's view is much more acceptable in England than on the continent, but he is quoted more often than understood. The UK consistently considers Semmelweis has supported their theory of transmission. A common example is W. Tyler Smith, who claims that Semmelweis "is made with great conviction" that "the miasm that originates from the surgical chamber will stimulate puerperal disease." One of the first to respond to the 1848 Semmelweis communications was James Young Simpson, who wrote a stinging letter. Simpson suspects that English obstetrics literature should be completely unknown in Vienna, or Semmelweis would know that Britain has long regarded childhood fever as infectious and would use chlorine leaching to protect it.
In 1856, Semmelweis's assistant Josef Fleischer reported successful results from hand-washing activities at St. Rochus and Pest birthing institution at Viennese Medical Weekly ( Wiener Medizinische Wochenschrift ). The editor commented sarcastically that it was time people stopped being misled about the theory of chlorine leaching. Two years later, Semmelweis finally published his own work on his work in an essay entitled "Etiology of Fever Children". Two years later, he published a second essay, "The Difference of Opinion between me and the British Doctor on Fever Children". In 1861, Semmelweis finally published his principal work of Die ÃÆ'â € žtiologie, der Begriff und die Prophylaxis des Kindbettfiebers (German for "Etiology, Concepts and Prophylaxis of Dengue"). In his book of 1861, Semmelweis deplored the slow adoption of his ideas: "Most medical lecture rooms continue to resonate with lectures on the epidemic of childhood fever and with discourse to my theory. [...] In published medical work, my teachings are ignored or The medical faculty at WÃÆ'¼rzburg gave a gift to a monograph written in 1859 where my teachings were rejected ".
In a textbook, Carl Braun, Semmelweis's successor as an assistant at the first clinic, identified 30 causes of puerperal fever; only 28 of these are very dangerous infections. Other causes include conception and pregnancy, uremia, pressure given to organs adjacent to the shrinking uterus, emotional trauma, dietary errors, chills, and the effects of atmospheric epidemics.
However, apart from this opposition, Braun, the Assistant in the First Division in the period April 1849 to the Summer of 1853, maintained a relatively low death rate in the First Division, roughly consistent with Semmelweis's own level achieved, due to the death rate in the April 1849 period until late 1953. These results indicate that Braun continued, diligently, to request chlorine washing.
At a conference of German physicians and natural scientists, most of the speakers rejected his doctrine, including the famous Rudolf Virchow, who was a scientist of the highest authority of his time. Virchow's immense medical authorities contribute strongly to Semmelweis's lack of recognition. Ede FlÃÆ'³riÃÆ'¡n Birly, the precursor of Semmelweis as Professor of Obstetrics at the University of Pest, never accepted the Semmelweis teachings; she continues to believe that puerperal fever is caused by intestinal defilement. August Breisky, an obstetrician in Prague, rejected Semmelweis's book as "naïve" and he called it the "Qur'anic theology of childbirth". Breisky objected that Semmelweis has not proved that puerperal fever and pyemia are identical, and he insists that other factors beyond decomposing organic matter must necessarily be included in the aetiology of the disease. Carl Edvard Marius Levy, head of Copenhagen maternity hospitals and a vocal critic of Semmelweis's idea, has doubts about the nature of the particle that is not specific and that the amount should not be unreasonably small. In fact, Robert Koch then uses this fact to prove that the various infecting materials contain living organisms that can reproduce in the human body; that is, because the poison is not chemical or physical in operation, it must be biological.
It has been argued that Semmelweis can have a greater impact if he successfully communicates his findings more effectively and avoids controversy with medical standpoints, even giving opposition from a rooted perspective.
Details and death
Beginning in 1861, Semmelweis suffered from various nervous complaints. She suffered from severe depression and became dazed. Paintings from 1857 to 1864 show the development of aging. He diverts every conversation to a puzzle puzzle topic.
After a number of unfavorable foreign reviews from his 1861 book, Semmelweis criticized his critics in a series of Open Letters. They addressed to various leading European obstetricians, including SpÃÆ'¤th, Scanzoni, Siebold, and for "all obstetricians". They are full of bitterness, despair, and anger and "very polemic and very offensive", sometimes denouncing their critics as murderers or irresponsible fools. He also asked Siebold to arrange a meeting of German obstetricians somewhere in Germany to provide a forum for discussion of puerperal fever, where he will stay "until everything has been converted to his theory."
By mid-1865, his public behavior became annoying and embarrassing for his colleagues. He also started drinking liquor; he spends more time away from his family, sometimes at a whore company; and his wife noticed changes in his sexual behavior. On July 13, 1865, the Semmelweites visited friends, and during the visit Semmelweis's behavior seemed inappropriate.
The exact nature of Semmelweis's suffering has become a matter of debate. According to K Codell Carter, in the Semmelweis biography, the exact nature of his suffering can not be determined:
It is impossible to assess the nature of the Semmelweis interruption.... It may be Alzheimer's disease, a type of dementia, which is associated with rapid cognitive decline and mood swings. It may be the third stage of syphilis, a common obstetrician disease that examines thousands of women in free institutions, or perhaps because of overwork and stress.
In 1865, JÃÆ'¡nos Balassa wrote a document referring Semmelweis to a mental institution. On July 30, Ferdinand Ritter von Hebra lured him, under the pretext of visiting one of the "new Institutions" of Hebra, to the Vienna municipal hospital located at Lazarettgasse ( Landes-Irren-Anstalt in der Lazarettgasse ). Semmelweis suspect what happened and tried to leave. He was beaten by several guards, secured in a tight jacket, and locked up in a dark cell. Apart from tight jackets, treatments in mental institutions include watering with cold water and provision of castor oil, laxatives. He died after two weeks, on August 13, 1865, age 47, of a gangrenous wound, possibly caused by a beating. Autopsy provides the cause of death as pyemia - blood poisoning.
Semmelweis was buried in Vienna on August 15, 1865. Only a few people attended the service. A brief announcement of his death appeared in several medical magazines in Vienna and Budapest. Although the rules of the Hungarian Doctors Association and the Natural Scientist determined that a warning speech was delivered in honor of a member who had died the previous year, there was no address for Semmelweis; his death was never mentioned.
János Diescher was appointed as a replacement for Semmelweis at Pest University's maternity clinic. Immediately, the death rate spiked sixfold to 6%, but doctors in Budapest did not say anything; no questions and no protests. Almost no one - either in Vienna or in Budapest - seems to have been willing to acknowledge the life and work of Semmelweis.
His body was transferred to Budapest in 1891. On October 11, 1964, they were transferred once again to the home where he was born. The house is now a museum and historical library, respecting Ignaz Semmelweis.
Legacy
Semmelweis's suggestion of chlorine washing may be more influential than it realizes. Many doctors, especially in Germany, seem quite willing to experiment with the practical handwashing steps that he proposes, but almost everyone rejects basic theoretical innovations and breakthroughs - that the disease has only one cause, a lack of cleanliness. Professor Gustav Adolf Michaelis of the birthing institution in Kiel responded positively to Semmelweis's suggestion - he eventually committed suicide, because he felt responsible for the death of his own cousin, whom he examined after he gave birth.
Only with late observational evidence receives wide acceptance; more than twenty years later, the work of Louis Pasteur offers a theoretical explanation for Semmelweis's observations - the germ theory of disease. Thus, the Semmelweis story is often used in university courses with epistemological content, such as the philosophy of science courses - demonstrating the virtues of empiricism or positivism and providing historical accounts of what kinds of knowledge are considered scientific (and thus accepted) knowledge, and which are not. It has been seen as an irony that critics of Semmelweis consider themselves positivist, but even positivism suffers from problems in the face of seemingly magical or superstitious theories, such as the idea that "corpse particles" can transform a person into a corpse, without the causal mechanism established, after simple contact. For his contemporaries, Semmelweis seems to have returned to speculative theory from previous decades so disgusting to his positivist contemporaries.
The so-called Semmelweis reflexes - a metaphor for certain types of human behavior characterized by reflex reflexes of new knowledge as opposed to embedded norms, beliefs, or paradigms-named after Semmelweis, whose ideas are mocked and rejected by people his contemporaries.
Source of the article : Wikipedia
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