And, of course, the application of that principle is not limited to the performance of the major operations of surgery. It is in daily use in every hospital, and in every practice all the world over, for the safe and quick healing of whole legions of injuries, "casualties," and minor operations.
But what of Semmelweis, and his study of puerperal fever? Did he not, before Lord Lister, and without the help of experiments on animals, discover antiseptic surgery? His claim is urged by those who are opposed to all such experiments. And the answer is, that his work was lost just for want of experiments on animals. If he could have demonstrated, as Pasteur did, the living organism, the thing itself, there in the tissues of an infected rabbit, and in a test-tube, and under a microscope, he might have stopped the mouths of his adversaries. He could not. He could only demonstrate to them the fact that their patients died, and his patients lived: and that some sort of direct infection was the cause of the deaths. The tragedy of his life cannot be told too often, and may be told again here.[13] For want of the final proof that bacteriology, and the inoculation of animals, alone could give, he was unable to hold out against his enemies till Pasteur could rescue him.
In 1846, when he was twenty-three years old, Ignaz Semmelweis was appointed assistant-professor in the maternity department of the huge general hospital of Vienna. For many years, the mortality in the lying-in wards had been about 1.25 per cent., and no more. Then, under a new professor, it had risen; and, for some years before Semmelweis came on the scene, it had been 5 per cent., or even 7 per cent. In October 1841, there had been an epidemic that had lasted till May 1843. In these twenty months, out of 5139 women delivered, 829 had died; that is to say, 16 per cent.
There were two sets of wards in the maternity department. The one set may be called Clinique A, and the other Clinique B. For many years, the mortality had been the same in each. In 1841 a change was made: Clinique A was assigned to the teaching of students, and Clinique B to the teaching of midwives: and, so soon as this change had been made, the mortality in Clinique B became less, but the mortality in Clinique A did not. Commissions of inquiry were held, and in vain. It was suggested that the foreign students were somehow to blame, nobody knew why; and many of them were sent away. Still the deaths went on. Women admitted to Clinique A would go down on their knees and pray to be allowed to go home; almost every day the bell was heard ringing in the wards, for the administration of the Sacrament to a dying woman. People talked about atmospheric influences, and overcrowding, and the tainted air of old wards, and the power of the mind over the body: and Semmelweis set to work.
He observed that cases of protracted labour in Clinique A died, almost all of them; but not in Clinique B. He observed also that cases of premature labour, nearly all of them, did well, whichever Clinique they were in; so did those women who were delivered before they came to the hospital, and were admitted after delivery. He observed also that a row of patients, lying side by side, would all be attacked at once in Clinique A; which never happened in Clinique B. He tried everything: he altered the details of treatment; he used various subterfuges to prevent one of the professors from examining serious cases; he enforced this or that rule in Clinique A, because it was the custom in Clinique B; he slaved away at the notes of the cases—and at last the truth came to him, by the death of one of his friends from a dissection-wound. He says, "My friend's fatal symptoms unveiled to my mind an identity with those which I had so often noticed at the deathbeds of puerperal cases." He saw now that the students, coming straight from the dissecting-rooms, had infected the patients during examination.
In May 1847 he gave orders that every student, before examining, should thoroughly disinfect his hands. But, though he had reckoned with dissecting-room poisons, he had forgotten to reckon with other sources of infection. In October of that year, a woman was admitted who had malignant disease; of twelve women examined after her, eleven got puerperal fever, and died. In November, a woman was admitted who had a suppurating knee-joint, with sinuses; and eight women were infected from her, and died. Therefore Semmelweis said, "Not only can the particles from dead bodies generate puerperal fever, but any decomposed material from the living body can also generate it, and so can air contaminated by such materials." Henceforth he isolated all infected cases, he enforced the strict use of disinfectants: and the mortality in Clinique A, which in May 1847 had stood at 12.24 per cent., fell in December to 3.04, and in 1848 was 1.27.
His work was taken up with enthusiasm by Hebra, Skoda, and Haller; the news of it was sent to every capital in Europe. In February 1849 Haller read a paper on it before the Medical Society of Vienna, and said, "The importance of these observations is above all calculation, both for the maternity department and for the hospitals in general, but particularly for the surgical wards." A committee was nominated to report on the whole matter; but it was opposed by the professor in charge of Clinique A, and nothing came of it. In May 1850, Semmelweis opened a great debate on puerperal fever, which occupied three sittings of the Vienna Medical Society. His opponents were there in full force, all the Scribes and Pharisees of the profession. They brought about a vague distrust of his figures and his facts; they got people to believe that there must be "something else" in puerperal fever, as well as the local infection. Semmelweis began to be discouraged. The University authorities made a dead set against him—they refused to renew his appointment, they got him out of the hospital, and out of Vienna. He went to Pesth, and was Professor of Midwifery there; but the same opposition and hostility were at Pesth as at Vienna. Slowly he began to lose his hold over himself, went down hill, became excitable and odd. The end came in July 1865. At a meeting of University professors, he suddenly took a paper from his pocket and read aloud to them a solemn oath, to be enforced on every midwife and every doctor. His mind had given way: he was moved to an asylum at Vienna, and died there a few weeks later. He was only forty-two when he died—What a wounded name, Things standing thus unknown, shall live behind me.
The contrast between the work of Semmelweis and the work of Pasteur cuts like a knife here. The failure of Semmelweis' teaching may be estimated by the fact that it had all to be done over again. The year of his success at Vienna was 1848. Eight years later, in the Paris Maternity Hospital, between 1st April and 10th May 1856, came such an outbreak of puerperal fever that out of 347 patients 64 died. In 1864, out of 1350 cases, 310 deaths. In Jan.-Feb. 1866, out of 103 cases, 28 deaths: "Women of the lower classes looked upon the Maternité as the vestibule of death." In 1877-78, came the use of carbolic acid and perchloride of mercury at the hospital, thirty years after Semmelweis' work: and, about the same time, Pasteur's discovery of the streptococcus in puerperal fever.[14] Pasteur could demonstrate to his opponents the visible cause of the infection, the thing itself. Roux tells the story:—
"Dans le pus des abcès chauds et dans celui des furoncles on constate un petit organisme arrondi, disposé en amas, qu'on cultive facilement dans le bouillon. On le retrouve dans l'ostéomyélite infectieuse des enfants. Pasteur affirme que l'ostéomyélite et le furoncle sont deux formes d'une même maladie, et que l'ostéomyélite est le furoncle de l'os. En 1878, cette assertion a fait rire bien les chirurgiens.
"Dans les infections puerpérales, les caillots renferment un microbe à grains arrondis se disposant en files. Cet aspect en chapelet est surtout manifesté dans les cultures. Pasteur n'hésite pas à déclarer que cet organisme microscopique est la cause la plus fréquente des infections chez les femmes accouchées. Un jour, dans une discussion sur la fièvre puerpérale à l'Académie de Médicine, un de ses collégues le plus écoutés dissertait éloquemment sur les causes des épidémies dans les maternités. Pasteur l'interrompt de sa place: Ce qui cause l'épidémie, ce n'est rien de tout cela: c'est le médecin et son personnel qui transportent le microbe d'une femme malade à une femme saine. Et comme l'orateur répondit qu'il craignait fort qu'on ne trouve jamais ce microbe, Pasteur s'élance vers le tableau noir, dessine l'organisme en chapelet de grains, en disant, Tenez, voici sa figure." (Roux, L'Œuvre Médicale de Pasteur. Agenda du Chimiste, 1896, p. 528.)