Sometimes you’re wrong
Riki Gifford-Ferguson (11 AM Micro) thought I was wrong, and it turned out she was right! For her diligence, I hereby award House Gryffindor a special Bonus Point. The discussion came about during my overview of the work of Ignaz Semmelweis, and the origins of public health measures. I won’t rehash the story of Semmelweis beyond briefly summarizing it; for a more in depth discussion, here is a link to a previous blog posting. Semmelweis charted the incidence of puerperal or childbed fever, in two Viennese hospitals during the early 1840’s, and noted a significant difference in the number of cases. From this data, he instituted infection control measures that essentially eliminated puerperal fever, and ultimately published his results in a lengthy monograph in 1861. His conclusions were not well received, and he was apparently tricked into being committed to an insane asylum in 1865. He died later that year after a beating.
Riki remarked in class that she thought Oliver Wendell Holmes (1809-1894) had provenance in the link between medical practice and puerperal fever, and pointed me to his story. I was not aware of Holmes’ role in medical research, but instead knew of him as an essayist and poet. It turns out that Holmes also postulated the role of the health care worker in transmitting puerperal fever between patients, and indeed published a monograph in The New England Quarterly Journal of Medicine and Surgery in 1843. This article essentially went unnoticed, and was republished in 1855 in expanded form several years before Semmelweis’ publication. Interestingly, Holmes first clue to the link between physician and sick patient was hearing about another physician who died a week after performing a postmortem exam on a woman with puerperal fever. This was an ‘Aha!’ moment very similar to that experienced by Semmelweis at just about the same time. I cannot find any indication that Semmelweis was aware of the work of Holmes at this time, which is not surprising, given the extremely low profile of Holmes’ 1843 publication.
So what about medical outcomes? Sadly, the recommendations by either man were not broadly accepted by their respective medical communities, and both were largely ridiculed by their colleagues. Semmelweis died before he could be vindicated, but Holmes at least was able to live to see the recognition of the Germ Theory of Disease during the latter part of the 19th century. At the time, Holmes argument of the link between physician and patient resulted in no changes to medical procedure. His recommendations (purification of surgical instruments, burning of clothes following a fatal delivery, not practicing medicine for 6 months following a case of puerperal fever) were not adopted. In contrast, while Semmelweis was in charge of the maternity clinic in the Vienna General Hospital, he was able to institute control procedures that immediately resulted in a drastic improvement in patient outcomes, and a maternal mortality rate very much in line with what we see today.
UPDATE: Yikes! A ton of Facebook referrals here this morning! Was this article re-shared by someone?