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the holiest hour of her life the woman is beaten down by an unknown hand. And the physicians who should save her, stand helplessly by discussing etiology.
The young doctor thinks and thinks. He is a favorite of Rokitansky, and in the early morning, before his duties in the hospital begin, he examines and operates on the females who died from puerperal fever, or any diseases peculiar to women. But nothing that he has ever observed can furnish an inkling of the truth.
What mystery of medicine is this which carries off women without a determinable cause? Pregnancy is not a nine months' disease; it is natural, and healthy puerperants should not succumb. And here is the strange part of it all: the maternity hospital is divided into two divisions: the first for medical students, and the second for midwives. The conditions are identical in each, and yet so many more die in the first division than in the second. The first clinic has long had a bad reputation, and therefore the second ward is always more crowded, and yet the mortality continues to be higher in the first. Why should this be?
Fear of the first division is claimed to have something to do with the matter. But psychic state can never produce such anatomical changes as are seen in puerperal fever.
They say the women are ashamed to undergo parturition in presence of the men, and therefore die from modesty. But how can a condition of mind cause a gangrenous endometrium?
They speak of epidemic influences. But why should an epidemic spare one clinic and attack another, when both are under the same roof? Besides, when the fever rages at its worst in
the hospital, the women delivered in their homes are not affected more than usual. An epidemic is not lim ited by walls: cholera spreads over a wide area.
It is said that so many of the women die because they are unmarried and have been seduced. But this cannot explain the difference in the mortality of the two divisions, since exactly the same class of patients are admitted to both clinics. Moreover, nature never feels outraged because the mother does not possess a marriage-ring.
It is argued that the medical students examine the women in a rougher manner than do the midwives, and thus cause injury which results in death. But certainly a uterus enlarged by a fetus can tolerate the most ungentle index finger.
They say the ventilation is wrong, but the same method of allowing air to enter is employed in both divisions.
It is all nonsense to talk about the diet, the warming, the washing. The same caterer supplies food to both divisions; the same washerwomen clean the linen of the first and second clinic.
The women surprised by labor in the streets, who give birth to children on door-steps and under arch-ways, tho the day be cold or the night stormy, are not attacked by puerperal fever. Why, women of the country, gored open and delivered of their seed by the horns of maddened bulls, have a better chance of life than the preg nant female who comes to lie in the First Obstetric Clinic of Vienna's famous Maternity Hospital.
Thus musing, the distracted Assistant finds he has walked far out-to the Central Cemetery, where reposes the illustrious dust of Beethoven and Mozart and Gluck and Schubert.
But Semmelweis is not in a mood for melody. The subtle and resistless onset of puerperal fever, the vacant chair by the desolated fireside, the straight road from the marriage-bed to the dead-house, the husband undone and a baby for a salaried wet-nurse,these are the discords which afflict the sensitive Hungarian who has taken the vow of Hippocrates.
He has reached the environs of Vienna. In the distance, seeming to come from the left bank of the Danube, in the direction of the battlefield of Wagram, he hears the note of a church-bell. He starts disagreeably at the sound. He has heard that doleful tone too often of late. At the Clinic, when the end draws near, and the priest bears the last sacrament to her who bids the world farewell, a bell is rung to mark the passing of a soul. And this frequent, solemn tolling jars with strange effect the nerves of the doctor.
He turns homeward: the problem yet unsolved, still in the grip of a hideous malady. Everywhere is endless confusion; only this much proven: they die, they die, they die. Again the bell clangs: it is an exhortation, O Semmelweis! to be clear of vision and find the source of childbed fever, so the mothers of the race may conceive in safety, and breasts ripe for nursing will not shrivel till the love-fruit takes its fill.
In the early spring of 1847.-the same year that Oliver Wendell Holmes became Professor of Anatomy at Harvard-Semmelweis went for a short vacation to Venice, but unlike Byron, he did not lean back in a gondola with voluptuous languor, while a black-eyed Venetian girl opposite read the tales of Boccaccio.
On the Twentieth of March he re
turned to Vienna, and a few hours. later was at his post, prepared to resume his duties with renewed ardor. But the first news he heard was the sad fate of Kolletschka, a friend whom he highly esteemed. Kolletschka was Professor of Medical Jurisprudence, and while performing a post-mortem examination in a medico-legal case, was accidentally pricked on the finger by the knife of a pupil. Thru the tiny stab-wound the poison from the scalpel's tip entered, and inflammation ran wild in the Professor's body: lymphangitis, phlebitis, peritonitis, pleuritis, meningitis. Blood-vessel and lymph-channel conveyed the infection to his eyes, and Kolletschka was sightless and lifeless before Semmelweis returned from feeding the pigeons that fly below the golden horses of St. Mark.
As Semmelweis listened to the details of the case, to him as to Porphyro on a sweeter occasion, "a thought came like a full-blown rose, flushing his brow, and in his pained heart made purple riot." Lymphangitis, phlebitis, peritonitis, pleuritis, meningitis,— these were the symptoms observed in women who perished of puerperal fever. Semmelweis saw that Kolletschka and the puerperal women died from an identical cause-from septic infection, from poisoned cadaveric material absorbed by the vascular system. Puerperal fever was not a malady unique in nature-it was simply a form of pyemia!
Now it became clear why the mortality of the first obstetric clinic was so much higher than the second: the instruction of the midwives did not include work on the cadaver; therefore they did not often come into contact with decomposing organic matter. But pathologic anatomy was all the
rage in Vienna, and the medical stuIdent had an overdose of dissection. From the dead-house they came to the labor-ward, and with hands to which the cadaveric particles still adhered, poison lurking behind every fingernail, they examined the pregnant, parturient, and puerperal women. And the gaping genitals freshly wounded by travail, the denuded surface of the vagina, the fissures about the fourchette, the lacerations near the mouth of the womb, easily sucked up the noxious virus that spelled disaster and death.
so alive to new ideas, we must say that Rokitansky kept sweet and sane by memorizing Kant and marrying a singer. Hebra, who knew so much about itch that we call him the Father of Modern Dermatology, was editor of the Journal of the Medical Society of Vienna, and wrote a couple of articles in which he linked the name of Semmelweis with that of Edward Jenner. In return for the compliment, Semmelweis acted as accoucheur in Frau Hebra's next confinement, and his skilled and sterilized hands delivered the good woman in safety.
But not many were as clear-headed as this triumvirate, and misoneism,that insidious inertia of the min:1 which makes mankind averse to innovation, soon asserted itself in clinic, hospital and lecture-room. Semmelweis awoke and found himself famous -and hated.
A little later Semmelweis discovered that not only decomposing cadaveric matter, but that putrid matter derived. from living organisms, and even the atmosphere when overloaded with foul exhalations, may produce the dreaded septicemia. After this, the students. who came to the First Clinic found a new rule: before touching a woman they must disinfect their hands with a solution of chlorinated lime. This was the introduction of antisepsis into obstetrics. Immediately the slaught--the fever of 1848. This was the ering of the mothers was lessened, and year in which barricades rose like soon-for the first time in the history magic to the sound of the singing of of the Vienna Lying-in Hospital-the the Marseillaise; the year of Mazzini mortality in the First Division fell be- and the Roman Republic; the year of low that of the Second Division. A Garibaldi and his red-shirts; the year chunk of chloride of lime upsetting a of flying popes and abdicating emperhundred theories, accomplished this ors; the year of overturned thrones. miracle. Now to proclaim the Doc- and angry peoples; the year when the trine to the whole world! workingman's pike was aimed at the monarch's scepter; the year of endless courage and divine defiance; the year of young blood and new life.
Semmelweis had reason to congratulate himself: the next day the three greatest men in Vienna were his disciples. Skoda referred to his discovery as one of the most important in the domain of medicine. Rokitansky at once accepted his new etiology of puerperal fever. Lest it be deemed strange that a man whose days were spent in the dissecting-room should be
At this period, however, something happened in Europe which caused even Semmelweis to forget puerperal fever. A nobler fever attacked Mother Earth
Knout-cursed Russia did not tug at her chains, but every other nation leaped up in fiery revolt. Of course, Austria was all turmoil, for Austria. the lengthened shadow of Metternich, was the chief oppressor of western Europe. The university students of
Vienna, cursing the prince's cruelty, broke into Metternich's home, and drove the old monster over the continent.
Professors and pupils, physicians and lawyers, formed an Academic Legion. Ferdinand Hebra, tho more accustomed to dermatologic eruptions than to political ones, enrolled as a member. Ernest Krackowizer, the first person in Vienna on whom the anesthetic properties of chloroform were tried, unsheathed his sword for freedom. And when the reactionary Professor Klein walked thru his clinic, whom should he see arrayed in the uniform of the revolutionary Legion, but his assistant, Dr. Ignaz Philipp Semmelweis. He could hardly recognize him at first because of the broad hat with the waving plume. And what was it he held in his hand-a scalpel or a sword? Hippocrates was supplanted by Louis Kossuth.
In Berlin the worthiest sons of Esculapius acted in the same way. Rudolph Virchow was deprived of his posts by the Prussian authorities, and another turn of the fickle wheel of fortune might have snuffed out his life. Physicians have not yet discovered the drug that ensures perpetual youth, and few who warmed their hearts in the sacred blaze of 1848, are now alive. Yet we all know one physician who was then in prison for liberty's sake, and still lives and practices his profession, and has recently become the President of the American Medical Association: Ave Magister, Abraham Jacobi!
Magyarland, under the brilliant. leadership of Kossuth, was gaining its independence. But the strong Czar poured his armies into Austria, and a hundred thousand armed Russians
trampled out Hungary's freedom. The flame of rebellion flickered low, and 1849 was the year of reaction. The barricades were razed to the ground, the Marseillaise was sung no more, the aspirations were quenched, the monarchs returned, a host of revolutionaries-those who escaped death and dungeons-flocked to England and America, while several who were not too deeply compromised sought to resume their former positions.
Semmelweis came back to the Obstetric Clinic, and found a new proof of the truth of his doctrine: during the month of March, 1848, such excitement had prevailed in Vienna, that the parturient women in the lying-in hospital were practically neglected, and that was the only month in which not a single death or sickness occurred.
Semmelweis and his companions decided to carry on their propaganda, not thru pamphlets or the press, but
by private letters addressed to various of remorse breathed hot into his ear. teachers of midwifery.
Professor Michaelis of Kiel, whose work on the Obliquely Contracted Pelvis is still famous, received one of these letters and was impressed by the contents. Michaelis, a conscientious man, was much worried over the prevalence of puerperal fever in his clinic. In fact, not being able to cope with the situation, he found it necessary to close the hospital for a time. He now introduced Semmelweis's method of chlorine disinfection, watching results, and the outcome was this: no more puerperal fever. Michaelis was profoundly grateful, and regarded Semmelweis as a benefactor of the human race.
Michaelis rushed from his house. His darkened eyes saw nothing, but he heard a train with snorting breath rumble over the parallel rails. He advanced feverishly, threw himself upcn the trackway, and when the locomotive passed there was only a book on The Contracted Pelvis to keep alive. the name and fame of Professor G. A. Michaelis of Kiel. So the gospel of Semmelweis was sanctified by a martyr's blood.
A scourge abolished! The excellent professor hummed in satisfaction, but a shooting pain broke off the song on the penult of a word. His niece, his beloved niece-what dreams she had when she felt her babe move within her already in anticipation she saw her child climb to distinguished heights-how anxious she was to sew a coverlet with which to warm the little stranger on his first appearance—and she had trusted her uncle-so innocently she had looked up in his face and put her doublyprecious life in his hands-and with these same hands he had murdered her -with these stained hands he had conveyed puerperal fever to her, and her dreams were done-she wrapped the sheets of the childbed around her as a snowy shroud, and said Good-by, and died. The warm-hearted Michaelis recoiled at the unlivable horror of the thing. Something sticky seemed to cling to his fingers. These fingers killed her, and she did not even reproach him. But how the keen voice
Semmelweis was likewise forced to admit that he himself had been the harbinger of death in many households: "When an assistant took special interest in pathologic anatomy, and made many post-mortem examinations, the mortality was high. Consequently must I here make my confession that God only knows the number of women whom I have consigned prematurely to the grave. I have occupied myelf with the cadaver to an extent reached by few obstetricians. However painful and depressing the recognition may be, there is no advantage in concealment; if the misfortune is not to remain permanent, the truth must be brought home to all concerned."
Correspondence was also entere into with Simpson of Edinburgh, who introduced anesthesia introduced anesthesia into obstetrics
the same year that Semmelweis introduced antisepsis. Simpson read the letter in haste, and replied with a Scotch accent: He knew without being told how filthy the maternity hos pitals in Germany and Austria were; he knew that the high mortality was due to the criminal carelessness of placing a healthy lying-in woman on the same bedclothes and linen in which a parturient woman had just died; if