Excerpts from the diary of Ignaz Phillip Semmelweis

February 28th, 1846 I have just received news of a most wonderful nature. I have been successful in my application of doctor at the Vienna Maternity hospital, where the poor women of the city give birth. I know that this is a complete change to my original career of a lawyer but I was just so overwhelmed by the amazing work that Professor Karl Rokitansky is doing there that I just could not turn down this opportunity. I will spend my days attending the women in childbirth and carrying out post-mortems.

April 14 th , 1846 I have just completed my first day working at the hospital. It was a real shock to see the women that suffer in the wards there. I found out that last month 36 of the 208 women died after childbirth from a fever. Professor Rokitansky informs me that this is quite normal and is common in hospitals throughout the country. It is caused by changes in the air, or for some women it is a punishment from God. Whatever the cause, I can’t help feeling sorry for those poor women, and their babies. I am going to make it my mission to stop this dreadful disease.

Read through these diary entries from Semmelweis, a doctor at the Maternity Hospital in Vienna, Austria. Your task is to look through the rest of the information in this pack and help him come up with a theory as to how this disease is being spread and how it can be stopped.

Passage taken from ‘The Oxford Medical Textbook’ (1825) Puerperal fever (Childbed fever)

This disease affects women within the first three days after childbirth and progresses rapidly, causing acute symptoms of severe abdominal pain, fever and debility. There is no treatment and most women will die within 3 days of onset of the disease.

The women die from inflammation in almost all parts of the body, including the womb, the liver, the spleen, the lymph glands, the peritoneum, the kidneys and the meninges.

The cause of the disease is not known (some have suggested a change in the air, a movement in the earth or extraterrestrial activity), although it is more common in women of a working class. It is probably spread through contaminated air.

A History of the Vienna Maternity Hospital

1784 – Hospital opened. The director was Lucas Boer.

1823 - Boer was succeeded as director by Johannes Klein. 1833 - The hospital had become so overcrowded that an extension was built and two clinics were created. 1839 – The first clinic became a training clinic for doctors. The second clinic was used for training midwives.

Vienna Hospital

Vienna hospital has a fine tradition of employing doctors of the highest academic standards.

Karl Rokitansky (1804 -) Professor of pathological anatomy at Vienna and with Joseph Skoda is a founder of the New Vienna School. One of the leading figures in pathological anatomy in Europe.

Lucas Boer (1754 – 1812) The first director of our famous Maternity Hospital. He was a well-respected leader but was unconventional in that he did not allow his medical students to carry out post-mortems on the deceased.

Dr Jan V Hirschmann (1741-1805) Highly respected doctor who had many rich Austrians as his private clients, including the composer Mozart.

Johannes Klein (1789 - ) Current director at the Vienna Maternity Hospital. Introduced routine post-mortems for the purpose of teaching. He trains his medical students by insisting they carry out post-mortem examinations as well as examinations of the women in the hospital to get a better understanding of human anatomy.

Timetable for Carl Menger, Medical Student

9 o’clock to 11 o’clock – Lecture on anatomy in main lecture theatre given by Professor Rokitansky.

11 o’clock to 1 o’clock – Visit to wards in first division.

1 o’clock to 2 o’clock – lunch 2 o’clock – 4 o’clock – Post-mortem examinations on deceased patients.

4 o’clock – 7 o’clock – Examinations of women on wards in first division including assisting in births.

Vienna Maternity Hospital

Memo to all Doctors and students On a recent visit to the first division I noticed that some men are attending to women with hands bloodied from post-mortems. This does not induce a calm feeling in the women. You must follow procedure and make sure your hands are wiped with a cloth before leaving the morgue. Johannes Klein (Director)

February 17 th , 1847 I am leaving to have a 3 week holiday. My colleagues are worried that I will suffer a nervous breakdown because of my ‘obsession’ with this illness.

March 9 th , 1847 I have come back to work to find that, not only the illness is rife within the clinic but a good friend, Professor Kolletschka has died. During an autopsy on a dead woman a clumsy student cut his arm with a scalpel. The next night Jakob came down with a terrible fever and a few days later died. I asked for the report on his post-mortem and I include it here.

Vienna Hospital Post-Mortem Report

Name: Jakob Yohann Kolletschka Date of Birth: 18 th July, 1812 Confirmed date of death: 27 th February, 1847 Post-Mortem carried out by: Dr Carl Heinst On opening of the peritineal cavity there was evidence of suppuration and inflammation of the lymph glands, the liver, the pleura, the peritoneum, the pericardium and the meninges. Cause of death was shutdown of vital body organs caused by fever.

Classified Information

Date Information

1784 1822 1823 1832 1833 1838 1839 1846 Director was Carl Boer.

Johannes Klein took over as director Separation of hospital into two clinics, with roughly the same number of midwives and doctors in each.

Separate arrangement of the two clinics: First clinic: Doctors and student doctors Second clinic: Midwives

Number of deliveries

71,395 28,429 First clinic 23,059 Second clinic 13,097 First clinic 20,204 Second clinic 17,791

Number of deaths

897 1,509 First clinic 1,505 Second clinic 731 First clinic 1,989 Second clinic 691

First Clinic

Vienna Maternity Hospital

Admits patients on Sunday, Tuesday, Thursday and Saturday.

Second Clinic Admits patients on Monday, Wednesday and Friday.

Doctors from the First Clinic carrying out a post-mortem examination.

Women on one of the wards in the Second Clinic.

B Ward A Ward nge lou ent’s Stud B Ward A Ward