Part I – What is the Problem? What is the Cause? Ignaz Semmelweis, a young Hunga

Question

Part I – What is the Problem? What is the Cause?

Ignaz Semmelweis, a young Hungarian doctor working in the obstetrical ward of Vienna General Hospital in the late 1840s, was dismayed at the high death rate among his patients giving birth. This phenomenon had come to be known as “childbed fever.” He began to collect data in the two maternity wards in the hospital (shown in Table 1 in your handout). The first clinic was the clinic attended by physicians and male medical students. The second clinic was the clinic attended by female midwifery students.

Additional reading: http://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives

(Answer each part in 2-3 sentences)

Homework Questions:

1) What were Semmelweis’ initial observations? What do you notice about the maternal death rate (# maternal deaths/# births in the population) from 1841 to 1846 in Table 1?

2) What were some of Semmelweis’ initial hypotheses about what might be causing these deaths?

3) Did Semmelweis understand how the disease was being spread? What do we now know about the spread of disease that Semmelweis and colleagues did not?

Table. Annual births, deaths, and mortality rates for all patients at the two clinics of the Vienna maternity hospital from 1841 to 1846. First Clinic Deaths Second Clinic Births 2,442 2,659 2,739 2,956 3,241 Births 1841 1842 1843 1844 1845 1846 Total Avg. 3,287 3,060 3,157 3,492 4,010 20,042 - Rate 3,0362377.7 15.8 8.9 8.2 6.8 518 274 260 241 459 1,989 Deaths 86 202 164 68 Rate 3.5 7.5 5.9 2.3 2.03 2.7 11.41 | 3.754 17,791 105 691 9.92 3.38

Explanation / Answer

1) Semmelweis' initial observation was the difference in mortality rates in the two clinics between 1841 to 1846. He observed that death rate in the clinic attended by medical students and physicians were higher than the clinic attended by the midwives. The figures in Table 1 shows that there's a higher rate of deaths in first clinic compared to the second. The death rate of first clinic is 9.92 , whereas,of the second clinic is 3.38 that is almost 3 times higher in the first clinic.

2) Intially Semmelweis hypothesized that women at first clinic gave births on their backs and in the second clinic on their sides,so this could be the reason. So he made the women in first clinic to give births on sides,but there was no difference in the mortality rate. Then he assumed that it was priests and his bell who went through the first ward for last rites of the dead, terrified the women in first ward that they developed child fever and so he changed the route of the priest and didn't allow the bell,but this too didn't change the mortality rate.

3) Semmelweis thought that the doctors and medical students who performed autopsies carried some particles of the corpses that got on their hands, to the women while delivering child and this caused the disease,and thus the disease spread. He didn't knew the exact reason of the disease. Now, we know that diseases are caused by pathogens or germs and the germs that got on to the hands of medical practitioner,who also delivered babies got this germs into women's bodies and,thus,the disease spread.

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