Blood and Guts by Richard Hollingham Page B

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the challenge of tackling childbed fever.
    He returned to find that, in his absence, one of his best friends
had died. Professor Jakob Kolletschka, a pioneer of forensic medicine,
had become fascinated by finding out how people died, and
conducted regular autopsies. It was during an autopsy that he met
his fate. He had been dissecting a body with some students. The
hand of one of them slipped while making an incision and accidentally
pricked Kolletschka's finger. The professor thought nothing of
it – the cut was small, these sorts of things happened all the time.
For anyone involved in surgery or medicine, cutting yourself with a
scalpel was an occupational hazard.
    Within a few hours there was some redness around the wound,
but nothing to worry about. The redness started to spread up
Kolletschka's arm, he became feverish and sores began to develop.
Soon he was covered in multiple abscesses and had a swollen
abdomen. The post-mortem found that his organs were infected and
he experienced pneumonia and meningitis. Kolletschka eventually
became delirious and slipped into a coma. Only a few days after
becoming infected, he was dead. Semmelweis was distraught.
    Kolletschka was not only a close friend – the two men had often
worked together, and Kolletschka had supported Semmelweis
throughout his obsession with childbed fever. But Kolletschka was to
help Semmelweis one last time.
    Reading through the post-mortem protocol, it did not take long
for Semmelweis to realize that his friend's symptoms were identical to
those of the women who died of childbed fever. His mourning would
have to wait. Now he knew what was killing the women. 'The exciting
cause of Professor Kolletschka's death was known,' he proclaimed. 'It
was the wound by the autopsy knife that had been contaminated by
cadaverous particles. Not the wound, but the contamination of the
wound by the cadaverous particles caused his death.'
    Semmelweis had realized that if his friend had been killed by
particles from a dead body, then the same particles were killing the
women. Doctors were conducting autopsies and then administering
to their patients. At best they might wash their hands with soap
before conducting vaginal examinations, but this still left the lingering
smell of the cadavers. The doctors were spreading the disease.
They had been carrying death on their hands. Semmelweis had
been killing the very patients he was trying to help. The conclusion
was shocking. 'I have examined corpses to an extent equalled by few
other obstetricians,' he wrote. 'Only God knows the number of
women who descended prematurely into the grave because of me.
None of us knew that we were causing the numerous deaths.'
    Semmelweis decided that something more than a quick wash
with soap and water was needed to stop the spread of material from
cadavers to patients. In the middle of May 1847 he introduced a
strict new regime in the clinic. Before examinations all doctors had
to wash their hands in chloride of lime, a caustic chemical much like
bleach. He posted notices to this effect:
    All students and doctors who enter the wards for the purpose
of making an examination must wash and scrub their fingers
and hands thoroughly in the solution of chlorinated lime
placed in basins at the entrance to the wards. One disinfection
is sufficient for one visit, but between the examination of each
patient the hands must be washed with soap and water.
    The results were better than Semmelweis could have hoped for.
    In April 1847 there had been 57 deaths, the worst monthly
mortality rate yet at 18.27 per cent. In May the figure came down to
36 deaths, or 12.24 per cent. The June figure was remarkable: there
were only six deaths – a rate of 2.38 per cent, better even than the
midwives' clinic. The following months were better still: in March
and August 1848 not one patient died. Statistically, it was now safer
for women to give birth in the hospital than at home. Thanks to
Semmelweis, the hospital was