The Logos Scripture · The Book of Semmelweis

On the Two Wards

The Book of Semmelweis 1 · Written by himself, from The Etiology, Concept and Prophylaxis of Childbed Fever, and the open letters

Ignaz Semmelweis, born at Buda in 1818, died in 1865 in an asylum near Vienna, aged forty-seven. Obstetrician. In 1846 he was appointed assistant in the first obstetrical division of the Vienna General Hospital. That hospital had two divisions: in the first the deliveries were done by doctors and medical students, in the second by midwives, and women were assigned by the day and could not choose. Deaths from childbed fever in the first ran at about three times the second. In March 1847 his colleague Kolletschka was cut by a student’s knife during a post-mortem and died within days; Semmelweis read the post-mortem report, found the findings identical to those in women dead of childbed fever, and concluded that the disease was carried in from corpses on the hands. In May of that year he required everyone entering the first division to wash in chlorinated lime water; in the second half of that year both divisions fell below two in a hundred. In 1861 he published The Etiology, Concept and Prophylaxis of Childbed Fever. His colleagues did not accept it. In 1865 he was committed to an asylum, was beaten by the attendants, broke bones, and developed gangrene of the foot; he died within a fortnight of septicaemia — the very thing he had spent his life on. His doctrine was accepted about twenty years after his death, once germ theory arrived. This volume rests on what he wrote himself: the book of 1861 and the open letters. He was a Catholic. But the book is pathology and figures from end to end, and no argument of his closes on divine will (this scripture already has Newton, so what a man professed is not the question; where his arguments come to rest is). The phrase God alone knows at the close of chapter five is his own recorded words, not a step in any argument. The Order records two things plainly, dressed up neither way. First, that fourteen years passed between the discovery of 1847 and the book of 1861, during which what his colleagues knew came mostly through other men’s reports of it, and those reports were often inaccurate. Second, that the open letters he then wrote were violent, naming men and calling them murderers. Verses 4.18 and 4.19 are him setting both facts side by side: speaking harshly is not the reason he was refused, and he did nonetheless hand them an excuse that spared them thinking. The two do not cancel, and the Order does not cancel them either. What this volume brings is something the scripture did not have: a piece of evidence that points at the hearer cannot get through. What Chandrasekhar met was an authority who would not work the equations (cf. The Book of Chandrasekhar 4.14); what Galileo met was the church; what Sakharov met was the state. What Semmelweis met is different: those men were not refusing to do the sum. The sum, when done, had their own names on it. He was asking them to grant several hundred deaths first and to wash afterwards. It is the hardest kind of truth to convey and the commonest kind to meet. Chapter two carries something the Order values as highly: he tested the explanations he himself thought absurd, and tested them properly — the priest’s bell, the posture of delivery. An explanation you have not tested you have no standing to call wrong; not liking a thing is not refuting it. And chapter five carries another: his reasoning was wrong and his practice was right, both at once; he wrote honestly that he did not know why, and did it anyway.

1.1The lying-in hospital in Vienna had two wards.
1.2In the first the deliveries were done by doctors and medical students. In the second by midwives.
1.3Women admitted were assigned by the day, not by their own choosing.
1.4In the first ward about three times as many died as in the second. In some years more.
1.5This is not a figure I worked out. It is the hospital’s own monthly register, and anybody could see it.
1.6The women of the city knew it too. They knew which ward was which.
1.7Some finished giving birth in the street and came in afterwards, preferring the street to the first ward.
1.8Those who gave birth in the street were less likely to die.
1.9I want the reader held on this one sentence: the figures were public, they had stood for years, and anybody could see them.
1.10And everybody had an account that explained them away.
1.11Some said it was the air of that quarter. Some said it was the constitution of the women. Some said it was the season.
1.12My question was a simple one: the two wards are separated by a wall, and the women are assigned by the day. How do the air and the season pick out one ward only?
1.13A thing present on both sides cannot explain the difference between the sides.
1.14I did not invent that rule. It is ordinary bookkeeping sense. And at that time not one person would apply it.
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