Scientific Inquiry: Invention and Test

Hampl

Hempl, in this essay, considers Semmelweis’ work on childbed fever to illustrate some important aspects of scientific inquiry. Ignaz Semmelweis was a physician who did this work at the Vienna General Hospital from 1844 to 1848. As a member of the medical staff of the First Maternity Division in the hospital, he was worried to find that a large number of the women who were delivered of their babies in that division caught a serious illness known as childbed fever. The death rate of the mothers of the division was also very high. But in the Second Maternity Division of the same hospital, the death rate from the fever was much lower. 

Semmelweis wanted to solve the problem. He began by considering various explanations that were current at that time. One widely accepted view attributed the childbed fever to epidemic influences. But he questioned how such influences could affect the first division only. Finally, he noted that some of the women admitted to the first division had given birth in the street. He thought they were the cause of this disease. But despite these adverse conditions, the death rate from the fever among them was lower.

Some said overcrowding was a cause of mortality in the first division. But Semmelweis refuted the statement by pointing out that overcrowding was heavier in the second division.

In 1846, a commission that had been appointed to investigate the matter concluded that injuries resulting from rough examination by medical students caused illness to the first division. But Semmelweis countered this view saying that the injuries resulting naturally from the process of birth were much more extensive than those that might be caused by rough examination.

Various psychological views were attempted. One of them noted that the first division was so arranged that a priest bearing the last sacrament to a dying woman had to pass through five wards before reaching the sickroom beyond: the appearance of the priest was held to have a terrifying effect upon the patients in the wards and thus to make them more likely victims of childbed fever. Semmelweis tested this and proved false.

He observed that in the first division the women were delivered lying on their backs; in the second, on their sides. So, he introduced the use of the lateral position in the first division, but the mortality remained unaffected.

At last, the death circumstances of his colleague enabled him to conclude that his patients had died of blood poisoning. He with his colleagues and medical students would come to the wards directly from performing dissections in the autopsy room and examine the patients after only superficially washing their hands. He put his idea to test. He ordered all medical students to wash their hands in a solution of chlorinated lime before making an examination. As a result, the death rate from the fever began to decrease.

The hypothesis also explained the lower mortality among street births. The reason was that women who arrived with babies in arms were rarely examined after admission and thus had a better chance of escaping infection.

Semmelweis broadened his hypothesis after further clinical experiences. His broadened hypothesis was that childbed fever can be caused not only by cadaveric (=of corpses) material but also by foul matter derived from living organisms.