Whistle-blower in the Maternity Ward

Whistle-blower in the Maternity Ward

Key Words: Whistleblower, Maternity

Ignaz Semmelweis was the Hungarian obstetrician and a whistle-blower who spoke out about bad practice in maternity wards. The work done by Semmelweis all but removed puerperal fever, commonly known as Childbed fever, from the maternity wards he worked in. He was not the first to try to change the medical practices of his day and like his predecessors, he was to suffer for his outspokenness.

The son of a tenant farmer from Aberdeen was the first modern doctor to realise how the infection was passed from person to person but he had no proof to back up his findings. Alexander Gordon was born in the hamlet of Milton of Drum, eight miles west of Aberdeen in 1752. His twin brother James went on to contribute to the development of farming introducing the Swedish turnip – the swede to Scotland and improving the diet of the Scottish people. James died at the grand old age of 90; his brother Alexander was not so lucky.

Alexander became a medical student and studied at the medical faculty of the University of Leiden in the Netherlands in March 1776. Teaching at the University took the form of topics rather than through learning the writings of the ancient Greek and Roman treatises on medicine. Students learned to exhibit a caring attitude at the bedside and to take meticulous notes.

After his time in Leiden, there is evidence that Gordon attended physicians’ ward rounds at Aberdeen Infirmary, although the city had no formally established medical school. His notes of lectures by Alexander Monro Secundus in the library of the University of Aberdeen indicate that he studied for a time in Edinburgh. After his time in Edinburgh, Gordon joined the Royal Navy, serving as a surgeon’s mate and ship’s surgeon, a move that would have offered the opportunity for adventure but also funding for further medical training before setting himself up in practice.

In April 1785, he retired from the Navy on half-pay and spent nine months in London, as a resident pupil at the Middlesex Hosptial and Store Street lying-in hospitals, where he heard lectures from leading obstetricians and attended dissections and lectures in surgery at the Westminster Hospital. Early in 1786, with an education gained in prestigious medical centres, he returned to practice in his native Aberdeen.

Gordon became a physician to the city Dispensary in February 1786. Here he saw sick people as outpatients or in their own homes, an activity that continued throughout his time in Aberdeen. The keeping of accurate medical records was a hallmark of the Scottish medical Enlightenment. Gordon was required to maintain a log of the dates of each patient’s attendance, their name, age, address, the presenting condition and its outcome; this discipline was to prove important for his later discovery about the spread of puerperal fever.

There were two major outbreaks of puerperal fever in and around Aberdeen while Gordon was there. From his notes, Gordon noticed that mothers living in the villages developed the fever if they were in the care of midwives from the city, where the infection was rife; village mothers attended by country midwives, who had no previous contact with the fever, avoided the disease.

Secondly, in common with what was becoming part of informed medical inquiry at this time, he created a table and noted the appearance of cases in date order, the maternal place of residence, the outcome and crucially, the name of the person who attended the birth. It was immediately apparent that cases of fever began in date sequence after visits by particular midwives. Furthermore, with impressive scientific objectivity, he implicates himself in the transmission, stating: It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women. This evidence-based discovery long preceded the findings of Oliver Wendell Holmes in 1843 and Ignaz Semmelweissin 1847, whose names are commonly associated with establishing the mode of transmission of puerperal fever.

Gordon’s advice to any physician who had seen a patient with severe fever was to return home and change and fumigate his clothes. By instituting hygiene measures that included hand washing, fumigation of rooms and burning of infected clothing, Gordon was able to claim, ‘In my practice, of 77 women, who were attacked with the puerperal fever, 28 died; so that very near two-thirds of my patients recovered.’ He goes on to quote contemporary reports of puerperal fever mortalities in the range 68–100%. Alexander Gordon died at the age of 47 in 1799. No one had listened to his advice and he had left the job in loved to work once more as a naval surgeon.

Ignaz Semmelweis suffered a similar fate. Semmelweis was not prepared to accept the belief that poison air was killing his patients in the No. 1 labour ward in the Vienna hospital where he worked. Semmelweis believed that the cause of so many deaths in the maternity ward was the nearby post-mortem room. Ward No. 1 was the preserve of doctors and trainee doctors whereas Ward No 2, where the death rate was lower, was the domain of the midwives who did not perform routine autopsies. Semmelweis believed that there had to be a link between the work done in the post-mortem room and the rate of infection in Ward No 1.

In 1847, a colleague of Semmelweis, Jakob Kolletschka, died from septicaemia. He had been cut with a scalpel during an autopsy. Semmelweis attended his colleague’s autopsy and noticed that the lesions on his body were very similar to those on many of the women who had died in Ward No 1. Semmelweis believed that it had been the scalpel that had transferred the ‘miasma’ from the corpse to his former colleague.

Semmelweis ordered that all medical staff in Ward No 1 had to wash their hands in chlorinated lime before visiting a patient and that the ward itself had to be cleaned with calcium chloride. The mortality rate in Ward No 1 dropped dramatically and by 1849, just 2 years after the death of his colleague Kolletschka, death from ‘miasma’ had all but disappeared.

Semmelweis provided his evidence to the medical elite of Vienna. He stated that cleanliness was the way to defeat ‘poison air’ and backed this up with the statistics he had gathered. His views were not part of the general medical beliefs of the time and he was immediately attacked by most senior medical figures – three did support him but none of them had a background in obstetrics. Semmelweis was dismissed from his position and went to live in Budapest. In Ward No 1, the doctors went back to their old ways and fatality rates immediately increased to their level pre-1847.

Semmelweis gained employment at the St. Rochus Hospital in Budapest and applied his findings there. The death rate in the maternity units there dropped drastically. In 1861, Semmelweis published ‘Die Aetiologie, der Begrif und die Prophylaxis des Kindbettfiebers’ (Etiology, Concept, and Prophylaxis of Childbed Fever) – “which stands as one of the epoch-making books of medical history.” (History of Medicine by Roberto Margotta)

The work was filled with a mass of statistics and proved difficult to read. It was met with hostility by the medical profession and many simply mocked its findings. It took another twenty years before his findings were universally accepted. For years many of Europe’s leading medical practitioners believed that childbed fever was a disease of the bowel and that purging was the best medicine for it.

The years of rejection by his colleagues almost certainly took its toll. Semmelweis suffered from severe depression and may have suffered from premature dementia as he became very absent-minded. After the effective rejection of his 1861 work on puerperal fever he wrote a series of ‘Open Letters’ to his main critics in which he openly called them “ignorant murderers”.

In 1865 he was tricked into visiting a mental asylum. When he tried to leave Semmelweis was forcibly restrained and put in a straitjacket. The injuries were such that they became infected and he died two weeks later.

Ignaz Semmelweis died in 1865. He was buried in Vienna. Very few people attended his funeral. In 1891, his body was transferred to Budapest. A statue was only erected to him and his achievements in 1894, nearly thirty years after his death; Alexander Gordon remains almost entirely unknown.

Sources: http://www.historylearningsite.co.uk/a-history-of-medicine/ignaz-semmelweis/

Image: The Knick—Steven Soderbergh’s riveting Cinemax series, which looks inside the Knickerbocker Hospital in Manhattan at the turn of the last century.

Princess Anne – The Princess Who Married a Hunchback

Princess Anne – The Princess Who Married a Hunchback

This is the story of Princess Anne, the Princess Royal was the eldest daughter of George II.

Princess Anne was born into what we would call a dysfunctional family in May 1709. (For more information about her grandmother and the House of Hanover read my blog on 15th November.) Anne was a remarkable woman in many ways; criticised and praised by contemporary chroniclers for her arrogance and her accomplishments in equal measure.

A Dysfunctional Family

Anne was born at Herrenhausen Palace, Hanover, five years before her paternal grandfather, Elector George Louis, succeeded to the British throne as George I.

Her parents’ relationship with King George I was a troubled one.

Her mother, Caroline of Ansbach, was brought up in the Prussian Court where she was treated as a surrogate daughter and was well educated. It is difficult to know to what extent her experience of life at the boorish and brutal Hanoverian Court influenced her opposition to George I in England.

One cannot help wondering did Caroline suspected her father-in-law of having her mother-in-law’s lover killed? Did she support her husband’s desire to set his mother free from her imprisonment at Ahlden? Whatever the cause,  their relationship was not good and Anne’s parents left Hanover in 1714 and did not return.

Political Differences

Political differences between father and son led to factions in the court in Hanover from the late 1710s.

These disagreements carried over to the British court and came to a head following the birth of George and Caroline’s second son, Prince George William in 1717.

At the baby’s christening, Anne’s father publicly insulted the Duke of Newcastle. This so infuriated George I he banished his son and daughter-in-law from St James’s Palace.

The king kept their children, including Anne under his guardianship at Leicester House.

The family rift was healed, in part at least, in 1720 when Anne’s brothers were returned to the care of her parents but she and the other girls remained the wards of the King.

Princess Anne Ravaged by Smallpox

That year, 1720, Anne’s body was ravaged by smallpox. It is estimated the disease killed an estimated 400,000 Europeans a year during the closing years of the 18th century.

This near-death experience and her parent’s experience of the disease at the beginning of their marriage led Anner to support her mother’s efforts to test the practice of variolation (an early type of immunisation against smallpox). The practice of variolation was witnessed and recorded by Lady Mary Wortley Montagu and Charles Maitland while they were in Constantinople.

 

Ophan Guinea-pigs

At the direction of her mother, Queen Caroline, six prisoners condemned to death were offered the chance to undergo variolation instead of execution. The prisoners all took the offer and they all survived, as did six orphan children given the same treatment as a further test. (There were no medical ethics committees then). Convinced of variolation’s safety, the Queen had her two younger daughters, Amelia and Caroline, inoculated. Royal patronage the practice spread the demand for inoculation amongst the upper classes.

Family Feud Continues

On 22 June 1727, George I died while in Germany, making Princess Anne’s father king.

The following year, her elder brother, Frederick, who had been educated in Germany, returned to England. Father and son had not seen one other in 14 years and when they did the fireworks began. Their relationship was even more tempestuous than the one between George I and George II especially after 1733 when Frederick purchased Carlton House and set up what George II considered to be a rival court.

Princess Anne’s Marriage Prospects

Anne’s sister, Princess Caroline

Anne’s sisters, Princess Caroline (1713-1757) left,
Princess Amelia (1711-1786), right.

As a daughter of the future British King Anne’s marriage was always going to be a dynastic one. As a princess requiring a Protestant marriage, her options were limited. The government hit on the idea of a marriage with the rather lowly William, Prince of Orange-Nassau to sure up their anti-French alliance.

George II was not enamoured with the proposal and Anne was concerned too because William had a well-known physical deformity. To find out more she dispatched Lord Hervey, a close confidant, to report on its extent.

First Sight of the Hunchback

Hervey reported that although William was no Adonis and his body was as bad as possible; William suffered from a pronounced curvature of the spine, probably the result of sclerosis-like the English King Richard III; he had a pleasing face.

Despite his deformity and the inferiority of his territory, Anne decided she would take him. She was already 25 years old and did not want to end up an old maid surrounded by her warring relatives. When they married in 1734, her mother and sisters wept through the ceremony. Lord Hervey described the marriage as more sacrifice than celebration.

Princess Anne Marries William, Prince of Orange-Nassau

As an outsider and British, Anne was not popular in the Netherlands. Her life must have been a lonely one as she did not get along with her mother-in-law and her husband was frequently on campaign protecting the states of the Dutch Republic from its enemies. In these lonely years Anne concentrated her efforts on literature and playing the harpsichord; she was an accomplished artist, musician, and lifelong friend of her music teacher George Frederic Handel.

 

Willem Karel Hendrik Friso van Oranje-Nassau, 1751

Willem Karel Hendrik
Friso van Oranje-Nassau, 1751.

Princess Anne’s Stillborn Baby

Producing the required heir was problematic too. In 1736, Anne gave birth to a stillborn daughter and then another in 1739. Her first live birth came in 1743 with the arrival of Princess Carolina of Orange-Nassau who was followed by another daughter, Princess Anna two years later. Her only son arrived in 1748 when she was 39 years old.

When her husband died three years later in 1751 at the age of 40, Anne was appointed regent for her 3-year-old son, Prince William V.

Princess Anne is Widowed

Anne was given all prerogatives normally given a hereditary Stadtholder of the Netherlands, with the exception of the military duties of the office, which were entrusted to Duke Louis Ernest of Brunswick-Lüneburg.

 

The Princess Takes the Tiler of Government

To say that she took to the role like a duck to water would not be an exaggeration. Finally free to exercise some power, in true Hanoverian style, Anne used her wit and her determination to secure her personal power base and with it the dominance of her family and the Orange dynasty.

Anne was hard-working but remained unpopular. Commercial rivalry between the Dutch and the British East India Companies was part of the cause. Another reason was the constitution of the United Provinces. But what made her most unpopular was that she seized the opportunity to centralise power in the office of the hereditary Stadtholder over the traditional rights of the Dutch states particularly the State of Haarlem. Her foreign policy was also a source of vexation for the Dutch as she favoured a British-German alliance over alliance with the French.

All a Woman Could Do

Ultimately, as a woman she was reliant on the men around her and it is fair to say that her husband and her son were fighting a losing battle against the tide of history at the end of the 18th century and Anne with all her skills could not realise the ambitions of the House of Orange on her own. She ruled the Netherlands for eight years dying of dropsy in 1759 when her son was 12. She was replaced as regent by her mother-in-law, Marie Louise of Hesse-Kassel and when she died in 1765,  Anne’s daughter, Carolina, was made regent until William V turned 18 in 1766.

The Remarkable Princess Anne

Anne was a remarkable woman. With her beauty shredded by smallpox, she took on the world and won. (I am sure she took the opportunity to show herself in her best light in her self-portrait above.) Anne accepted and made a success of her marriage which on the face of it held little prospect for personal happiness. An intelligent if a haughty woman she endured many years of loneliness, the pain of 2 stillborn children and widowhood. As Staadholder (chief executive of the Dutch Republic) she was as effective as any man and laid the foundations of the Dutch royal family. Her grandson, William I became the first king of the Netherlands in 1815.

 

Sources:

George II: King and Elector By Andrew C. Thompson, 2011, Yale University Press.

https://en.wikipedia.org/wiki/Anne,_Princess_Royal_and_Princess_of_Orange

Photo credits.