医学 1861

产褥热的病因、概念与预防

伊格纳茨·塞麦尔维斯

医生用自己的手把死亡带进产房——一盆氯水，止住了它。

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In depth · the introduction

分娩最危险的地方，竟是由医生坐诊的那间病房——因为医生正用自己的手，浑然不觉地把死亡从解剖室带了进来。

核心想法

在维也纳一家大医院里，两间产科病房并排而设。一间由医生和他们的学生坐诊，另一间由助产士坐诊。在医生那间病房，产妇死于产褥热——分娩后一场凶猛的感染——的几率要高出好几倍。没人知道为什么，产妇们都哀求别把自己送进去。

塞麦尔维斯找到了答案。与助产士不同，医生们还要在解剖室里解剖尸体——然后不洗手便径直走向产床。他们正用自己的手，把看不见的「腐败物质」从死者带给活人。他的对策，简单得近乎令人难堪：在碰病人之前，用氯水洗手。医生那间病房的死亡，从大约每八名产妇中一人，骤降到约每八十人中一人。

它是如何诞生的

那是 1847 年，比任何人知道细菌的存在还早了几十年。塞麦尔维斯，一位在维也纳的年轻匈牙利医生，被自己病房里的死亡率折磨着。他把流行的种种理论一个个排除——坏空气、拥挤，甚至床的摆位——因为没有一种能解释：为什么自己这间病房，比隔壁助产士那间糟糕得多。

随后，他的同事雅各布·科莱奇卡在解剖时划破了手指，死于一种看上去与产褥热一模一样的病。塞麦尔维斯灵光一闪：那个害死好友的致命之物，正是害死产妇的同一样东西，而医生的手，就是那座桥。他下令用氯水洗手，于是，死亡停住了。

它为何重要

塞麦尔维斯用确凿的数字证明：医生自己的手，可能就是那个凶手——而一次简单的清洗，就能成千上万地拯救生命。这是人类头一回，像现代医学那样，靠「施加干预、再清点结果」来证明一个医学想法。然而他的同行大多拒绝他：承认他对，就等于承认自己曾害死人命。好的证据，被冷落了整整一代人——这是一句告诫：若你无法让他人倾听，仅仅是「正确」还远远不够。

一个可以想象的画面

想想有人在厨房里处理生鸡肉，然后不洗手就去拌沙拉——你看不见他手上有什么，但你绝不会去吃那盘沙拉。塞麦尔维斯意识到，产房也是同一个道理：危险既不在空气里，也不在病人身上，而在照护者带进来的那个看不见的东西。先把它冲掉，伤害便压根不会到来。

它的位置

塞麦尔维斯，来得正好赶在能解释他的人之前。不出二十年，路易·巴斯德便证明：活的微生物会引起发酵与疾病；约瑟夫·李斯特又据此建起消毒外科——这才给了塞麦尔维斯的氯水洗手那个一直欠缺的「为什么」。在本馆里，你可以顺着这条线索往下走到亚历山大·弗莱明，他的青霉素让医学不仅能把微生物挡在外面，更能杀死那些已经进到体内的。今天，每一家医院对手部卫生那份不松懈的执着，正是塞麦尔维斯的想法——终于被人相信了。

The original document

Original source text

两座诊所

Ignaz Semmelweis · Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers · 1861 (trans. K. Codell Carter, 1983)

In the Vienna maternity hospital, expectant mothers were admitted on alternate days to one of two clinics. The first was the teaching service of physicians and medical students; the second was the school for midwives. The two differed in almost nothing — except that, year after year, far more mothers died of childbed fever in the first clinic than in the second.

The disparity was no secret. The patients knew it, and dreaded assignment to the first clinic; some, Semmelweis records, would rather give birth in the street than be admitted there.

尸体的线索

On the death of Jakob Kolletschka, March 1847

The decisive clue came when his colleague Jakob Kolletschka, his finger pricked by a student's knife during an autopsy, died of an illness identical in its course to childbed fever. Semmelweis drew the inference that undid the mystery: what killed Kolletschka and what killed the mothers were one and the same.

Day and night I was haunted by the image of Kolletschka's disease, and was forced to recognize, ever more decisively, that the disease from which Kolletschka died was identical to that from which so many maternity patients died.

产褥热是什么

The definition

Semmelweis gave childbed fever a single cause. Every case, without exception, he held to be a resorption fever — the consequence of decaying animal-organic matter absorbed into the mother's bloodstream. In his own German: “die Resorbtion eines zersetzten thierisch-organischen Stoffes.”

Childbed fever is, without exception, a resorption fever caused by the resorption of decaying animal-organic matter.

The carriers of that matter, he wrote, were the examining finger, the operating hand, instruments, bed linen, the air, sponges — anything that touched decomposing matter and then the genitals of women in labour or just delivered.

氯水洗手的规定

The prophylaxis · Vienna, May 1847 onward

The cadaveric material adhering to the examining hand of the accoucheur is the cause of the greater mortality in the first obstetrical clinic; I have eliminated this factor by the introduction of the chlorine washings.

From mid-May 1847 every doctor and student was required to wash the hands in a solution of chlorinated lime until the cadaveric smell was gone, before each examination. The mortality of the first clinic, which had reached 18.3 per cent in April 1847, fell within months to a few per cent; for the full year 1848, under the rule, it was 1.27 per cent.

作者的自省

Semmelweis understood what his discovery implied about the years before it — about the hands, including his own, that had carried the contagion. He did not spare himself.

Only God knows the number of patients who went prematurely to their graves because of me. I have examined corpses to an extent equalled by few other obstetricians.

Ignaz Philipp Semmelweis · Pest · 1861

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