戲劇–醫院衛生之父

資料來源：2023 年 8 月 7 日線上發布 https://doi.org/10.1016/S1473-3099(23)00513-3

     如今，我們理所當然地認為醫院的衛生和消毒對於減輕醫療保健相關感染的負擔至關重要，但在路易斯·巴斯德和羅伯特·科赫提出細菌理論之前的 19 世紀，情況並非如此。然而，在他們之前，另一位醫生伊格納茲·塞梅爾維斯（Ignaz Semmelweis）已經證明，當醫生在看望病人之前用氯化石灰溶液洗手時，死亡率會降低。儘管取得了這一令人印象深刻的結果，塞梅爾維斯的發現還是遭到了當時醫學界的強烈反對。 塞梅爾維斯的故事現已成為斯蒂芬·布朗（Stephen Brown）撰寫的戲劇，其名字恰如其分地命名為「塞梅爾維斯醫師」，該劇在湯姆·莫里斯的指導下在布里斯托爾的老維克劇院上演後，現已登陸倫敦的哈羅德·品特劇院。

     伊格納茲·塞梅爾維斯(Ignaz Semmelweis) 這一角色由奧斯卡金像獎得主馬克·里朗斯(Mark Rylance) 飾演，他成功地展現了這位匈牙利醫生在其工作的產科病房減少死亡人數的強烈動力，以及他在面對同事的懷疑時逐漸崩潰的精神狀態。 戲劇開始於塞梅爾維斯在他位於佩斯的家中，他的前同事邀請他在維也納的一次醫學會議上展示他的工作成果。 那時塞梅爾維斯已經切斷了與維也納醫療機構的所有聯繫，他的精神狀態也岌岌可危。 昔日好友的到來，讓他回想起了往事。 Semmelweis 於 1818 年出生於布達佩斯，年輕時轉到維也納總醫院第一產科診所，成為約翰·克萊因 (Johann Klein) 的助手。 他的職責主要包括在卡爾·馮·羅基坦斯基的監督下為分娩婦女提供醫療援助並幫助屍檢。 Semmelweis 驚訝地發現，在由醫生照顧婦女的病房中，產褥熱的死亡率極高（9%），而在鄰近的由助產士操作的病房中，產褥熱死亡率僅為 3%。 兩個病房之間唯一不同的變量是人類變量。 當他的同事雅各布·科萊奇卡(Jakob Kolletschka) 在屍檢過程中不小心被骯髒的手術刀戳傷而死亡時，塞梅爾維斯意識到他同事的身體表現出與他在死於產褥熱的女性身上觀察到的相同的疾病跡象。 因此，塞梅爾維斯認為醫生病房死亡率較高的原因是醫生在進行屍檢後攜帶「屍體顆粒」到產科病房（而助產士則不允許進入屍檢區域）。 因此，塞梅爾維斯率先提出了醫生在進入產科病房後應該用氯化石灰溶液洗手的想法。 幾週之內，塞梅爾維斯將醫生病房的死亡率降低到助產士病房的水平。 儘管塞梅爾維斯取得了出色的成績，但他並沒有受到醫院上級的重視，因為他不知道哪種確切機制可以解釋「屍體顆粒」。 塞梅爾維斯對同事的排斥越來越感到沮喪，並且無法在不攻擊醫學界的情況下解釋他的結果，他首先被維也納的醫院不公正地解僱，然後搬回布達佩斯，在那裡他被降級​​到管理一個小型產科病房。 不斷貶低他的成就導致塞梅爾維斯精神崩潰。 最終，一位前同事出於對塞梅爾維斯精神狀況的擔憂，將塞梅爾維斯關進了一家精神病院，他在那裡遭到看守的毆打，並在抵達十四天后因傷口感染敗血症而死亡。 只有當巴斯德、科赫和李斯特證明了細菌的致病潛力時，手部衛生的好處才變得顯而易見。 然而，塞梅爾維斯從未因其開創性的工作而獲得讚譽，至今仍處於醫學史記錄的邊緣。

     「塞梅爾維斯醫師」一劇成功地將一個被遺忘的人物塑造成一個有趣的人物，他在以科學思維研究醫學方面領先於同時代人，但缺乏能力向他人傳達他的工作。 該劇還顯示，當未知研究人員提出創新時，同一醫學界往往無法識別這些創新。 至少，透過這部劇，塞梅爾維斯最終會被更多受益於他的作品的人所認識。

馬可·德·安布羅吉

Theatre

The father of hospital hygiene

Published Online August 7, 2023 https://doi.org/10.1016/ S1473-3099(23)00513-3

   Nowadays, we take for granted that hygiene and disinfection in hospitals are paramount to reduce the burden of healthcare-associated infections, but it was not so in the 19th century before the germ theory was developed by Louis Pasteur and Robert Koch. However, before them, another doctor had already demonstrated a reduction in mortality when doctors washed their hands with chlorinated lime solutions before visiting their patients: Ignaz Semmelweis. Despite this impressive result, Semmelweis’ discovery faced strenuous opposition from the medical establishment of the time. Semmelweis’ story has now become a play written by Stephen Brown, aptly named Dr Semmelweis, that after opening at the Bristol Old Vic under Tom Morris’ direction, has now arrived at the Harold Pinter Theatre in London.

    The role of Ignaz Semmelweis is played by Academy Award winner Mark Rylance who succeeds in giving life to both the deep drive of the Hungarian doctor to reduce deaths in the obstetrics wards where he works and his progressive mental unravelling when confronted with disbelief from his colleagues. The play starts with Semmelweis in his house in Pest where his former colleagues have come to invite him to present the results of his work at a medical conference in Vienna. At that point Semmelweis has broken all connections with the Viennese medical establishment and his mental status is precarious. The arrival of his former friends brings him back to the memories of his past. Born in Budapest in 1818, Semmelweis moves to Vienna General Hospital’s First Obstetrical Clinic as a young doctor, becoming assistant of Johann Klein. His role consists mainly of providing medical assistance to women delivering babies and helping with autopsies, under Carl von Rokitansky’s supervision. Semmelweis is shocked to discover that the mortality for puerperal fever is extremely high in the ward where women are looked after by doctors (9%), whereas it is only 3% in the neighbouring ward where midwifes operate. The only variable that appears to differ between the two wards is the human one. When his colleague Jakob Kolletschka dies after having been accidentally poked with a dirty scalpel during an autopsy, Semmelweis realises that his colleague’s body shows the same signs of disease that he has already observed in women who have died of puerperal fever. Thus, Semmelweis identifies the reason for the higher mortality in the doctors’ ward with the fact that doctors are carrying “cadaverous particles” to the obstetrics ward after performing autopsies (midwifes instead are not allowed in the areas where autopsies are carried). So Semmelweis pioneers the idea that doctors should wash their hands with chlorinated solutions after entering the parturients’ ward. Within few weeks, Semmelweis brings down the mortality in the doctors’ ward to the midwifes’ ward levels. Despite his superb results, Semmelweis is not taken seriously by his superiors at the hospital because he does not know which exact mechanism could explain the “cadaverous particles”. Growingly frustrated by the ostracism from his colleagues and incapable of explaining his results without attacking aggressively the medical community, Semmelweis is first unjustly dismissed from the hospital in Vienna and then moves back to Budapest where he is reduced to manage a small obstetrics ward. The constant belittling of his achievements then leads Semmelweis to a nervous breakdown; ultimately, concerned by his mental status, a former colleague has Semmelweis interned in an asylum, where he is beaten by the guards and dies of sepsis from an infected wound fourteen days after his arrival. It is only when Pasteur, Koch, and Lister demonstrate the pathogenic potential of bacteria that the benefit of hand hygiene becomes clear. However, Semmelweis never gets the credit for his groundbreaking work and remains at the margin of the records of medical history to this day.

    Dr Semmelweiss manages to make a forgotten figure an interesting character who was ahead of his contemporaries in approaching medicine with a scientific mind but illequipped to communicate his work to others. The play also shows how the same medical community is often incapable of recognising the innovations when proposed by unknown researchers. At least, with this play, Semmelweis will finally be known by more of those benefitting from his work.

Marco De Ambrogi