Ignaz Philipp Semmelweis

Hungarian physician

• Born: July 1, 1818
• Birthplace: Buda, Hungary, Austrian Empire (now Budapest, Hungary)
• Died: August 13, 1865
• Place of death: Vienna, Austrian Empire (now in Austria)

Semmelweis was the first medical professional to recognize the infectious nature of puerperal fever (childbed fever). His use of antiseptic techniques in obstetric practice greatly reduced deaths from the fever and paved the way for the development of modern surgery.

Early Life

Ignaz Philipp Semmelweis (ZEHM-el-vis) was the fifth of ten children of József Semmelweis, a prosperous grocer, and Terézia Müller, the daughter of a coach manufacturer, one of the richest men in Buda, Hungary. Semmelweis’s father belonged to a German ethnic group and had moved to Buda from Kismarton, becoming a citizen in 1806. During the early nineteenth century, the influence of the German and Serbian elements was so great in Buda that the busy center of commerce had lost much of its Hungarian, Magyar, character.

The trading class, including the Semmelweis family, spoke a German dialect, Buda Swabian, at home and in commerce. Although most people in this class spoke Hungarian fluently, few were able to read and write it correctly. The teaching of Hungarian was compulsory in the secondary schools, but formal instruction was still, for the most part, in Latin and German. Consequently, Semmelweis experienced language difficulties throughout his lifetime. His clumsy German dialect made him the butt of jokes in Vienna, where he was to spend the most important part of his life, and his confessed antipathy to writing made him reluctant to publish his discoveries and respond to his critics.

Little is known about Semmelweis’s childhood. Described by his contemporaries as a happy, honest, and industrious child, Semmelweis attended the Royal University Catholic Grammar School, one of the best schools in Hungary, where he placed second in a class of sixty. After a two-year arts course at the University of Pest, he began the study of law in 1837 in Vienna. The University of Vienna and its affiliating general hospital, the Allegemeines Krankenhaus, were world centers for the study of medicine. After attending an autopsy with friends who were medical students, Semmelweis abandoned the study of law for medicine. He studied medicine in Vienna for a year, continued his studies from 1839 to 1840 at the University of Pest, and returned to Vienna to complete his studies and receive his medical degree in 1844 at the age of twenty-six.

Three rising young professors who were to make medical history befriended and influenced Semmelweis: Josef Škoda, professor of internal medicine, Karl von Rokitansky, the pathologist who directed the Institute for Pathological Anatomy of the medical school, and Ferdinand von Hebra, the first professor of dermatology at the University of Vienna. Under these professors, the carefree young Semmelweis became a serious and disciplined doctor.

Life’s Work

Semmelweis decided to specialize in obstetrics and gynecology, working in the obstetric and surgical clinics of the Allgemeines Krankenhaus. During the two years he had to wait for the position that he had been promised, he obtained his master’s degree in obstetrics and doctor’s degree in surgery, visited the obstetric clinic daily, frequented Škoda’s lectures, and dissected with Rokitansky. Semmelweis was appointed first assistant lecturer to Professor Johann Klein in July of 1846.

The obstetric clinic was divided into ward 1, where medical students were instructed, and ward 2, where midwives were taught. Semmelweis was assigned to ward 1, where Klein was in charge. Before going to the clinic each day, Semmelweis performed autopsies on obstetric and gynecological cases. Postmortem dissection followed every death in the hospital. Ward duties included examining every patient in labor, conducting daily teaching rounds, assisting with operations, and instructing the medical students through autopsies and clinical practice.

Sensitive and compassionate by nature, Semmelweis was appalled by the mortality rate from childbed fever, or puerperal fever (from puerperium, the six weeks following childbirth), which ranged as high as 25 to 30 percent. Although the disease had been known since ancient times, it did not become a scourge until the beginning of the seventeenth century, when lying-in hospitals were established to care for the poor. It rarely occurred outside the hospitals. Between 1653 and 1863, there were two hundred so-called epidemics of puerperal fever in Europe.

The disease was variously attributed to atmospheric influences, overcrowding, poor ventilation, the onset of lactation, anxiety, bowel inflammation, deterioration of the blood, suppression of the discharge from the uterus, and a host of other causes. By the end of the eighteenth century, many English physicians had come to believe it was a specific acute infectious disease peculiar to pregnant women, transmitted in the same way as smallpox or scarlet fever, through direct or indirect contact. To prevent epidemics, doctors isolated the patient, used disinfectants, and maintained clean and well-ventilated wards. Thus, they were able to prevent the spread of the disease, while not completely understanding its nature. Oliver Wendell Holmes, Harvard anatomist and professor, subscribed to this contagion theory and in 1843 was the first to discuss the danger of attending women in labor after performing autopsies.

Although most obstetricians in Europe believed that puerperal fever was unpreventable, Semmelweis was obsessed by the desire to discover the cause of the disease. He systematically eliminated each hypothesis. Except for the fact that medical students were taught in ward 1 and midwifery students were taught in ward 2, the two wards were identical; they were both filthy, poorly ventilated, and crowded. Admissions to each ward occurred on alternate days. However, the death rate in ward 1 was two to three times higher than in ward 2. Semmelweis concluded that puerperal fever could not be an epidemic of infectious disease because an epidemic would affect the two wards indiscriminately, occur outside the hospital, and exhibit seasonal variations.

Through careful analysis of statistical data from 1789 on, Semmelweis determined that the fatality rate was lower during periods when there was less interference with the birth process, fewer examinations, or fewer dissections. Gradually he came to suspect a connection between puerperal fever and the students’ common practice of examining patients without careful handwashing after dissection. However, his preoccupation with a problem that Klein considered inevitable and the collection of statistics that put the clinic in a bad light alienated his superior, and on October 20, 1846, Semmelweis’s appointment was discontinued.

Semmelweis was reinstated in his position on March 20, 1847, and returned to work from a holiday, only to learn that his friend Jakob Kolletschka had died in his absence from blood poisoning from a septic wound incurred during an autopsy. The findings at Kolletschka’s autopsy were identical to those of the puerperal patients and their babies. By May, 1847, Semmelweis was sure that matter from the cadavers caused puerperal fever. The mortality in the second ward was low because midwifery students did not do postmortem examinations. Semmelweis decided that hands could only be considered clean if they no longer smelled of the cadavers.

Semmelweis instituted a strict policy of handwashing in chlorinated lime and using a nailbrush before each examination. Mortality rates in his ward dropped from 18.27 in April, 1847, to 0.19 by the end of the year. There were no deaths in March and August of 1848, but mortality rates increased when students were careless and when a woman with cancer of the uterus and another woman with an infected knee were admitted. Semmelweis now realized that infection could be airborne and transmitted from any infected source as well as from the examining hand soiled from cadavers. He prescribed handwashing between examination of individual patients.

Semmelweis encountered resistance to his methods. Klein did not understand him, resented his innovations, and became his bitter enemy. Medical students and nurses resented having to wash their hands. The rest of the world misunderstood his theory. Because he refused to publish, his friend Hebra published an editorial in December, 1847, in the journal of the Medical Society of Vienna about Semmelweis’s discovery. Hebra clearly indicated that discharge from living organisms as well as cadaveric infection could cause puerperal fever but made the mistake of calling it an epidemic disease.

A second article by Hebra, stressing the spread of puerperal infection from postmortem dissection, appeared in the journal in April, 1848, but this time he failed to allude to Semmelweis’s discovery that the disease could be transmitted by material from living bodies as well as from cadavers. This created a serious misunderstanding of Semmelweis’s theory. Physicians who did not practice postmortem dissection rejected the theory outright.

Meanwhile, Europe was in political turmoil and Semmelweis’s Hungarian patriotism further offended Klein. When his appointment ended in March, 1849, Klein refused to renew it. Semmelweis tried to regain his post. When it was finally offered to him, there were restrictions he believed too degrading to accept. Before leaving Vienna for the last time, in May, 1850, he presented his discovery to the Medical Society of Vienna in a lecture, “The Origin of Puerperal Fever.”

For the following six years, Semmelweis was in charge of the obstetrics department at the St. Rochus Hospital in Pest. There, he reduced the mortality rate from puerperal fever to less than 1 percent, compared with 10 percent to 15 percent in Vienna during the same period. He became professor of obstetrics at the University of Pest in 1855, developed a successful private practice, married in 1857, and had five children. His theory was accepted in Budapest, but the hostility of Vienna and the world community of obstetricians filled him with agony and bitterness.

In 1861, he finally published his life’s work, Die Ätiologie, der Begriff, und die Prophylaxis des Kindbettfiebers (The Cause, Concept, and Prophylaxis of Childbed Fever , 1941). Prominent obstetricians and medical societies ignored or rejected his work, and he responded in scathing open letters that alienated even his friends. In 1865, fifteen years after leaving Vienna, Semmelweis developed signs of mental illness, and on August 13, died in a mental home in Vienna. Ironically, the cause of death was blood poisoning from an injury sustained during an operation he had performed. The truth of his doctrine was not accepted in Europe for at least two decades after his death.

Significance

It is difficult to appreciate Ignaz Philipp Semmelweis’s contribution to medical science from the perspective of the present, as so many advances have become commonplace; so many truths that were bitterly resisted have become self-evident. Working before Louis Pasteur’s research in 1857 led to the germ theory and laid the foundation for advances in modern medicine, Semmelweis recognized the infectious nature of puerperal fever and realized that it was not a specific disease per se but could be caused by contact with any infected material through either direct or indirect means.

Many physicians of Semmelweis’s day working in different countries recognized aspects of the truth about puerperal fever. There are similarities in the work of Semmelweis, Holmes, and Joseph Lister, so the debate about who deserves the most credit in the history of antisepsis may never be resolved. Semmelweis, however, was the first to recognize that the disease was a form of blood poisoning, and he applied antisepsis in surgery as well as in obstetrics fifteen years before Lister.

Semmelweis was a great scientist who combined the powers of clinical observation, expert knowledge of pathology and obstetrics, and scientific honesty. He refused to accept the prevailing dogma of his day but persevered in his determination to understand the cause of the disease and the means of preventing it. He developed a theory about the cause of puerperal fever, tested it, and developed a means of preventing the disease. He was the first person in medical science to prove his theory using statistics.

It was Semmelweis’s great misfortune that all but a few of his contemporaries rejected his theory, which resulted in the needless sacrifice of countless lives. Great discoveries have seldom been accepted without a struggle, but there can be no doubt that he contributed to his own tragedy. He antagonized his critics by his abrasive manner, and he refused to publish. If he had published when he was in Vienna with the help of Škoda and Hebra, his ideas might have been received more favorably.

Bibliography

Antall, József, and Géza Szebellédy. Pictures from the History of Medicine: The Semmelweis Medical Historical Museum, Budapest. Budapest, Hungary: Corvina Press, 1973. A collection of color photographs of portraits and artifacts from the Semmelweis Museum. Narrative includes a brief overview of Semmelweis’s life and contributions and a history of the museum, which is the house where he was born.

Carter, K. Codell, and Barbara R. Carter. Childbed Fever: A Scientific Biography of Ignaz Semmelweis, with a New Introduction by the Authors. New Brunswick, N.J.: Transaction, 2005. The Carters’ book, originally published in 1994, describes birthing conditions in the Vienna hospital where Semmelweis worked and his attempts to eradicate the disease.

Céline, Louis-Ferdinand. Mea Culpa and the Life and Work of Semmelweis. Translated by Robert Allerton Parker. Boston: Little, Brown, 1937. Reprint. New York: Howard Fertig, 1979. A subjective, romantic, and passionate tribute to Semmelweis, written by a French novelist.

Dormandy, Thomas. Moments of Truth: Four Creators of Modern Medicine. Hoboken, N.J.: Wiley, 2003. Semmelweis is one of the four nineteenth century physicians and scientists whose efforts to improve the quality of medicine are described in this book.

Gortvay, György, and Imre Zoltán. Semmelweis: His Life and Work. Translated by Eva Rona. Budapest, Hungary: Akademiai Kiadó, 1968. A comprehensive and definitive biography, translated from Hungarian for the Federation of Hungarian Medical Societies’ celebration of Semmelweis’s birth. Incorporates the latest research to correct errors in previous biographies and includes a chronological list of events in the life of Semmelweis, along with numerous illustrations.

Nuland, Sherwin B. The Doctors’ Plagues: Germs, Childbed Fever, and the Strange Story of Ignaz Semmelweis. New York: W. W. Norton, 2003. Recounts how Semmelweis uncovered the origins of childbed fever and the controversy his discovery created.

Semmelweis, Ignaz. The Etiology, Concept, and Prophylaxis of Childbed Fever. Translated by K. Codell Carter. Madison: University of Wisconsin Press, 1983. Semmelweis’s classic contribution to medical literature. Includes statistical proofs and logical arguments. Redundant, awkward style.

Slaughter, Frank G. Semmelweis, the Conqueror of Childbed Fever. Reprint. New York: Collier Books, 1961. A readily available and beautifully written biography of Semmelweis, with imaginative speculations. Helpful orientation to historical and scientific context of Semmelweis’s life and work. Contains a few insignificant errors from previous biographers.