Semmelweis Develops Antiseptic Procedures
Ignaz Semmelweis was a Hungarian physician whose groundbreaking work in the mid-19th century led to the development of antiseptic procedures in obstetrics. He is best known for identifying that puerperal fever, a severe infection affecting women after childbirth, was often transmitted by medical staff who had just performed autopsies. Semmelweis observed that the mortality rate from puerperal fever was significantly higher in the ward where medical students trained compared to that attended by midwives. In 1847, he instituted a protocol requiring handwashing with a chlorinated lime solution before medical personnel entered the delivery room. This simple yet profound intervention led to a dramatic decrease in mortality rates, showcasing the importance of hygiene in medical practices.
Despite his success, Semmelweis faced significant resistance from the medical community, which was reluctant to accept that their practices could contribute to patient deaths. His insistence on hand hygiene and his inability to effectively communicate his findings led to professional isolation. After leaving Vienna, he continued to advocate for antiseptic practices but struggled to gain full recognition for his contributions during his lifetime. Semmelweis’s work laid the foundation for modern antiseptic techniques, which, alongside advances in bacteriology in the late 19th century, led to a drastic reduction in puerperal fever cases. His legacy lives on today, as the implementation of hygiene protocols in healthcare continues to save countless lives.
Semmelweis Develops Antiseptic Procedures
Date May, 1847
While working in the maternity ward of the Vienna General Hospital, Hungarian obstetrician Ignac Philipp Semmelweis greatly reduced the incidence of puerperal fever through his pioneering work developing antiseptic techniques. He went on to develop antiseptic surgical techniques, although he was unable to popularize them.
Locale Vienna, Austro-Hungarian Empire (now in Austria); Buda and Pest, Austro-Hungarian Empire (now Budapest, Hungary)
Key Figures
Ignaz Philipp Semmelweis (1818-1865), Hungarian obstetricianJohann Klein (d. 1856), head of the obstetrical clinic at Vienna General HospitalJakob Kolletschka (1803-1847), professor of forensic medicine at Vienna General HospitalOliver Wendell Holmes (1809-1894), American physician and authorAlexander Gordon (1752-1799), Scottish surgeon
Summary of Event
Puerperal, or childbed, fever was recognized as far back as Hippocrates. The condition was named in Latin febris puerperum, or childbearing fever, by the notable English physicianThomas Willis (1621-1675). Scottish physician Alexander Gordon found in 1795 that puerperal fever was communicable and could be transmitted from one woman to another by a birth attendant. However, that idea had not yet taken root in 1847.
Ignaz Philipp Semmelweis seems himself to have been unfamiliar with the scanty published literature on the subject of puerperal fever. Nevertheless, he determined independently by 1847 that puerperal fever was transmitted by bits of decomposed organic matter. More specific, Semmelweis discovered that decomposing animal or other putrefactive organic matter was being carried to women in the obstetric ward by medical staff members who came straight from the morgue to perform vaginal examinations on expectant mothers and those in labor. This putrefactive matter was in fact infecting the women’s genital tracts.
General acceptance of the procedure of using disinfectants to counter puerperal fever and other such maladies occurred only after Semmelweis’s death, when Louis Pasteur in France and Joseph Lister in Britain developed the science of bacteriology and antisepsis. Semmelweis was nonetheless able to help his own patients. As a provisional assistant and then assistant at the First Obstetrical Clinic of Vienna General Hospital, Semmelweis noticed the high incidence of mortality in the clinic’s First Division, where medical students were trained by the doctors. This rate was several times higher than in the Second Division, where midwives, who unlike the doctors and their students did not perform autopsies, received instruction.
Many Viennese doctors in the 1840’s attributed puerperal fever to nefarious atmospheric conditions, which they gave names such as “milk fever” and “miasma.” In 1842, however, Bostonian physician Oliver Wendell Holmes published The Contagiousness of Puerperal Fever, containing his theory that it was medical staff who infected mothers. Semmelweis independently came to the same conclusion. He became convinced of it when his colleague and friend Jakob Kolletschka cut his finger while performing a postmortem examination in March, 1847. The cut produced symptoms, similar to puerperal fever, from which Kolletschka died.
After a detailed study of mortality rates, Semmelweis concluded with certainty that it was primarily doctors and medical students who, following autopsies in the morgue, brought cadaveric contamination to their patients. By May, 1847, Semmelweis was ordering all the members of the Obstetrical Division whom he had trained to scrub their hands thoroughly in solutions of chloride of lime, or chlorinated lime, prior to entering the ward. He placed basins containing sand covered by the antiseptic at the ward’s entrances. In barely a month, the mortality rate from puerperal fever in his clinic declined from 12.14 percent to 2.38 percent. By the following year, there were barely any cases of septicemia in the First Division, which now matched or even bettered the rate of the midwives’ Second Division. The order to wash thoroughly was extended in 1848 to instruments and other medical paraphernalia coming in contact with patients.
Semmelweis urged this prophylactic practice spiritedly. The obstetrician refused to communicate his method to the learned circles of Vienna, however. Even two supportive explanatory articles by his colleague at the hospital, Ferdinand von Hebra, failed to generate widespread recognition. The request by another colleague, Josef Skoda, for an official investigation of the matter was quashed for political reasons. Semmelweis’s dogmatic nature and his unwillingness to tolerate criticism stood in the way of his ability effectively to communicate the nature and importance of his discovery. Additionally, many members of the medical profession fumed at the implication that they had been responsible for most deaths in the obstetrical ward by their transmission of the killer germs, and they were thus unwilling to hear what Semmelweis was unwilling to say.
As a result of the controversial nature of Semmelweis’s findings, he was denied promotion to the rank of clinical professor at Vienna General Hospital. He was thrwarted primarily by one superior and nemesis, Johann Klein. It had been Klein’s innovation to have his obstetricians and their students begin their day in the dissecting room of the morgue before proceeding to the delivery rooms. He thus stood the most to lose from Semmelweis’s discovery of the connection between that practice and puerperal fever. As a result of Klein’s enmity, Semmelweis was instructed that he could use only a mannequin for demonstration purposes in his midwifery classes. The limitation practically forced him out of his position.
Shortly thereafter, Semmelweis abruptly returned to his native city of Buda, where he worked across the river at the city of Pest’s St. Rochus Hospital from 1851 to 1857. Practicing what he preached, he performed both deliveries and general surgery under antiseptic conditions. The hospital soon offered him a teaching chair.
Semmelweis died in 1865 at the insane asylum in Vienna some two weeks after his admission there. It is not clear whether his death resulted from a gangrenous infected finger originating from a cut during the last autopsy he had performed or from staff at the asylum who tried to restrain him during one of his violent episodes in a straitjacket. Sympathizers ascribe his insanity to the opposition and ridicule with which his work was received.
Significance
Before his tragic death, Semmelweis published his momentous discovery in Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers (1861; The Cause, Concept, and Prophylaxis of Childbed Fever, 1941). Currently in the United States only about one woman in one thousand deliveries dies from puerperal fever each year, a tribute to Semmelweis’s pioneering work in the field. Only when doctors, their students, and midwives were persuaded to employ antiseptic procedures when they attended women in labor—beginning around the 1890’s, when bacteriology had come into its own—did the malady become nearly extinct. Only then could it be proven which specific pathogens were responsible for childbed fever. Once these pathogens were isolated, Semmelweis’s work was finally, conclusively vindicated.
Bibliography
Carter, K. Codell, and Barbara R. Carter. Childbed Fever: A Scientific Biography of Ignaz Semmelweis. Westport, Conn.: Greenwood Press, 1994. A brief but well-researched history of puerperal infection, Semmelweis’s work, and its effects on the disease.
Dormandy, Thomas. Moments of Truth: Four Creators of Modern Medicine. Chichester, West Sussex, England: Wiley, 2003. Short chronological account of Semmelweis’s life and work in the context of his medical innovations. Biographical profile and bibliography.
Loudon, Irvine. The Tragedy of Childbed Fever. New York: Oxford University Press, 2000. One of the most detailed studies of puerperal septicemia and the fight against it by Alexander Gordon, Ignaz Semmelweis, and Joseph Lister.
Nuland, Sherwin B. The Doctors’ Plague: Germs, Childbed Fever, and the Strange Story of Ignác Semmelweis. New York: W. W. Norton, 2003. An account in conversational style about puerperal septicemia, asepsis, and antiseptics.
Semmelweis, Ignaz. The Etiology, Concept, and Prophylaxis of Childbed Fever. Translated by K. Codell Carter. Madison: University of Wisconsin Press, 1983. The pioneer’s own story about his rediscovery of the cause of puerperal fever and the ways to prevent it with antiseptics.
Sinclair, Sir William J. Semmelweis: His Life and Doctrine: A Chapter in the History of Medicine. Manchester, England: Manchester University Press, 1909. An adulatory biography of Semmelweis by a renowned British obstetrician representing the Hungarian pioneer as a hero.
Slaughter, Frank G. Immortal Magyar: Semmelweis, Conqueror of Childbed Fever. New York: Henry Schuman, 1950. Another popular account praising the pioneer by an American physician.