One of the saddest stories of a prophet who was treated as a quack by his contemporaries
is that of Ignaz Semmelweis. In 1847, at age 29, he was the chief obstetrician in charge of two maternity clinics in a hospital in Vienna. The first clinic was at a medical school in which pregnant women were treated by doctors and medical students who went from doing autopsies in their morgue, to treating patients with infections of every sort, to delivering babies. The second clinic was a charity clinic for impoverished pregnant women whose babies were delivered by midwives.
Semmelweis reviewed records from 1844 to 1848 and noticed that 12 percent of the women at the clinic run by doctors died of childbed fever, an illness that developed after their babies were delivered. Only 2.8 percent of the women whose babies were delivered by midwives died of that disease.
He wanted to explain why the doctors’ patients had so many more deaths than those of the midwives. The dominant view at that time was that something in the air in Vienna caused childbed fever, but that was nonsense because both clinics were in the same hospital. Another theory was overcrowding, but that was also ridiculous because the charity clinics were far more crowded than the clinics for paying patients. The diets and general care in both clinics were the same, and it was not the way the babies were delivered because both the doctors and the midwives were taught the same techniques.
Psychological explanations were equally foolish. Doctors thought that deaths in their clinic might be caused by fear from hearing an attendant ringing a bell, followed by a priest coming to administer last rights. Semmelweis decided to test this conjecture. He persuaded the priests to come by a roundabout route with no ringing of the bell. The high death rate in the doctors’ clinic failed to drop.
In 1847 a colleague of Dr. Semmelweis had his finger punctured by a scalpel during an autopsy, and he later died with a high fever and all of the other symptoms that the women had when they died of childbed fever. Semmelweis concluded that his colleague and the women with childbed fever may both have died from the same cause. Medical students went from the autopsy room to the delivery rooms and must have carried something on their hands from cadavers to the women. The doctors’ hands almost always had a foul fishy odor after leaving the autopsy room and they did not wash their hands before going on to see their patients.
Semmelweis ordered that all doctors, medical students and midwives wash their hands in chlorinated lime before examining the women. In one year, the death rate from childbed fever dropped from 12 percent to 1.27 percent in the doctors’ clinic and from 2.8 percent to 1.33 percent in the midwives’ section. He brilliantly recommended that all instruments to be used on patients also be cleansed with chlorinated lime solutions.
Hand-Washing Saves Lives Today we know that hand-washing in hospitals and clinics has undoubtedly saved thousands of lives, but at that time nobody understood about bacteria causing infections. Semmelweis’s theory that putrid material from dead people could have caused childbed fever was rejected by most doctors. The germ theory of disease was not proposed until two decades later.
On March 15, 1848, Hungarians, who wanted their independence from Austria, went to war against the ruling Hapsburgs of the Austrian Empire. Viennese medical students and faculty rallied for increased civil rights, trial by jury and freedom of speech. Semmelweis did not participate in any of the rallies or political activities in Vienna, but his medical school director decided that a Hungarian obstetrician working at an Austrian hospital had insulted the Austrian medical students by claiming that women died because they did not wash their hands. He gave Semmelweis’s medical school appointment to an Austrian doctor and Semmelweis had to leave the obstetric clinic. After 18 months without a job, he finally became a private lecturer who taught students but could not do autopsies. He was so hurt that he left Vienna and returned to his native Hungary.
A Sad Life in Hungary Meanwhile, the Austrian army had executed and imprisoned the leaders of the rebellion and destroyed parts of the cities of Buda and Pest (present-day Budapest). Semmelweis could not find a job, so he worked as the unpaid head-physician at the obstetric ward in Pest's St. Rochus Hospital and virtually eliminated the epidemic of childbed fever there. Yet Ede Flórián Birly, professor of obstetrics at the University of Pest, considered Semmelweis a nut and continued to believe that childbed fever was caused by a dirty colon and treated it with enemas. Fortunately for the patients, Birly died in 1854 and Semmelweis replaced him. He started chlorine hand washing and instrument washing, and childbed fever almost disappeared in his clinic. In 1857 he married Maria Weidenhoffer, who was 19 years younger than him, and they had five children.
Driven to Madness By 1861 he had started to show signs of mental illness. He turned every conversation to the topic of childbed fever. He wrote critics of his theory letters that were bitter and angry and denounced them as murderers and ignoramuses. He began to drink heavily in public, spent time away from his family, and had sexual relations with prostitutes. Several historians have diagnosed him as being depressed, suffering from Alzheimer's disease, and of having brain damage from late-stage syphilis. In addition to having sexual relations with prostitutes, he had used his bare hands to examine numerous women who were infected with syphilis.
Death from Infection On July 30, 1865 another physician, Ferdinand Ritter von Hebra, took him to an insane asylum. Semmelweis tried to leave, but he was held captive by several guards who beat him and put him in a straitjacket. He was doused with cold water and forced to take castor oil as a laxative. On August 13, 1865, at age 47, he died from an infected wound caused by the beating. His autopsy showed extensive internal injuries and blood poisoning, so he died from the same type of infection that he had prevented in his patients.
Only a few people attended his funeral and there was no acknowledgement of his death or his accomplishments by the local medical society. After Semmelweis died, the death rate at the Pest University maternity clinic rose from almost zero to six percent.
Exonerated Long After His Death More than twenty years after Semmelweis’ death, Louis Pasteur offered the germ theory to explain the cause of childbed fever and other infections, and suggested using boric acid to kill the microorganisms before and after a woman goes to deliver a baby. Later work by Joseph Lister and Robert Koch showed that bacteria caused disease.
Semmelweis is now recognized as one of the founders of modern antiseptic methods. Today we have Semmelweis University in Budapest, the Semmelweis Klinik Hospital for women in Vienna and the Semmelweis Hospital in Miskolc, Hungary. A 1938 film about his work, “That Mothers Might Live”, won an Academy Award for best documentary. In 2008, Austria issued a gold commemorative coin with his picture. The Semmelweis Medical History Museum is located in his former home in Budapest, and he is buried there.
Ignaz Semmelweis July 1, 1818 to August 13, 1865 (aged 47)
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