Semmelweis, Ignaz Philipp (1818-1865)

Semmelweis, Ignaz Philipp (1818-1865)

Hungarian physician

Along with American physician Oliver Wendell Holmes (1809–1894), Ignaz Semmelweis was one of the first two doctors worldwide to recognize the contagious nature of puerperal fever and promote steps to eliminate it, thereby dramatically reducing maternal deaths.

Semmelweis was born in Ofen, or Tabàn, then near Buda, now part of Budapest, Hungary, on July 1, 1818, the son of a Roman Catholic shopkeeper of German descent. After graduating from the Catholic Gymnasium of Buda in 1835 and the University of Pest in 1837, he went to the University of Vienna to study law, but immediately switched to medicine. He studied at Vienna until 1839, then again at Pest until 1841, then again at Vienna, earning his M.D. in 1844. Among his teachers were Karl von Rokitansky (1804–1878), Josef Skoda (1805–1881), and Ferdinand von Hebra (1816–1880). He did postgraduate work in Vienna hospitals in obstetrics, surgery, and, under Skoda, diagnostic methods. In 1846, he became assistant physician, tantamount to senior resident, at the obstetrical clinic of the Vienna General Hospital.

In the mid-nineteenth century, the maternal death rate for hospital births attended by physicians was much higher than for either home births or births attended by midwives. The principal killer was puerperal fever, or childbed fever, whose etiology was then unknown, but which Louis Pasteur (1822–1895) learned in 1879 was caused by a streptococcal infection of the open wound at the site of the placenta in women who had recently given birth. The infection could remain topical or it could pass through the uterus into the bloodstream and quickly become fatal. Before Semmelweis and Holmes, physicians generally assumed that puerperal fever was an unpreventable and natural consequence of some childbirths, and accepted the terrifying mortality statistics.

Witnessing so many healthy young mothers sicken and die greatly affected Semmelweis, and he grew determined to discover the cause and prevention of puerperal fever. Using Rokitanksy's pathological methods, he began a comparative study of autopsies of puerperal fever victims. The break-through came when his fellow physician, Jakob Kolletschka (1803–1847), died of blood poisoning after cutting his finger while performing an autopsy. Semmelweis noticed that the pathological features of the autopsy on Kolletschka's body matched those of the autopsies of the puerperal fever victims. Semmelweis then only suspected, and did not prove, that the fever was a septicemia, an intrusion of microorganisms from a local infection into the bloodstream, but he instantly took action. In May 1847, he ordered all personnel under his authority to wash their hands between patients. This was a novel, radical, and unpopular rule, but in just a month the maternal death rate at the Vienna General Hospital dropped from twelve to two percent.

Even though Semmelweis had solid results and statistics on his side, many physicians simply refused to believe that washing their hands, which they considered undignified, could save lives. Resistance to his rule stiffened. Semmelweis made many powerful enemies, and in March 1849, he was demoted from his supervisory role. He served at St. Rochus Hospital in Pest from 1851 to 1857, but never achieved his former professional status.

Holmes was facing a similar crisis in America. In 1843, Holmes first claimed in print that puerperal fever was contagious. Semmelweis first published his findings in 1848. Now having heard of Semmelweis, Holmes in 1855, expanded his original article into a small book that explicitly praised Semmelweis. Likewise, having now heard of Holmes, Semmelweis published Die Aetiologie, der Begriff, und die Prophylaxis des Kindbettfiebers [The Etiology, Concept, and Prophylaxis of Childbed Fever] in 1861. The book was not well received. Semmelweis was a poor prose stylist, and his lack of writing skill adversely affected his campaign. Holmes, on the other hand, an accomplished essayist and poet as well as a first-rate physician, proved more persuasive, although it would still be thirty years before sanitary and hygienic methods became standard in American and European hospitals.

While no one ridiculed Holmes, who had enough charm and grace to forestall such attacks, Semmelweis became subject of mockery in the central European medical community. In 1863, the frustration he had long felt finally took its toll on his spirit. He became chronically depressed, unpredictably angry, socially withdrawn, and increasingly bitter. In July 1865, a coalition of colleagues, friends, and relatives committed him to the Niederösterreichische Heil-und Pflegeanstalt, an insane asylum in Döbling, near Vienna. He died there a month later, on August 13, 1865, from bacteremia due to an infected cut on his finger, with symptoms markedly akin to those of puerperal fever.

See also Bacteria and bacterial infection; Contamination, bacterial and viral; Germ theory of disease; Hygiene; Infection control; Streptococci and streptococcal infections; Transmission of pathogens; Viruses and responses to viral infection