Ignaz Semmelweis

Ignaz Semmelweis (1860 portrait): advised handwashing with a chlorinated-lime solution in 1847.

File:I Semmelweis.jpg

Semmelweis on an old Austrian postage stamp.

Ignaz Philipp Semmelweis (July 1, 1818 - August 13, 1865), also Ignac Semmelweis (born Semmelweis Ignác Fülöp), was an Austrian-Hungarian physician called the "savior of mothers" who discovered, by 1847, that the incidence of puerperal fever could be drastically cut by use of hand washing standards in obstetrical clinics. Puerperal fever (or childbed fever) was common in mid-19th-century hospitals and often fatal, with mortality at 10%-35%. Semmelweis postulated the theory of washing with "chlorinated lime solutions" in 1847 as head of Vienna General Hospital's First Obstetrical Clinic, where doctor wards had 3 times the mortality of midwife wards. In 1851, Semmelweis moved to work in Hungary, which accepted the theory by 1857 (see below).

Despite his publications by 1861 of statistical/clinical trials where hand-washing reduced mortality below 1%, Semmelweis' practice only earned widespread acceptance years after his death, when Louis Pasteur confirmed the germ theory. A nervous breakdown (or possibly Alzheimer's) landed him in an asylum, where Semmelweis died of injuries, at age 47 [see details below].

Early history

Semmelweis was born on July 1, 1818 in Tabán, an old commercial sector of Buda, the fifth child of a prosperous shopkeeper of German origin. He received his elementary education at the Catholic Gymnasium of Buda, then completed his schooling at the University of Pest from 1835 to 1837. Semmelweis' father wanted him to become a military advocate in the service of the Austrian bureaucracy, but when Semmelweis travelled to Vienna in the fall of 1837 to enroll in its law school he was instead attracted to medicine. Apparently without parental opposition, he enrolled in the medical school instead.

Semmelweis returned to Pest after his first year and continued his studies at the local university from 1839-1841. However, displeased by the backward conditions at Pest University, he moved to the Second Vienna Medical School in 1841. The latter school combined laboratory and bedside medicine and became one of the most prominent centers of medicine for the next century. In the last two years some of his teachers included Carl von Rokitansky, Josef Skoda and Ferdinand von Hebra. Semmelweis completed his botanically-oriented dissertation early in 1844 and remained in Vienna after graduation to repeat a two-month course in practical midwifery. He received a Magister degree in the subject. He also completed some surgical training and spent almost fifteen months (October 1844 - February 1846) with Skoda learning diagnostic and statistical methods. Afterward he became assistant in the First Obstetrical Clinic of the Vienna General Hospital (German: Wiener Allgemeines Krankenhaus), the university's teaching hospital.

In the mid-19th century it was common for a doctor to move directly from one patient to the next without washing his hands, or to move from performing an autopsy on a diseased body to examining a living person. Semmelweis hypothesized that "particles" introduced into the women caused puerperal fever, and that these particles were spread on the hands of the doctors and students. Semmelweis ordered that hands be washed in a chlorine solution before each examination. Mortality rates among women attended by doctors and medical students quickly dropped from 18.27 to 1.27 percent. In 1861, Semmelweis published a book that described his findings and recommendations. He influenced Joseph Lister but years passed before the importance of disinfection was widely appreciated.

Discovery of the importance of hygiene

It was at the Vienna General Hospital that Semmelweis began investigating the causes of puerperal fever, against the resistance of his superiors who believed it to be non-preventable. Semmelweis became the titular house officer of the First Obstetrical Clinic in July 1846, which had a maternal mortality rate due to puerperal fever of 13.10%. This was well known at the time and many women preferred to give birth to their children on the street rather than being brought there. The Second Obstetrical Clinic had a mortality rate due to puerperal fever of only 2.03%, however; both were located in the same hospital and used the same techniques, with the only difference being the individuals who worked there. The first was the teaching service for medical students, while the second had been selected in 1839 for the instruction of midwives.

The breakthrough for Ignaz Semmelweis occurred in 1847 with the death of his friend Jakob Kolletschka from an infection contracted after his finger was accidentally punctured with a knife while performing a postmortem examination. Kolletschka's own autopsy showed a pathological situation similar to that of the women who were dying from puerperal fever. Semmelweis immediately proposed a connection between cadaveric contamination and puerperal fever and made a detailed study of the mortality statistics of both obstetrical clinics. He concluded that he and the students carried the infecting particles on their hands from the autopsy room to the patients they examined in the First Obstetrical Clinic. The germ theory of disease had not yet been developed at the time. Thus, Semmelweis concluded that some unknown "cadaveric material" caused childbed fever. He instituted a policy of using a solution of chlorinated lime for washing hands between autopsy work and the examination of patients and the mortality rate dropped from its then-current level of 12.24% to 2.38%, comparable to the Second Clinic's.

Rejection by the medical establishment

His observations went against the current scientific opinion of the time, which blamed diseases (among other quite odd causes) on an imbalance of the basic "four humours" in the body, a theory known as dyscrasia. It was also "argued" that even if his findings were correct, washing one's hands each time before treating a pregnant woman, as Semmelweis advised, would be too much work. Nor were doctors eager to admit that they had caused so many deaths.

There were ideological issues at the time that prevented the medical establishment from recognizing and applying the findings of Semmelweis. One was that Semmelweis' claims were thought to lack scientific basis, since no explanation was given to his findings. Such a scientific explanation was only made possible some decades later when the germ theory of disease was developed (see Pasteur, Lister, and others). Another ideological problem was the fact that Semmelweis' ideas were thought to give special significance to death and dying (it was mainly doctors not washing their hands after autopsies who transferred germs), an idea which was deemed "religious" or "superstitious" in the post-Enlightenment intellectual environment that dominated scientific circles at the time.

During 1848 Ignaz Semmelweis widened the scope of his washing protocol to include all instruments coming in contact with patients in labor and he statistically documented success in virtually eliminating puerperal fever from the hospital ward. Despite this dramatic result, Semmelweis refused to communicate his method officially to the learned circles of Vienna, nor was he eager to explain it on paper. Ferdinand von Hebra finally wrote two articles in his behalf but although foreign physicians and the leading members of the Viennese school were impressed by Semmelweis' apparent discovery the papers failed to generate widespread support.

Skoda attempted to create an official commission to investigate the results. The commission proposal was ultimately rejected by the Ministry of Education due to a political conflict in the university and government bureaucracies. Semmelweis was an active liberal, but a conservative movement gained power in 1848 and in 1849 he was fired from his position. Skoda delivered an address on the subject in the Imperial and Royal Academy of Sciences in October of 1849, but Semmelweis had neglected to correct his friends' papers to make known their mistakes in describing his work. Semmelweis was finally persuaded to present his findings personally in 1850 with some success. However, Semmelweis abruptly left Vienna later that year to return to Pest, apparently due to financial difficulties, without notifying even his closest friends. This hasty decision ruined his chances to overcome the Viennese skeptics.

In Hungary, Semmelweis took charge of the maternity ward of Pest's St. Rochus Hospital from 1851 to 1857. His hand- and equipment-washing protocols reduced the mortality rate from puerperal fever to 0.85% there, and his ideas were soon accepted throughout Hungary. He married, had five children, and built a large private practice. He became chair of theoretical and practical midwifery at the University of Pest in July 1855. Semmelweis turned down an offer in 1857 to chair obstetrics in Zurich. Vienna remained quite hostile to him, however. In the autumn of 1860 at Vienna General Hospital, long after the dismissal of Semmelweis, in the same ward where he demonstrated how to virtually eradicate childbed fever, 35 of 101 patients died.

In 1861, Semmelweis finally published his discovery in the book "Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers" (German for "The Etiology, Concept and Prophylaxis of Childbed Fever") of which Semmelweis sent copies to medical societies and also to leading obstetricians in Germany, France, and England. A number of unfavorable foreign reviews of the book prompted Semmelweis to lash out against his critics in series of open letters written in 1861-1862, which did little to advance his ideas. At a conference of German physicians and natural scientists, most of the speakers rejected his doctrine, including Rudolf Virchow.

The establishment's failure to recognize his findings earlier led to the tragic and unnecessary death of thousands of young mothers, but he was ultimately vindicated. This case is sometimes put forward as an example of a situation where scientific progress was slowed down by the inertia of established professionals. It has been contended, however that Semmelweis could have had an even greater impact if he had managed to communicate his findings more effectively and avoid antagonising the medical establishment, even given the opposition from entrenched viewpoints.

Breakdown and death

In July 1865 Semmelweis suffered what appeared to be a nervous breakdown, though some modern historians believe his symptoms may have indicated the onset of Alzheimer's disease or senile dementia. After a journey to Vienna imposed by friends and relatives he was committed to a mental asylum, the Niederösterreichische Landesirrenanstalt in Wien Döbling, where he died only two weeks later. Traditionally, he is said to have died the victim of a generalized blood poisoning similar to that of puerperal fever, which had been contracted from a surgically infected finger. According to an article in the Journal of Medical Biography by H. O. Lancaster, however, this is not true:

"Much biographical material has been written on Semmelweis, yet the true story of his death on 13 August 1865 was not confirmed until 1979, by S. B. Nuland. After some years of mental deterioration, Semmelweis was committed to a private asylum in Vienna. There he became violent and was beaten by asylum personnel; from the injuries received he died within a fortnight. Thus some dramatic theories have been destroyed, including that he was injured and infected at an autopsy, which if true would have been a wonderful case of Greek irony."

Legacy

The legacy of Ignaz Semmelweis continues in various ways:

• Only after Dr. Semmelweis's death was the germ theory of disease developed, and Semmelweis is now recognized as a pioneer of antiseptic policy and prevention of nosocomial infection;
• Semmelweis University, a university for medicine and health-related disciplines (located in Budapest, Hungary), is named after the physician Ignaz Semmelweis; and
• The Semmelweis Orvostörténeti Múzeum is located in the former home of Ignaz Semmelweis.
• The Semmelweis Klinik, a hospital for women only, located in Vienna, Austria.

Semmelweis Reflex

The Semmelweis Reflex is the dismissing or rejecting out of hand any information, automatically, without thought, inspection, or experiment. The phrase stems from a number of people's personal experiences with the phenomenon, and denotes the reactions of anyone who engages in such behaviour. The expression "Semmelweis Reflex" has been attributed to author Robert Anton Wilson.

See also

• Semmelweis University (Budapest)
• Joseph Lister

References

• William Broad and Nicholas Wade, Betrayers of the Truth: Fraud and Deceit in the Halls of Science, Simon and Schuster, NY; 1982.
• Louis-Ferdinand Celine, "Semmelweis",Gallimard, 1977.

• Nuland, Sherwin B, The Doctors' Plague: Germs, Childbed Fever, and the Strange Story of Ignác Semmelweis, 2003.

External links

• BMJ: Ignaz Semmelweis
• Catholic Encyclopedia entry
• John H. Lienhard: Ignaz Philipp Semmelweis
• Who Named it? Ignaz Philipp Semmelweis
• Tan S Y and Brown J Ignaz Philipp Semmelweis
• Caroline M De Costa, The contagiousness of childbed fever : a short history of puerperal sepsis and its treatment, eMJA The Medical Journal of Australia, MJA 2002 177 (11/12): 668-671
• review, The Fool of Pest, The New York Review of Books, 51:3 (February 26, 2004)
• The Semmelweis Society an organization dedicated to protecting physicians from sham peer review, named for Ignaz Semmelweis.