Ignaz Philipp Semmelweis ( Hungarian Semmelweis Ignác Fülöp ; * July 1, 1818 in the Tabán subdistrict of Buda , Kingdom of Hungary , Austrian Empire ; † August 13, 1865 in Oberdöbling near Vienna , Austrian Empire) was a surgeon and obstetrician . He studied medicine at the Universities of Pest and Vienna and received his doctorate from the University of Vienna in 1844 .
Semmelweis attributed the more frequent occurrence of childbed fever in public clinics compared to private delivery to poor hygiene among doctors and hospital staff and tried to introduce hygiene regulations . He was later called "the mothers' savior". His study from 1847/48 is today considered to be the first practical case of evidence-based medicine ( medicine based on empirical evidence) in Austria and a prime example of a methodically correct verification of scientific hypotheses. During his lifetime, his findings were not recognized and were rejected by colleagues as “speculative nonsense”. Few doctors supported him, as hygiene was viewed as a waste of time and inconsistent with the theories about the causes of illness then prevailing . Semmelweis practiced temporarily in Pest in what is now Hungary. He died at the age of 47 in Vienna under unspecified circumstances during a 2-week stay in the psychiatric clinic "Landesirrenanstalt Döbling" near Vienna. Numerous contradictions and inconsistencies indicate, in addition to the exhumation report from 1963 and the motives for its removal, to arbitrary psychiatric treatment and a subsequent homicide .
Youth and Career
Ignaz Semmelweis was born in 1818 as the fifth child of the specialty and colonial goods wholesaler Josef Semmelweis (1778–1846) and Theresa born from a wealthy family. Müller (1789–1844) was born in the Tabán subdistrict in Buda . The parents attached great importance to a good school education for their children, as this enabled them to advance to the relevant social classes of the domestic intelligentsia. The father had all of his sons enrolled in the archiepiscopal grammar school in Buda. After attending the elementary school in Buda, Ignaz went to the Piarist high school on St. Niklas Tower. He then completed a year of high school in Stuhlweissenburg . Originally he was supposed to be a military lawyer, so he studied philosophy and law at the University of Pest from 1835 to 1837 . In 1837 he came to Vienna to law to study, but moved in 1838 to medicine, continued his studies from 1839 to 1840 in Pest and in 1841 again in Vienna on. In 1844 he completed his studies with a master's degree in obstetrics and in the same year with a doctorate in medicine. med. from. His dissertation ( Tractatus de vita plantarum "On the life of plants") dealt with the theory of vitalism , which was popular at the time , and which, interestingly enough , resulted from the introduction of systematic clinical observation, which he himself demanded soon (1847/48), which made him a co-founder of evidence-based medicine was gradually being supplanted as unscientific. In 1845 he received his doctorate in surgery. He then began to work at Josef Skoda's chest outpatient department (1805–1881) and in the rash department, led by Ferdinand von Hebra (1816–1880), of the Imperial General Hospital founded by Emperor Joseph II . Here he learned Skoda's method of diagnosis by exclusion ("diagnosis per exclusionem") and scientific work with statistical instruments. In the Carl von Rokitansky's Institute for Pathological Anatomy under the direction of Carl von Rokitansky (1804–1878) he made findings on female corpses.
Assistant doctor in Vienna
In 1846 Semmelweis became an assistant doctor in the obstetrical department of the General Hospital. Supported by well-known doctors, he became the assistant to Prof. Johann Klein (1788–1856), head of the 1st obstetric clinic, under whose direction the mortality rate was between 5 and 15 percent; sometimes it was up to 30 percent in clinics. It was known that worked in the department in which doctors and medical students through the puerperal fever related mortality of mothers after childbirth was much higher than in the second division in which midwifery student nurses trained and no body sections were made. Semmelweis wanted to find out the reason for this and therefore examined the mothers even more thoroughly. But precisely because of these efforts, the number of deaths in his department increased even further, so that expectant mothers finally refused to be transferred to his department. According to his diary entries, 36 of 208 mothers in the entire clinic died of puerperal fever. So giving birth to a child was just as dangerous as getting pneumonia.
Only when the friendly with him medical examiner Jakob Kolletschka (1803-1847) during a corpse section of a student with the scalpel was injured and a few days later at a blood poisoning died - an illness that showed a pattern similar to puerperal fever - believed Semmelweis, to be able to name the cause of the disease:
The doctors and students performed daily clinical dissections on the corpses of the patients who had previously died of puerperal fever. They then went to the woman giving birth "with cadaver parts stuck to the hand" and washed their hands with soap (or in some cases not at all), but did not disinfect them. With these hands, they examined women during delivery and transmitted infectious material. The actual cause of the infection - the transmission of bacteria that are normally found in large numbers on the hands - was not yet known at the time (cf. corpse poison ). The midwifery students in the second department, on the other hand, did not come into contact with corpses and did not perform vaginal examinations.
In the years 1847 to 1848 he made a targeted study under the title The Etiology, the Concept and Prophylaxis of Puerperal Fever . As a result of this study, Ignaz Semmelweis instructed his students to disinfect their hands and instruments with a chlorine solution after a cadaver, and later with the cheaper chlorinated lime - as it turned out to be an effective measure, since the mortality rate rose from 12.3 to 2 to in just a few months 3 percent fell. When twelve women who had recently given birth fell ill with puerperal fever in one fell swoop, the cause of which was initially suspected to be infected, positive uterine carcinoma in a fellow patient, he realized that the infection could not only come from dead bodies, but also from living people. So he tightened the regulations so that the hands must be disinfected before each examination . This enabled him to reduce the death rate to 1.3 percent in 1848, a value that was even slightly below that of the second hospital department with midwives.
Despite this success, the work of Semmelweis was for a long time mainly by leading physicians such as Anton von Rosas (1791–1855), Rudolf Virchow (1821–1902), Eduard Kaspar Jakob von Siebold (1801–1861), Friedrich Wilhelm Scanzoni von Lichtenfels ( 1821–1891), James Young Simpson (1811–1870) and others not recognized. Many doctors and also his students thought cleanliness was unnecessary and refused to admit that they themselves were the cause of the disease that they actually wanted to cure. Some doctors, such as Gustav Adolf Michaelis , caused this to take their own lives as they could not bear this guilt. Other medics were very hostile to Semmelweis and called him a "nest polluter".
He found support with his theory from well-known representatives of the Vienna Medical Faculty such as Skoda, Rokitansky and Hebra. Ferdinand von Hebra had even urged Semmelweis to publish his scientific results. When that did not happen, Hebra himself took over the task. The opponents of Semmelweis prevented the extension of his assistant doctor activity in 1849, so that he resigned from the hospital in March 1849. In June of the same year he became a member of the k. k. Society of Doctors elected. Here, the suggested formation of a commission to examine Semmelweis's theses was accepted by majority vote, but at the instigation of his former boss in Vienna, Professor Klein, then ministerially rejected. It was not until March 15, 1850, that Semmelweis presented his findings in a lecture to the Society of Doctors.
Professor in Pest
Due to further hostility and intrigues from colleagues such as Johann Klein or Anton von Rosas , Ignaz Semmelweis was only appointed private lecturer for theoretical obstetrics with exercises on the phantom in 1850. He was so angry about this restriction that he left Vienna only five days after his appointment and moved to Pest . Here he opened a private practice. In addition, he worked as an unpaid primary physician in the maternity ward of St. Rochus Hospital in Pest. From 1851 Semmelweis was head of the obstetrics department in Pest, from 1855 professor for theoretical and practical obstetrics and as a midwifery teacher at the university there, the Semmelweis University that is now named after him . In 1857 he turned down a professorship in Zurich. In Pest, however, he also dealt with surgical gynecology, where he performed an operation on the ovary for the first time. He took the step of publishing his work results - albeit with little exposure - in the medical weekly "Orvosi Hetilap". Since this paper was not widely used, these activities were insufficient to stand up to its international adversaries. He then summarized his results and experiences until 1860 in the book The Etiology, the Concept and Prophylaxis of Child Bed Fever , which appeared in 1861. The 500-page, but clumsily presented and linguistically weak volume failed to succeed. Only a few doctors supported him (Semmelweis himself names the professors Michaelis from Kiel and Wilhelm Lange from Heidelberg, but Hebra , Škoda and von Rokitansky also stood up for him), since hygiene was viewed as a waste of time and incompatible with the theories about the causes of illness that were valid at the time . Rather, many attributed puerperal fever, for example, to bad air, the absence of menstruation or a milk congestion.
Since he repeatedly encountered rejection in parts of the medical profession with regard to the disinfection methods he recommended, from around 1861 he switched to sending open letters - first to his worst opponents, to Scanzoni, Späth and v. Siebold, then later to all professors in the field of obstetrics. In this he threatened to publicly expose the stupid if they did not implement his code of conduct. He did not always choose the right words diplomatically.
“I have the awareness within me that since 1847 thousands and thousands of newborns and babies have died who would not have died if I had not kept silent, but every error that was spread about puerperal fever had the necessary rebuke be let […]. The killing must stop, and in order for the killing to stop I will keep vigil, and anyone who dares to spread dangerous errors about puerperal fever will find an active opponent in me. For me there is no other means of stopping the killing than relentlessly exposing my opponents, and no one with their hearts in the right place will blame me for taking these means. "
And then continues:
"But if you, Mr. Hofrat, without having refuted my teaching, continue to educate your pupils in the teaching of epidemic childbed fever, I will declare you a murderer before God and the world."
Apparently in response to Semmelweis' letter of thought, Louis Kugelmann wrote from Hanover on August 10, 1861:
“Very few have been given real, great, and lasting services to humanity, and with few exceptions the world has crucified and burned its benefactors. I therefore hope you will not tire in the honorable fight that remains to you. You cannot miss an early victory any more, as many of your original opponents are de facto already professing your teaching. How surprising is it that people who for years in word and in writing, incomprehensible perhaps even to themselves, wrote and talked about things that were not understood, try to cover up this gap in their knowledge immediately. Not many put love to truth over self-love, some are probably caught up in the usual self-deception. Heinrich Heine's coarse sarcasm fits in with others, who says somewhere: 'When Pythagoras discovered his famous theorem, he sacrificed a hecatomb . Ever since then, the [ox] have had an instinctive fear of truth being discovered. '"
In 1865 Ignaz Semmelweis fell ill with severe depression and in July 1865 was admitted to the state insane asylum in Döbling near Vienna by three doctors without a diagnosis . According to some sources, Semmelweis' admission to the insane asylum was due to an intrigue . Semmelweis had repeatedly tried to convince his colleagues in writing that his findings were correct, but he was met with almost only rejection, as was the case around 1850 by his former superior at the Vienna General Hospital , Johann Klein (1788-1856), in his pathological institute Semmelweis was later autopsied . The biographer Fritz Schürer von Waldheim wrote in 1905:
“Nowadays it seems almost incomprehensible that these successes of Semmelweis did not induce the surgeons to imitate his method. Even in his close circle of friends, Semmelweis received no attention! (...) We thank his enemies that the general antisepsis did not start from Austria-Hungary. "
Semmelweis only mentioned Professors Michaelis in Kiel and Lange in Heidelberg as praiseworthy, and from his conversation in letters we know of others who were at least inclined to him.
On August 13, 1865 two weeks after his admission to Döbling, Ignaz Semmelweis died - the former, according to autopsy reports - at age 47 due to a small injury he have their own special section of injury in its sections have drawn, at a blood poisoning . A very similar assumption (died “of pyaemia , probably as a result of an operation wound”) was then expressed in the medical literature. According to other reports, this took place instead during a fight with the prison staff or at least within the hospital stay. For example, the pediatrician Janós Bókai, who wrote a report on Semmelweis' previous condition in 1865, said nothing of a previous injury, according to the gynecologist and medical historian Georg Silló-Seidl, who researched the original clinic documents in the archives of the Vienna Health Authority, although this, how claims to have been previously inflamed. According to Silló-Seidl, there were various other inconsistencies. Since multiple fractures of the hands, arms and left chest were found during an exhumation of Semmelweis's remains in 1963 , the clinic's memo, in which instead cerebral palsy was named as the cause of his death, appears all the more dubious. Considerations from u. a. According to the American Semmelweis biographer Sherwin Nuland, nurses are said to have beaten Semmelweis in the asylum yard and trampled on him.
Ignaz Semmelweis was buried on August 15th in the Schmelzer Cemetery in Vienna. After this was abandoned , the remains were buried in the grave of his parents on the Budapest Kerepesi temető . In 1963 she was transferred to the house where he was born, which is now the Semmelweis Museum for Medical History .
Semmelweis left a wife and three children. Obituaries were scanty and scarce. The only acknowledgment of his life's work was found in the journal Orvosi Hetilap , in which Semmelweis had published some of his lectures (even before he had written his book) - albeit in Hungarian. After all, the Wiener Medizin Wochenschrift dedicated a short obituary to him: “On Tuesday, Professor Semmelweis was buried. Many professors, primary physicians, etc. followed his coffin and escorted him to his final resting place. The deceased was only 47 years old and leaves behind a grieving widow and three underage children. Rest of his ashes. "
For a long time Semmelweis' importance was not recognized or misunderstood. It was not until 1882 that it received its first public recognition through the biography of Alfred Hegar . His biographers, whose books mostly appeared at the end of the 19th or beginning of the 20th century, often advocated him with drastic, very clear words.
The District Court of Döbling has been housed in the main building of the institution in Vienna-Döbling since 1991 . The new building of a retirement home is located on the former premises of the institution.
After his death, the Scottish surgeon Joseph Lister (1827–1912) demonstrated in 1867 that the surgical field was sprayed with disinfecting carbolic , which resulted in a drastic reduction in operating mortality . The asepsis is often ascribed to him, although he had drawn his knowledge from those of Semmelweis. A generation of doctors later, the implementation of hygiene measures in women in childbed prevailed, and the scientific world became aware of the importance of Semmelweis' findings.
The term Semmelweis reflex , known in the English-speaking world, describes the "immediate rejection of information or scientific discovery without further consideration or examination of the facts". In many cases, the scientific achievement results in a punishment rather than a corresponding reward. The concept formation is attributed to the American author Robert Anton Wilson .
In the former Brandenburg an der Havel District Hospital, now the Brandenburg City Hospital , there was a bust of Ignaz Semmelweis to the right of the entrance to the old delivery room. With the demolition of the building wing and the move of the delivery room to the new West building, this bust disappeared.
On February 20, 2019, a statue of the doctor was unveiled at the Medical University of Vienna , a gift from the Semmelweis University in Budapest. The unveiling took place in the presence of János Áder , Ernst Woller and the rectors of the two universities, Béla Merkely and Markus Müller . The statue was created by the Hungarian artist Péter Párkányi Raab.
Reception of Semmelweis' theses
Semmelweis' work was partially rejected by his colleagues. Three possible complexes can be named as the cause:
- the clientele,
- Semmelweis' character,
- the state of research and the self-interest of the leading professors.
With the biographers, the resistance of the leading professors is in the foreground. The prevailing opinion in the general reception is that Semmelweis himself damaged the implementation of his teaching through his clumsy and obsessive behavior.
Obstetrics enjoyed little reputation as a medical specialty. Obstetrical departments were often located in old, desolate hospital wings, with a view of the courtyard or the morgue . The facilities and hygienic conditions were extremely primitive, partly because the connection between hygiene and the risk of infection was not known. Unfortunately, there are no demographic data on the patient's status, origin, marital status, etc. in the statistics. All that is clear from the available documents is that the majority of the patients came from poor backgrounds and had no lobby .
Influential doctors spoke for him, but they made small mistakes that Semmelweis did not correct and that made him vulnerable. His first collegial supporter was Gustav Adolf Michaelis , who was the first obstetrician to test the discovery and agreed that Semmelweis was right. Apart from a few letters that Semmelweis sent to the professor of obstetrics in Kiel asking for an examination, Semmelweis did not respond either in writing or orally, despite many requests and opportunities. He did not appear publicly until mid-1850 in Vienna. His biographers explain this with inadequate schooling and the associated fear of speaking and writing. Semmelweis made grammatical and spelling mistakes and spoke dialect.
Semmelweis is described as modest and undemanding, as a good company, of childlike, naive way of thinking and trusting, but who reacted very decisively to mean things ( Alfred Hegar , 1882). His later bitterness and increasing psychological change - aggressiveness, confusion, forgetfulness, lack of control - are often accepted as the reason for the failure of his ideas. Alwin Schönberger described his illness: “He became increasingly impulsive, irascible and irritable, he raged, cursed and insulted colleagues, on the other hand had phases of apathy and lack of drive, neglected his appearance, sensed enemies, envious people and schemers everywhere. Researchers now suspect a progressive disease as the cause. The symptoms could match a neurosyphilis that was not accompanied by physical decline, but with a dramatic change in character. "
state of research
The German and Austrian textbooks on obstetrics ignored Semmelweis and continued to represent old teachings. Chlorine washes have occasionally been introduced without the professors responsible for the disinfection being scientifically recognized. A major obstacle to the spread and acceptance of his theory, however, was not ignorance, but rather the negligent performance of the chlorine washes, the unsuccessful success of which was viewed as a refutation of Semmelweis's thesis. At home and abroad, Semmelweis' findings were judged negatively. Leading doctors were critical and hostile to him. The state of research was different, the theory of wound diseases had found a different basis for explanation through Rudolf Virchow . The main cause of childbed fever was weather conditions and illnesses.
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|ALTERNATIVE NAMES||Semmelweis, Ignaz Philipp (full name); Semmelweis, Ignác Fülöp|
|BRIEF DESCRIPTION||Surgeon and obstetrician in the Austrian Empire|
|DATE OF BIRTH||July 1, 1818|
|PLACE OF BIRTH||Tabán, subdistrict of Buda , Kingdom of Hungary , Empire of Austria|
|DATE OF DEATH||August 13, 1865|
|Place of death||Oberdöbling near Vienna , Austrian Empire|