Ignaz Semmelweis
Ignaz Philipp Semmelweis was a Hungarian physician and scientist of German descent who was an early pioneer of antiseptic procedures and was described as the "saviour of mothers". Postpartum infection, also known as puerperal fever or childbed fever, consists of any bacterial infection of the reproductive tract following birth and in the 19th century was common and often fatal. Semmelweis demonstrated that the incidence of infection could be drastically reduced by requiring healthcare workers in obstetrical clinics to disinfect their hands. In 1847, he proposed hand washing with chlorinated lime solutions at Vienna General Hospital's First Obstetrical Clinic, where doctors' wards had thrice the mortality of midwives' wards. The maternal mortality rate dropped from 18% to less than 2%, and he published a book of his findings, Etiology, Concept and Prophylaxis of Childbed Fever, in 1861.
Despite his research, Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. He could offer no theoretical explanation for his findings of reduced mortality due to hand-washing, and some doctors were offended at the suggestion that they should wash their hands and mocked him for it. In 1865, the increasingly outspoken Semmelweis allegedly suffered a nervous breakdown and was committed to an asylum by his colleagues. In the asylum, he was beaten by the guards. He died 14 days later from a gangrenous wound on his right hand that may have been caused by the beating.
His findings earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory of disease, giving Semmelweis' observations a theoretical and scientific explanation, and Joseph Lister, acting on Pasteur's research, practised and operated using hygienic methods with great success.
Family and early life
Ignaz Semmelweis was born on 1 July 1818 in the Tabán neighbourhood of Buda, Kingdom of Hungary, Austrian Empire. He was the fifth child out of 10 of the prosperous grocer family of József Semmelweis and Teréz Müller.Of German ancestry, his father was an ethnic German born in Kismarton, in the Kingdom of Hungary, and his mother an ethnic German from Buda. József Semmelweis was granted citizenship in Buda in 1806 and, in the same year, he opened a wholesale business for spices and general consumer goods. The company was named Zum weißen Elefanten in the Meindl House. By 1810, he was a wealthy man and married Teréz Müller, daughter of the coachbuilder Fülöp Müller.
Ignaz began studying law at the University of Vienna in the autumn of 1837, but switched to medicine. He was awarded his doctor of medicine degree in 1844. After failing to obtain an appointment in a clinic for internal medicine, Semmelweis specialized in obstetrics. His teachers included Carl von Rokitansky, Joseph Škoda, and Ferdinand von Hebra.
Work on cause of child bed fever mortality
Position at Vienna General Hospital
Semmelweis was appointed assistant to Professor Johann Klein in the First Obstetrical Clinic of the Vienna General Hospital on 1 July 1846.There were two maternity clinics at the Viennese hospital. The First Clinic had an average maternal mortality rate of about 10% due to puerperal fever. The Second Clinic's rate averaged less than 4%. Women begged to be admitted to the Second Clinic, due to the reputation of the First Clinic. Semmelweis described desperate women begging on their knees not to be admitted to the First Clinic.
Women began purposefully giving birth in the streets, pretending to have given birth en route to the hospital so they could avoid being admitted to the clinic where the risk of infection, birth complications and death were substantially higher.
Semmelweis was puzzled that puerperal fever was rare among women giving street births, prompting his curiosity as to what protected those who delivered outside the clinic.
Analysis of childbed fever mortality
Troubled by the mortality discrepancy between the two clinics, Semmelweis searched for differences. He excluded overcrowding as a cause since the Second Clinic was always more crowded. He eliminated climate because the two clinics were in close geographical proximity to each other. He altered the position in which mothers gave birth, and proposed that the giving of last rites by priests in the clinic was terrifying women after birth, causing them to develop the fever.Theory of cadaverous poisoning
Semmelweis' breakthrough occurred in 1847, following the death of his good friend Jakob Kolletschka, who had been accidentally poked with a student's scalpel while performing a post mortem examination. Kolletschka's autopsy showed a pathology similar to that of the women who were dying from puerperal fever. Semmelweis immediately proposed a connection between cadaveric contamination and puerperal fever.He proposed that he and the medical students carried "cadaverous particles" on their hands from the autopsy room to the patients they examined in the First Obstetrical Clinic. This explained why the student midwives in the Second Clinic, who were not engaged in autopsies and had no contact with corpses, saw a much lower mortality rate.
The germ theory of disease had not yet been accepted in Vienna. Thus, Semmelweis concluded some unknown "cadaverous 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. He did this because he found that this chlorinated solution worked best to remove the putrid smell of infected autopsy tissue, and thus perhaps destroyed the causal "poisonous" or contaminating "cadaveric" agent hypothetically being transmitted by this material. The result was the mortality rate in the First Clinic declined 90% and was then comparable to that in the Second Clinic. The mortality rate in April 1847, before the new hand washing procedures were instituted, was 18.3%. The new procedures started in mid-May leading to lower rates: June 2.2%, July 1.2%, and August 1.9%. In two months in the year following this discovery, for the first time since the introduction of anatomical orientation, the death rate was zero.
Efforts to reduce childbed fever
Semmelweis's hypothesis, that there was only one cause, that the primary factor was cleanliness, was extreme at the time and was largely ignored, rejected, or ridiculed. He was dismissed from the hospital for political reasons and harassed by the medical community in Vienna, being eventually forced to move to Budapest.Semmelweis was outraged by the indifference of the medical profession and began writing open and increasingly angry letters to prominent European obstetricians, at times denouncing them as irresponsible murderers. His contemporaries, including his wife, presumed he was losing his mind, and in 1865, nearly 20 years after his breakthrough, he was committed to the Landesirrenanstalt Döbling. He died there of septic shock only 14 days later, possibly as the result of being severely beaten by guards. Semmelweis's practice earned widespread acceptance only years after his death when Louis Pasteur further developed the germ theory of disease, offering a theoretical explanation for Semmelweis's findings. He is considered a pioneer of antiseptic procedures.
Conflict with established medical opinion
Semmelweis's observations conflicted with the established scientific and medical opinions of the time. The theory of diseases was highly influenced by ideas of an imbalance of the basic "four humours" in the body, a theory known as dyscrasia, for which the main treatment was bloodlettings. Medical texts at the time emphasized that each case of disease was unique, the result of a personal imbalance, and the main difficulty of the medical profession was to establish precisely each patient's unique situation, case by case.The findings from autopsies of deceased women also showed a confusing multitude of physical signs, which emphasized the assumption that puerperal fever was not one, but many different, yet unidentified, diseases.
Also, some historians of science argue that resistance to path-breaking contributions of obscure scientists is common and "constitutes the single most formidable block to scientific advances".
As a result, his ideas were rejected by the medical community. Other, subtler factors may also have played a role. Some doctors, for instance, were offended at the suggestion that they should wash their hands, feeling that their social status as gentlemen was inconsistent with the idea that their hands could be unclean.
Semmelweis's results lacked scientific explanation at the time. That became possible only in the 1860s and 1870s, when Louis Pasteur, Joseph Lister, Robert Koch, and others further developed the germ theory of disease.
During 1848, Semmelweis widened the scope of his washing protocol, to include all instruments coming in contact with patients in labour, and used mortality rates time series to document his success in virtually eliminating puerperal fever from the hospital ward.
Hesitant publication of results and first signs of trouble
Toward the end of 1847, accounts of the work of Semmelweis began to spread around Europe. Semmelweis and his students wrote letters to the directors of several prominent maternity clinics describing their recent observations. Ferdinand von Hebra, the editor of a leading Austrian medical journal, announced Semmelweis's discovery in the December 1847 and April 1848 issues of the medical journal. Hebra claimed that Semmelweis's work had a practical significance comparable to that of Edward Jenner's introduction of cowpox inoculations to prevent smallpox.In late 1848, one of Semmelweis's former students wrote a lecture explaining Semmelweis's work. The lecture was presented before the Royal Medical and Surgical Society in London and a review published in The Lancet, a prominent medical journal. A few months later, another of Semmelweis's former students published a similar essay in a French periodical.
As accounts of the dramatic reduction in mortality rates in Vienna were being circulated throughout Europe, Semmelweis had reason to expect that the chlorine washings would be widely adopted, saving tens of thousands of lives. Early responses to his work also gave clear signs of coming trouble, however. Some physicians had clearly misinterpreted his claims. Additionally, initial responses to Semmelweis's findings tended to downplay their significance by arguing that he had said nothing new. James Young Simpson, for instance, saw no difference between Semmelweis's groundbreaking findings and the idea presented in an 1843 paper by Oliver Wendell Holmes Sr. that childbed fever was contagious.
In fact, Semmelweis was warning against all decaying organic matter, not just against a specific contagion that originated from victims of childbed fever themselves. This misunderstanding, and others like it, occurred partly because Semmelweis's work was known only through secondhand reports written by his colleagues and students. At this crucial stage, Semmelweis himself had published nothing. These and similar misinterpretations continued to cloud discussions of his work throughout the century.
Some accounts emphasize that Semmelweis neither wished to communicate his method officially to the learned circles of Vienna, nor was eager to explain it on paper.