Ignaz Phillip Semmelweis

1818-1865

Hungarian Physician

Ignaz Semmelweis was the first to recognize that the hands of physicians carried the dreaded puerperal, or childbirth, fever. Although his observations were scoffed at and largely ignored during his lifetime, Semmelweis introduced aseptic techniques into medical practice that later proved fundamental to the profession.

Born July 1, 1818, in Buda (now Budapest), Austria-Hungary, Semmelweis attended the University of Pest and graduated a doctor of medicine from the University of Vienna in 1844. He also received a master's degree in midwifery and surgical training, as well as instruction in diagnostic and statistical methods. While at the First Obstetrical Clinic at the university teaching center at Vienna General Hospital, where he received his first appointment, Semmelweis's duties included the instruction of medical students, surgical procedures, and clinical examination.

Semmelweis was puzzled by the problem of puerperal fever, a condition related to childbirth where the mother, after several days, developed a high fever then died. While most women delivered babies at homes, those who came to the maternity hospitals faced mortality rates as high as 25 to 30 percent. The chief of the hospitals accepted these deaths as unavoidable, attributing it to overcrowding, onset of lactation, poor ventilation, or just bad air, called miasma.

Semmelweis observed that the death rate among women who delivered in a second clinic, designed for the training of midwifes, was two to three times lower than those in his clinic, where they were examined by medical students. In the medical school all patients who died were placed in a room for post-mortem examination. A friend, Jakob Kolletschka, died after accidentally puncturing his hand during a post-mortem examination. Autopsy revealed the same pathology as those who were dying with puerperal fever. Semmelweis made the connection that something on the hands of the doctors was carrying disease to healthy patients.

In May 1847, he devised a system where doctors and students would wash their hands in a solution of chlorinated lime after autopsy and before examination of patients. The staff protested, but Semmelweis was able to enforce the policy. In only one month puerperal fever had declined to less than two percent. He expanded the treatment to all instruments coming in contact with patients in labor.

Unfortunately, Semmelweis lost his position at the hospital after participating in a liberal revolution that swept Europe in 1848. He returned to Pest and private practice in 1850, married, and eventually had five children.

However, when an outbreak of puerperal fever was devastating the hospital in Pest, Semmelweis requested to be put in charge of the department. Implementing his techniques, he saw a reduction to less than one percent, while hospitals in Prague and Vienna were still experiencing up to 15 percent mortality.

In 1855 Semmelweis became a professor of obstetrics at the University of Pest and his techniques were accepted throughout Hungary. In 1861 he published a major paper, "Etiology, Understanding, and Preventing of Childbed Fever," that displayed his meticulous research. However, other countries, especially Germany, remained disdainful and critical of hand-washing and dismissed Semmelweis's writings and papers. Increasingly bitter and frustrated, in 1863 Semmelweis began to suffer from mental illness and was committed to an asylum. He died two weeks later. Ironically, his death was the result of a blood poisoning condition resembling puerperal fever, caused by a surgical accident.

Semmelweis's basic insights about the transmission of contagious diseases, underappreciated during his life, later influenced the work of Joseph Lister (1827-1912) and contributed to the germ theory of Louis Pasteur (1822-1895).

EVELYN B. KELLY