Bust of Lajos Markusovszky, in the inner garden of Semmelweis Medical University, Budapest. Photo by Attila Kovács, by kind permission.

The name “Ignaz Semmelweis” is at least vaguely familiar to many people, even if they need reminding that he was “the hand-washing guy.” He was the first fully to grasp why so many apparently healthy women died in childbirth. His hypothesis (which he supported with elaborate if sometimes-flawed statistics) was that if doctors and medical students washed their hands thoroughly before they examined women about to give birth or actually delivered their babies, the number of deaths from childbed fever would plummet. Though we now know he was right, the idea was novel in the 1840s. During his lifetime, Semmelweis was excoriated by many for insisting on such a simplistic solution to an ancient problem and widely criticized for his sometimes abrasive manner.

Myths grow up around many figures in medical history, but the discoverer of what caused childbed fever has been mythologized more than most. He has often been portrayed as a classic example of a tragic and lonely figure. So little is recounted about his friends that it has been easy to assume he had none.

By no means was that the case. Above all, there was Lajos Markusovszky. Yet in many accounts of Semmelweis’s life and career, Markusovszky appears (if at all) as a kind of shadowy figure, referred to only as Semmelweis’s “best friend,” his “countryman” (two sympathetic Hungarians living in Vienna), the friend with whom he shared rooms in the Hapsburg capital,¹ and his companion on a trip to Venice. Most English-language accounts of Semmelweis’s career neither mention Markusovszky’s name nor explain why it matters that precisely this man was his closest friend.

We know less than we should about Lajos Markusovszky because so little has been written about him in English. Only those who read Hungarian and troll through medical history archives and medical journals in Budapest are likely to learn anything about Markusovszky’s many contributions. Understanding the extent of his wide-ranging influence in medicine, education, and politics in nineteenth-century Hungary—never mind his importance to the Semmelweis story—requires patient slogging and the help of Hungarian historians, librarians, and archivists. Markusovszky should count as a significant figure in the history of medicine even if he had done nothing more than befriend, stand by, and support Semmelweis. But there is much more.

Markusovszky and Semmelweis became friends in Vienna, where Semmelweis had gone to study law. How the two met is not clear, but the fact that neither was Viennese may initially have brought them together. Furthermore, Markusovszky himself had initially studied law before being encouraged by Hungary’s leading physician to switch to medicine. Perhaps he recognized a kindred spirit in the younger man (born in 1815, Markusovszky was three years older than Semmelweis.) Tradition has it that he urged his young friend to attend an anatomy lecture, an experience that so dazzled Semmelweis he decided to forget law and take up medicine. Though fewer than half a dozen letters written by Semmelweis are extant, the teasing, joking tone of one he wrote to Markusovszky with the salutation “My dear Markó!” and signed “Friend Natzl” gives credence to the idea that they were friends.²

A tenuous thread, perhaps. But considerable written evidence exists in what Markusovszky himself published that it was he who pushed Semmelweis to give public lectures on his theory about childbed fever—that it was not a disease sui generis, that it was infectious rather than contagious, and that hand-washing would sharply reduce the incidence of death among just-delivered and apparently healthy mothers. Not only was it Markusovszky who made sure these lectures and other papers by Semmelweis were published; Markusovszky was also the one who persuaded Semmelweis finally to write a book on his theory about childbed fever.

Never mind that the resulting Aetiology, Concept, and Prophylaxis of Childbed Fever³ would have been a far better book if Markusovszky (or someone) had had an opportunity to edit it for Semmelweis. By his admission, he disliked anything having to do with writing, and it shows. Much in the book comes across as a disjointed and intemperate rant rather than a serious medical treatise. Semmelweis’s anger over the fact that so relatively few people had seen the truth of what he had discovered mars the book considerably. But Markusovszky saw through all that. Out of loyalty to his friend and because he was convinced the theory was correct, he wrote and published a long and positive review of the book, spread over three issues of the weekly Hungarian medical journal, Orvosi Hetilap.

Markusovszky was in a position to do that not only because he was the editor of the journal; Orvosi Hetilap, was in fact his creation. To be sure, he had encouragement and founding help from the widely admired leader of the medical community in Hungary, the brilliant surgeon János Balassa—the man who had persuaded Markusovszky to take up medicine as a career. Semmelweis and others also supported the idea. Without Markusovszky, however, there would have been no weekly medical journal in Hungary, certainly not at that time. Vienna had the German-language Wiener medizinische Wochenschrift, which was founded in 1851 and was clearly Markusovszky’s model. Inspired and undaunted, he launched his journal in 1857.

This was still a period of considerable political tension between the ruling Hapsburgs and the Hungarians. Although educated Hungarians spoke and read German, Markusovszky grasped the value of a journal that would provide a place where Hungarian physicians could publish or read colleagues’ contributions in their own language. A journal of their own would help boost professional pride and encourage colleagues to share with one another their medical experiences and insights. For Markusovszky, this project was a logical extension of earlier interests; his doctoral dissertation at Pest in 1844 was titled “The Physician as Educator.”⁴

Markusovszky served as the sole or primary editor of Orvosi Hetilap for more than thirty years. In addition to soliciting contributions from others, he produced articles, penned notes, wrote editorials; he also read and reviewed new medical books (whether in Hungarian, German, French, or English) as they appeared. He was clearly a man of prodigious energy. Although others supported the effort, with the founding of Orvosi Hetilap, this remarkable individual essentially single-handedly revolutionized continuing education for physicians in Hungary.

Portrait of Lajos Markusovszky by András Sós (date unknown). Photo from the Archives of Semmelweis Medical University, Budapest. By kind permission of László Molnar, Head Archivist.

On the 25th anniversary of the journal’s founding, Markusovszky was presented with a handsome leather-bound album dedicated to him with a calligraphed inscription that was “signed” (with pasted-in calling cards) by 176 physicians from across Hungary and beyond. A crucial point made in the testimonial was that because physicians who had begun practice after the journal’s founding had always been able to take it for granted, they could not fully appreciate its importance. (A further indication of the power of this great project of Markusovszky’s is that Orvosi Hetilap is still being published today.)

To a considerable extent, Markusovszky exercised his influence behind the scenes, perhaps because he was himself more than once the beneficiary of quiet but crucial support. János Balassa, the undisputed leader of Hungary’s medical fraternity, had an eye for talent. He twice took Markusovszky on as his personal assistant when the younger man’s career path was being blocked because he was a Protestant. This association with Balassa and the founding of the journal helped put Markusovszky in the public eye. During the 1848–49 Revolution and War of Independence, he was asked by the Minister of Education, József Eötvös, to establish courses on military surgery to help Hungarian physicians deal more efficiently with battle casualties. Among Markusovszky’s military patients was General Artúr Görgey, who later made him his Staff Physician.

As if founding the journal had not been enough, Markusovszky teamed with Balassa (and others) once again to establish a Hungarian medical book publishing company, modeled on the New Sydenham Society’s similar effort in London. Eötvös later invited Markusovszky to join the Ministry of Education as, in effect, Under Secretary for Medical Education. He found himself having to overcome opposition from traditional and conservative practitioners but steadfastly continued advocating for modern and progressive ideas. Not least among those ideas was Markusovszky’s insistence on the importance of a strong scientific basis for the study of medicine. He was also instrumental in drawing attention to the importance of improvements in hygiene and sanitation (he helped found the first National Public Health Council for Hungary) as well as in preventive medicine.

When Markusovszky died, writers of obituary notices seemingly vied with each other to sing his praises. The Hungarian authors of one of the very few thorough-going accounts of Semmelweis’s career available in English summed up his friend Markusovszky by calling him merely “a remarkable figure in the medical profession in Hungary” and “a pioneer in medical science after 1867.”⁵ Elected as a corresponding member of the Hungarian Academy of Science already in 1863, Markusovszky in 1890 was made an “Honored” member. He died in 1893, full of years and honors.

Clearly, Semmelweis was not the only figure of importance in nineteenth-century Hungarian medicine. The “Savior of Mothers” would not have had even the degree of success he did have without Markusovszky’s friendship and support; it is also likely that his relationship with Markusovszky was what led Semmelweis to be a part of the important “Balassa Circle” of progressive physicians. Granted, Semmelweis played a role of importance on this particular stage. What also matters, however, is seeing that far more was happening in Hungary during the second half of the century, medically speaking, than is generally acknowledged. In no small part, what transpired was due to that “remarkable figure,” Lajos Markusovszky.⁶

 

References

1. This oft-made claim was confirmed by Markusovszky himself when he reviewed Semmelweis’s book. See Orvosi Hetilap (1861): 5, no. 12: 226. Thanks to Katalin Kapronczay for tracking down the citation.
2. György Gortvay and Imre Zoltán, Semmelweis: His Life and Work [available in Hungarian and German as well] (Budapest: Akadémiai Kiadó, 1968), p. 71.
3. Ignaz Semmelweis, Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers (Pest, Wien and Leipzig: C.A. Hartleben, 1861). Frank P. Murphy’s translation (The Aetiology, Concept, and Prophylaxis of Childbed Fever), which appeared first in Medical Classics (1941): 5, nos. 5–8, pp. 338–773, remains the only complete English translation. That translation was also used in the special edition prepared for The Classics of Medicine Library (Birmingham, 1981) with commentary and translations of the Semmelweis “Open Letters” by Sherwin B. Nuland and Ferenc A. Gyorgyey.
4. József Antall, “Markusovszky Lajos (1815-1893),” Híres magyar orvosok (Budapest: Galenus, 2000), p. 48.
5. Gortvay and Zoltán, p. 285.
6. For an overview of Markusovszky’s career with more specifics about his accomplishments, in English, see Constance Putnam, “Markusovszky, Lajos,” in W. F. Bynum and Helen Bynum, eds., Dictionary of Medical Biography (Greenwood Press: Westport CT, 2007), Vol. 4: 849–50.

 

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CONSTANCE E. PUTNAM, Ph.D., is an independent scholar from Concord, Massachusetts, who specializes in medical history (19th and 20th century, United States and Hungary), bio-ethics, and the history of medical education. She has written three books in these fields and has contributed to several others. She has also published a wide range of articles and book reviews in professional journals, magazines, and newspapers. Having a review-essay included in a recent volume commemorating the sesquicentennial of Ignaz Semmelweis’s death, she is currently working on her own book about the medical scene in Budapest during the final fifteen years of Semmelweis’s life.