Matthew Hill
Abdullah Mubarik
Julius Bonello
Peoria, Illinois, United States

Ignaz Philipp Semmelweis (1818–1865) was born on July 1, 1818, in Budapest, Hungary. He was the son of a wealthy grocer and the fifth of ten children. While little is known of his childhood, he would eventually go on to study law at the University of Vienna in 1837 at the request of his father. However, his growing fascination with human anatomy soon led him to abandon law in favor of medicine. By 1845, he had attained his Doctor of Medicine, Master of Midwifery, and had graduated as an operating surgeon specializing in obstetrics.

In July 1846, Professor Johann Klein, a physician in the maternity department at Vienna General Hospital, appointed him as the first assistant obstetrician, a role similar to that of chief resident. Professor Klein took a hands-on approach to medical education, different from the teaching styles of his predecessors. Every morning, he had his all-male medical student cohort examine cadavers in the lab before attending rounds on the wards. In the maternity department at Vienna General, there were two divisions. In the first division, medical students attended deliveries. The second division was composed of an all-female midwife team.

During Semmelweis’s tenure at the hospital, he became increasingly disturbed by the appalling maternal mortality rate. The most common cause of death amongst these women was a sickness known as “puerperal fever.” Puerperal fever was an epidemic in Europe in the mid-nineteenth century. Typically occurring in the first three days following childbirth, the sickness was described as follows: “A woman could be delivered on Monday, happy and well with her newborn baby on Tuesday, feverish and ill by Wednesday evening, delirious and in agony with peritonitis on Thursday and dead on Friday or Saturday.” At Vienna General Hospital, maternal mortality was reported to be 9.4%, though this rate differed between the two divisions. In the division without the medical students, the mortality rate was only 3.4%. The medical student division was three times higher. Both rates were higher than death rates for women who gave birth at home or even on the street. Semmelweis therefore became obsessed with this paradox—that birth could be more dangerous at the hospital—and began research to understand why.

Semmelweis stepped away from his clinical duties and headed to Venice, with the theory that Venetian art would revive his spirits. Upon his return, he was met with devastating news: his dear friend, Professor Jacob Kolletschka, had died after a student had pricked his finger during an autopsy. Semmelweis examined the autopsy report, and what he found was shocking: the findings—including lymphangitis, peritonitis, pericarditis, pleurisy, and meningitis—were identical to those of women with puerperal fever. Semmelweis therefore proposed a hypothesis that was quite radical at the time: that puerperal fever was not exclusive to women in labor, but could affect anyone, and originated from some outside source. He thought back to how the women who had been treated by medical students had a higher rate of puerperal fever—medical students who had been in the cadaver lab that morning and then assisted in birth without washing their hands or cleansing themselves in any fashion. He reasoned that there was some poisonous material, which he coined “cadaverous particles,” in rotting flesh that caused both puerperal fever and Kolletschka’s death. If this were true, eliminating these particles should prevent disease.

With Klein’s support, Semmelweis instated a hand-washing protocol at the hospital with a chlorine solution (choral lime), which was known for its disinfectant properties. Physicians in the first clinic were mandated to wash their hands with the chlorinated solution after autopsies and before seeing patients. Maternal mortality rates were compared to the second clinic, where practices were unchanged. Almost immediately, the first clinic’s maternal mortality rate dropped by 90%. Rates at the hospital dropped overall to less than 2%. His theory had held up in the wards!

For Semmelweis, this was incontrovertible proof that puerperal fever was preventable and that hand hygiene was the key. To further test his theory, Semmelweis decided to perform a prospective animal study. In nine adult female rabbits, he vaginally inserted “cadaver particles” from women who had died from puerperal fever. At autopsy, seven of the nine rabbits were found to have the same pathological findings of the women who died after childbirth, once again validating his hypothesis.

Despite these extraordinary results, Semmelweis encountered fierce resistance from the medical establishment. His findings challenged the fundamentals of medicine at the time, where disease was believed to be caused by miasma and humoral imbalance. Most offensively, his research implied physicians themselves were responsible for transmitting lethal diseases to their patients. At the time, it was believed that physicians could not transmit disease to patients, as a gentleman’s hands were considered “pure” and therefore could not be infected with disease. Many medical professionals argued against his findings, rejecting the notion that some invisible contaminant on their hands could be deadly, and instead argued it was a natural fluctuation reflected by natural epidemics or coincidence. 

To compound his disappointments, Klein declined to renew Semmelweis’s appointment at the University of Vienna, and he was denied further academic advancement. Although some colleagues quietly implemented his practices, widespread acceptance never materialized during his time in Vienna. Dejected, Semmelweis returned to Hungary, where he continued to demonstrate dramatic reductions in maternal mortality at St. Rokus Hospital. Nevertheless, his failure to publish his findings, and his increasingly confrontational responses to critics only further alienated him from the European medical community. 

Years of marginalization took a toll on Semmelweis’s mental and physical health. He became depressed, irritable, and erratic. In 1865, concerned colleagues and family members arranged for his admission to an Austrian asylum under false pretenses. There, he was restrained and beaten by attendants, causing him to develop a wound infection that progressed to septicemia. On August 13, 1865, he died at the age of forty-seven. Ironically, the pioneer of antiseptic technique himself died of sepsis. His legacy today is undeniable as the initiator of the germ theory of disease and life-saving contributions to medicine that are practiced to this day. 

References

• Kader, N. Rediscovering Ignacio Philipp Semmelweis (1818-1865). American Journal of Obstetrics and Gynecology. Jan 2019, 22)(1): 26-39.
• Manor, J, Blum, N, Laurie, Y. “No Good Deed Goes Unpunished”: Ignaz Semmelweis and the story of Puerperal Fever. Infection Control and Hospital Epidemiology. Aug 2016, Vol 37 no 8: 881-887.