Semmelweis, Ignac

views updated

SEMMELWEIS, IGNAC

SEMMELWEIS, IGNAC (1818–1865), Austrian physician.

Born in the Hungarian capital of Buda, Ignac Semmelweis received his medical degree from the University of Vienna in 1844. While training as an obstetrician at the university's teaching hospital, the Allgemeine Krankenhaus, he became increasingly intrigued by the puzzle of childbed, or puerperal, fever, which at the time claimed the lives of some 15 percent of the mothers who delivered in the major hospitals of Europe. Although numerous theories existed to explain childbed fever's cause, none of them satisfied Semmelweis, especially because the preventive measures based on them were having no effect on incidence or mortality.

Relying on extensive autopsy studies, careful clinical observations, and a review of hospital records, Semmelweis determined that the disease was being spread by the unwashed hands of physicians, who began each day with the postmortem dissection of women who had died during the past twenty-four hours. The doctors' contaminated fingers, he asserted, were inoculating what he called "invisible cadaver particles" into the genital passages of women in labor. In May 1847 he instituted the policy that all students and physicians working on the ward under his direction must clean under their fingernails and wash carefully in a chlorine solution before examining patients. In the first full year of the program, the maternal mortality rate dropped to 1.2 percent, a figure astonishingly low for its time.

Semmelweis's theory indicted the very professors of obstetrics who throughout their careers had been struggling with, and failing to find a solution for, the tragedy of dying young mothers. These men, who were much senior to Semmelweis and owed their positions to powerful government connections, were threatened by the astuteness of a thesis that grew out of new discoveries in pathological anatomy, a discipline in which they were untrained. The theory became a battleground: they resisted the incursions of the younger clinical scientists, of whom Semmelweis was only one, while the younger clinicians approached medical problems with a form of investigative reasoning of which the older doctors were incapable.

It was at this point that Semmelweis committed a series of blunders that would in time destroy his career and ensure the rejection of his theory. The first of these was his failure to carry out the confirmatory laboratory experiments and microscopic studies that would have provided scientific rather than only clinical confirmation to his thesis. The second was his stubborn refusal, in spite of the urging of supportive and scientifically minded young colleagues, to publish his findings in a medical journal. And the third was his confrontational approach to his seniors, never hesitating to accuse them of continuing to murder their patients by ignoring his findings.

All of this resulted in the authorities refusing to renew Semmelweis's hospital appointment when it came up for review in 1850. Distraught, he returned to Hungary where he consoled himself with an appointment as professor of obstetrics at the University of Pest. Although his preventive measures were as successful there as they had been in Vienna, he became increasingly embroiled in personal disputes with colleagues and in acrimonious institutional battles in which he was the central figure. All of the frustrations and rages of the years were vented in the book he finally published in 1861, The Etiology, the Concept, and the Prophylaxis of Childbed Fever, a volume in which he tortuously explicated the details of his discovery and heaped insults on the leading obstetricians who had failed to appreciate its value. He followed this publication with a series of open letters to some of the most prominent European professors of obstetrics, castigating them for continuing their "murderous deeds" and "arrogant ignoring of my doctrine."

By this time it was becoming apparent that Semmelweis was showing signs of mental instability. As his deterioration progressed, he began to exhibit bizarre behavior and was finally admitted, in July 1865, to a mental institution, where he died two weeks later, probably at the hands of orderlies attempting to restrain him.

Two years after these tragic events, Joseph Lister of Glasgow began to publish the series of papers that, combined with the work of Louis Pasteur and Robert Koch, would establish the germ theory of disease, vindicating Semmelweis and in time rehabilitating his reputation. The key moment in this course of events took place in 1879, when Pasteur demonstrated the presence of streptococci in the blood and vaginal secretions of women who had died of childbed fever. These were the "invisible cadaver particles" that had been hypothesized by Semmelweis three decades earlier.

In time, Ignac Semmelweis became a Hungarian national hero, the subject of adulatory essays and biographies and the namesake of the nation's leading medical school. His childhood home is now the Semmelweis Museum of Medical History.

See alsoKoch, Robert; Lister, Joseph; Pasteur, Louis.

bibliography

Primary Sources

Semmelweis, Ignac. The Etiology, Concept, and Prophylaxis of Childbed Fever. Translated by K. Codell Carter. Madison, Wis., 1983. Translation of Die Aetiologie, der Begriff, und die Prophylaxis des Kindbettfiebers, 1861.