Ignaz Philipp Semmelweis (German: [ˈɪɡnaːts ˈfɪlɪp ˈzɛml̩vaɪs]; Hungarian: Semmelweis Ignác Fülöp [ˈsɛm(ː)ɛlvɛjs ˈiɡnaːts ˈfyløp]; 1 July 1818 – 13 August 1865) was a Hungarian medical doctor and scientist of German descent who was an early pioneer of antiseptic procedures, known as the "saviour of mothers". Postpartum infection, also known as puerperal fever or childbed fever, was common in the 19th century, 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 views of the time, and his ideas were rejected by the medical community. He could not offer a theoretical explanation for his findings of reduced mortality due to hand washing; additionally, some doctors were offended by the suggestion that they should wash their hands, and mocked him for it. In 1865, the increasingly outspoken Semmelweis purportedly 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. Semmelweis's findings only gained widespread acceptance years after his death, when Louis Pasteur confirmed the germ theory of disease, giving Semmelweis's observations a scientific explanation, and Joseph Lister, acting on Pasteur's research, pioneered antiseptic surgical 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 (now Eisenstadt, Austria), 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 (At the White Elephant) in the Meindl House (today's Semmelweis Museum of Medical History, located at 1–3 Apród Street, Budapest). 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 (calcium hypochlorite) 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.
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