Semmelweis, Father of Infection Control
By Olga Vállay Szokolay
In the age of public telephone booths and pertinent phone books in Budapest, one would have found names of the most diversified nationalities, representing the historic ethnic composition of the country. In my opinion, Hungary has been one of the ethnically most mixed nations, second only to the United States.
The name is German, as many Magyars’ name is. The fifth child out of ten, by parents successful grocery store owner Semmelweis József and Müller Teréz, Semmelweis Ignácz Fülöp was born on July 1st, 1818 in the Tabán section of Buda. Considering the size of their family, lack of information about his early years is understandable.
At age 19, Ignácz began studying law at the University of Vienna. Next year he must have heard his calling and he 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, he was relegated to specialize in obstetrics.
In the mid-19th century, about five women in 1,000 died in deliveries performed by midwives or at home. Yet, when doctors working in the best maternity hospitals in Europe and America performed deliveries, the maternal death rate was often 10 to 20 times greater. At the Vienna General Hospital there were two obstetrical clinics. One under the supervision of a professor, assisted by Dr. Semmelweis teaching medical students, the other clinic teaching midwives. The mortality rate at the first one was far greater than that of the second.
Invariably, the cause was puerperal fever or childbed fever, with its raging fevers, putrid pus oozing from the birth canal and painful abscesses in the abdomen and chest, leading to an irreversible descent into an absolute hell of sepsis and death, within 24 hours of the baby’s birth.
Women assigned to Dr. Semmelweis’ jurisdiction were begging him on their knees to be discharged, because they believed these doctors to be the “harbingers of death”. Some opted for delivering in the street on their way to the hospital, since their chances for survival seemed better that way.
He listened, while he was severely troubled. He was on the verge of depression trying to find the cause of the puzzling reality. The only difference between the two clinics was the group of medical students who would come to obstetrics, to mothers delivering babies, straight from the morgue just as they were, without any means of disinfection. Horrifying as it may be for us today, that was the medical norm of the day.
Though Semmelweis’ observations conflicted with the established medical opinion, he ultimately made the vital connection that childbed fever was caused by the doctors transferring some type of “morbid poison” from dissected corpses in the autopsy suite to the women laboring in the delivery room. That morbid poison is now known as the bacteria called Group A hemolytic streptococcus.
Simultaneously, other theories were circulating about the cause of puerperal fever. In international medical circles, the idea of the disease’s contagiousness spread by doctors was accepted. Harvard anatomist Oliver Wendell Holmes published “The Contagiousness of Puerperal Fever” in 1843, in which he recommended that actively practicing obstetricians abstain from performing autopsies on women who died of childbed fever.
Concurrently, Dr. Semmelweis ordered his medical students and junior physicians to wash their hands in a chlorinated lime solution until the putrid smell of the bodies they dissected in the autopsy suite was no longer detectable. In 1847, soon after this protocol was instituted, the mortality rates on the doctor-dominated obstetrics service plummeted.
170 years ago, on May 15th, 1850 he presented the “Wash Your Hands” idea to his illustrious colleagues at the grand and ornately decorated Vienna Medical Society’s lecture hall. Despite his rather obvious data, he met with enormous resistance and criticism.
Semmelweis had two strikes against him from the beginning: he was Hungarian and he was Jewish. This was aggravated by his difficult temperament and inconsiderate manners. Against the repeated urging of his supporters, he refused to publish his “self evident” findings until 13 years after making them. To make matters worse, he hurled outrageously rude insults to some of the most powerful doctors who questioned his ideas.
This unhappy man was increasingly becoming so angry at each criticism that he lost his clinical appointment at the Vienna General Hospital. That prompted him to abruptly leave for Pest-Buda in October 1850, without even telling his closest colleagues. In May, 1851 he took the unpaid honorary head-physician position of the obstetrics ward of Szent Rókus Hospital, at Pest. At his first visit to the location, he found deplorable conditions, childbed fever being rampant. After taking over he virtually eliminated the disease. In four years, only eight patients out of 933 who gave birth died from it.
In 1857, he declined an offer to become professor of obstetrics at the University of Zürich. Instead, he married Weidenhofer Mária,19 years his junior, with whom he had five children.
Finally, in 1861, he published his work “The Etiology, Concept and the Prophylaxis of Childbed Fever”. In this work he explained his theories on the disease, the ways to avoid spreading it by means of vigorous hand washing as well as an attack on every one of his critics “with a vitriol that still leaps off the page”.
As his behavior became more and more erratic, his contemporaries, including his wife, believed he was losing his mind. Nearly twenty years after his breakthrough, Semmelweis was committed to a provincial insane asylum in Dőbling, Austria on July 30th, 1865 for what may have been an unbridled case of bipolar disease. He died two weeks later there, on August 13th, 1865, at age 47, of septic shock.
Historians still argue over what caused his mental breakdown and subsequent death. Some point to an operation he had performed where he infected himself with syphilis that would also explain his insanity. Others suspect his guards beat him to death.
The professional timing of Semmelweis could not have been worse. He made his landmark discovery long before the medical profession was ready to accept it. He was derided as eccentric at best and, at worst, as an angry, unstable man who ought to be drummed out of the profession. The unstable political situation between Austria and Hungary did not work in his favor either.
Pasteur’s germ theory of disease occurred in the early 1860s. A few years later, the Scottish surgeon Joseph Lister (who had never heard of Semmelweis!) advocated the theory and practice of antiseptic surgery, including hand washing with carbolic acid to prevent infection.
It was not until the dawn of the 20th century that Semmelweis and his theory became accepted and appreciated. Since then, physicians and historians have highly praised his work and expressed sympathy for his emotional troubles and premature death. Today, in every school of medicine and public health, his name is uttered with great reverence whenever the importance of hand washing is mentioned. And, most appropriately, Semmelweis University in Budapest is proudly saving his name forever.
His detractors were wrong and he was right. For that, Semmelweis paid a heavy price as he devoted his short, troubled life’s obsession pushing the boundaries of knowledge in the noble quest to save lives.
Olga Vállay Szokolay is an architect and Professor Emerita of Norwalk Community College, CT after three decades of teaching. She is a member of the Editorial Board of Magyar News Online.