Ignaz Semmelweis
Encyclopedia
Ignaz Philipp Semmelweis (July 1, 1818 – August 13, 1865) was a Hungarian physician now known as an early pioneer of antiseptic procedures. Described as the "savior of mothers", Semmelweis discovered that the incidence
of puerperal fever
could be drastically cut by the use of hand disinfection in obstetrical
clinics. Puerperal fever was common in mid-19th-century hospitals and often fatal, with mortality at 10%–35%. Semmelweis postulated the theory of washing with chlorinated lime solutions
in 1847 while working in Vienna General Hospital
's First Obstetrical Clinic, where doctors' wards had three times the mortality of midwives' wards. He published a book of his findings in Etiology, Concept and Prophylaxis of Childbed Fever
.
Despite various publications of results where hand-washing reduced mortality
to below 1%, Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands and Semmelweis could offer no acceptable scientific explanation for his findings. Semmelweis's practice earned widespread acceptance only years after his death, when Louis Pasteur
confirmed the germ theory
. In 1865, Semmelweis was committed to an asylum
, where he died of septicemia
, at age 47.
Ignaz Semmelweis was born on July 1, 1818 in the Tabán
, an area of Buda
, part of present Budapest
, Hungary (then part of the Habsburg
Empire). He was the fifth child out of ten of a prosperous grocer
family of Josef and Teresia Müller Semmelweis.
His father, Josef Semmelweis (1778–1846), was born in Kismarton
, at that time in Hungary. Josef achieved permission to set up shop in Buda in 1806 and, in the same year, opened a wholesale business with spices and general consumer goods named zum Weißen Elephanten (to the White Elephant) in Meindl-Haus in Tabán
(today's 1-3, Apród Street, Semmelweis Museum of Medical History). By 1810, he was a wealthy man when he married Teresia Müller, daughter of the famous coach (vehicle) builder Fülöp Müller.
Ignaz Semmelweis began studying law at the University of Vienna
in the autumn of 1837, but by the following year, for reasons that are no longer known, he had switched to medicine. He was awarded his doctorate degree in medicine in 1844. After failing to obtain an appointment in a clinic for internal medicine, Semmelweis decided to specialize in obstetrics. Some of his teachers included Carl von Rokitansky
, Josef Skoda
and Ferdinand von Hebra
.
in the First Obstetrical Clinic of the Vienna General Hospital
on July 1, 1846. A comparable position today would be "chief resident." His duties were to examine patients each morning in preparation for the professor's rounds, supervise difficult deliveries, teach students of obstetrics and be 'clerk' of records.
Maternity institutions were set up all over Europe to address problems of infanticide
of illegitimate children. They were set up as gratis institutions and offered to care for the infants, which made them attractive to underprivileged women, including prostitutes. In return for the free services, the women would be subjects for the training of doctors and midwives. There were two maternity clinics at the Viennese hospital. The First Clinic had an average maternal mortality rate
due to puerperal fever of about 10% (actual rates fluctuated wildly). The Second Clinic's rate was considerably lower, averaging less than 4%. This fact was known outside the hospital. The two clinics admitted on alternate days but women begged to be admitted to the Second Clinic, due to the bad reputation of the First Clinic. Semmelweis described desperate women begging on their knees not to be admitted to the First Clinic. Some women even preferred to give birth in the streets, pretending to have given sudden birth en route to the hospital (a practice known as street births), which meant they would still qualify for the child care benefits without having been admitted to the clinic. Semmelweis was puzzled that puerperal fever was rare amongst women giving street births. "To me, it appeared logical that patients who experienced street births would become ill at least as frequently as those who delivered in the clinic. [...] What protected those who delivered outside the clinic from these destructive unknown endemic influences?"
Semmelweis was severely troubled and literally sickened that his First Clinic had a much higher mortality rate due to puerperal fever than the Second Clinic. It "made me so miserable that life seemed worthless". The two clinics used almost the same techniques, and Semmelweis started a meticulous process of eliminating all possible differences, including even religious practices. The only major difference was the individuals who worked there. The First Clinic was the teaching service for medical students, while the Second Clinic had been selected in 1841 for the instruction of midwives only.
He excluded "overcrowding" as a cause, since the Second Clinic was always more crowded and yet the mortality was lower. He eliminated climate as a cause because the climate was the same. The 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 postmortem examination. Kolletschka's own autopsy
showed a pathology
similar to that of the women who were dying from puerperal fever. Semmelweis immediately proposed a connection between cadaver
ic contamination and puerperal fever.
He concluded 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 developed. Thus, Semmelweis concluded some unknown "cadaverous material" caused childbed fever. He instituted a policy of using a solution of chlorinated lime
(modern calcium hypochlorite
, the compound used in today's common household chlorine bleach solution) 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 destroying the causal "poisonous" or contaminating "cadaveric" agent hypothetically being transmitted by this material.
The result was that the mortality rate dropped 90%, comparable to the Second Clinic's. The mortality rate in April 1847 was 18.3%; after handwashing was instituted in mid-May, the rates in June were 2.2%, July 1.2 %, August 1.9% and, for the first time since the introduction of anatomical orientation, the death rate was zero in two months in the year following this discovery.
, a form of septicaemia also known as childbed fever, could be cut drastically if doctors washed their hands in a chlorine solution before gynaecological examinations.
While employed as assistant to the professor of the maternity clinic at the Vienna General Hospital
in Austria
in 1847, Semmelweis introduced hand washing with chlorinated lime solutions
for interns who had performed autopsies. This immediately reduced the incidence of fatal puerperal fever from about 10 percent (range 5–30 percent) to about 1–2 percent. At the time, diseases were attributed to many different and unrelated causes. Each case was considered unique, just as a human person is unique. Semmelweis's hypothesis, that there was only one cause, that all that mattered was cleanliness, was extreme at the time, and was largely ignored, rejected or ridiculed. He was dismissed from the hospital for political reasons and harassed by the medical community in Vienna, being eventually forced to move to Pest.
Semmelweis was outraged by the indifference of the medical profession and began writing open and increasingly angry letters to prominent European obstetricians, at times denouncing them as irresponsible murderers. His contemporaries, including his wife, believed he was losing his mind, and in 1865 he was committed to an asylum
. In an ironic twist of fate, he died there of septicaemia only 14 days later, possibly from the result of being severely beaten by guards. Semmelweis's practice earned widespread acceptance only years after his death, when Louis Pasteur
developed the germ theory of disease
, offering a theoretical explanation for Semmelweis's findings. He is considered a pioneer of antiseptic procedures.
Semmelweis's observations conflicted with the established scientific and medical opinions of the time. The theory of disease
s was highly influenced by ideas of an imbalance of the basic "four humours
" in the body, a theory known as dyscrasia
, for which the main treatment was bloodletting
s. Medical texts at the time emphasized that each case of disease was unique, the result of a personal imbalance, and the main difficulty of the medical profession was to establish precisely each patient's unique situation, case by case.
The findings from autopsies of deceased women also showed a confusing multitude of various physical signs, which emphasised the belief that puerperal fever was not one, but many different, yet unidentified, diseases. Semmelweis's main finding — that all instances of puerperal fever could be traced back to only one single cause: lack of cleanliness — was simply unacceptable. His findings also ran against the conventional wisdom that diseases spread in the form of "bad air", also known as miasmas
or vaguely as "unfavourable atmospheric-cosmic-terrestrial influences". Semmelweis's groundbreaking idea was contrary to all established medical understanding.
As a result, his ideas were rejected by the medical community. Other more subtle factors may also have played a role. Some doctors, for instance, were offended at the suggestion that they should wash their hands; they felt that their social status as gentlemen was inconsistent with the idea that their hands could be unclean.
Specifically, Semmelweis's claims were thought to lack scientific basis, since he could offer no acceptable explanation for his findings. Such a scientific explanation was made possible only some decades later, when the germ theory of disease was developed by Louis Pasteur
, Joseph Lister
, and others.
During 1848, Semmelweis widened the scope of his washing protocol to include all instruments coming in contact with patients in labor, and used mortality rate time series
to document his success in virtually eliminating puerperal fever from the hospital ward.
Toward the end of 1847, accounts of Semmelweis's work began to spread around Europe. Semmelweis and his students wrote letters to the directors of several prominent maternity clinics describing their recent observations. Ferdinand von Hebra
, the editor of a leading Austrian medical journal, announced Semmelweis's discovery in the December 1847 and April 1848 issues of the medical journal. Hebra claimed that Semmelweis's work had a practical significance comparable to that of Edward Jenner
's introduction of cowpox inoculations to prevent smallpox.
In late 1848, one of Semmelweis's former students wrote a lecture explaining Semmelweis's work. The lecture was presented before the Royal Medical and Surgical Society in London and a review published in The Lancet
, a prominent medical journal. A few months later, another of Semmelweis's former students published a similar essay in a French periodical.
As accounts of the dramatic reduction in mortality rates in Vienna were being circulated throughout Europe, Semmelweis had reason to expect that the chlorine washings would be widely adopted, saving tens of thousands of lives. Early responses to his work also gave clear signs of coming trouble, however. Some physicians had clearly misinterpreted his claims. James Young Simpson
, for instance, saw no difference between Semmelweis's groundbreaking findings and the British idea suggested by Oliver Wendell Holmes
in 1843 that childbed fever was contagious (i.e. that infected persons could pass the infection to others). Indeed, initial responses to Semmelweis's findings were that he had said nothing new.
In fact, Semmelweis was warning against all decaying organic matter, not just against a specific contagion that originated from victims of childbed fever themselves. This misunderstanding, and others like it, occurred partly because Semmelweis's work was known only through secondhand reports written by his colleagues and students. At this crucial stage, Semmelweis himself had published nothing. These and similar misinterpretations would continue to cloud discussions of his work throughout the century.
Some accounts emphasise that Semmelweis refused to communicate his method officially to the learned circles of Vienna, nor was he eager to explain it on paper.
swept across Europe. The resulting political turmoil would affect Semmelweis's career. In Vienna on March 13, 1848, students demonstrated in favor of increased civil rights, including trial by jury and freedom of expression. The demonstration was led by medical students and young faculty members and were joined by workers from the suburbs. Two days later in Hungary, demonstrations and uprisings led to the Hungarian Revolution of 1848
and a full-scale war against the ruling Habsburgs of the Austrian Empire
. In Vienna, the March demonstration was followed by months of general unrest.
There is no evidence that Semmelweis was personally involved in the events of 1848. It is known that some of his brothers were punished for active participation in the Hungarian independence movement, and it seems likely that the Hungarian-born Semmelweis was sympathetic to the cause. Semmelweis's superior, professor Johann Klein
, was a conservative Austrian, likely at unease with the independence movements and alarmed with the other revolutions of 1848 in the Habsburg areas
. It seems likely that Klein mistrusted Semmelweis.
When Semmelweis's term was about to expire Carl Braun also applied for the position of assistant in the First Clinic, possibly at Klein's own invitation. Semmelweis and Braun were the only two applicants for the post. Semmelweis's predecessor, Breit
, had been granted a two-year extension. Semmelweis's application for an extension was supported by Josef Škoda
and Carl von Rokitansky
and by most of the medical faculty, but Klein chose Braun for the position. Semmelweis was obliged to leave the obstetrical clinic when his term expired on March 20, 1849.
The day his term expired, Semmelweis petitioned the Viennese authorities to be made docent
of obstetrics. A docent was a private lecturer who taught students and who had access to some university facilities. At first, because of Klein's opposition, Semmelweis's petition was denied. He reapplied, but had to wait until October 10, 1850 (almost years) before finally being appointed docent of theoretical obstetrics. The terms refused him access to cadavers and limited him to teaching students by using leather-fabricated mannequin
s only. A few days after being notified of his appointment, Semmelweis left Vienna abruptly and returned to Pest. It appears that he left without so much as saying good-bye to his former friends and colleagues, a move that may have offended them. According to his own account, he left Vienna because he was "unable to endure further frustrations in dealing with the Viennese medical establishment".
During 1848–1849 some troops from the Habsburg
-ruled Austrian Empire
thwarted the Hungarian independence movement
, executed or imprisoned its leaders and in the process destroyed parts of Pest. It seems likely that Semmelweis, upon arriving from the Habsburg Vienna in 1850, was not warmly welcomed in Pest.
On May 20, 1851 Semmelweis took the relatively insignificant, unpaid, honorary head-physician position of the obstetric ward of Pest's small St. Rochus Hospital. He held that position for six years, until June 1857. Childbed fever was rampant at the clinic; at a visit in 1850, just after returning to Pest, Semmelweis found one fresh corpse, another patient in severe agony, and four others seriously ill with the disease. After taking over in 1851, Semmelweis virtually eliminated the disease. During 1851–1855 only 8 patients died from childbed fever out of 933 births (0.85%).
Despite the impressive results, Semmelweis's ideas were not accepted by the other obstetricians in Budapest. The professor of obstetrics at the University of Pest, Ede Flórián Birly
, never adopted Semmelweis's methods. He continued to believe that puerperal fever was due to uncleanliness of the bowel. Therefore, extensive purging was the preferred treatment.
After Birly died in 1854, Semmelweis applied for the position. So did Carl Braun — Semmelweis's nemesis and successor as Johann Klein
's assistant in Vienna — and Braun received more votes from his Hungarian colleagues than Semmelweis did. Semmelweis was eventually appointed in 1855, but only because the Viennese authorities overruled the wishes of the Hungarians, as Braun did not speak Hungarian. As professor of obstetrics, Semmelweis instituted chlorine washings at the University of Pest maternity clinic. Once again, the results were impressive.
Semmelweis turned down an offer in 1857 to become professor of obstetrics at the University of Zurich
. The same year, Semmelweis married Maria Weidenhoffer (1837–1910), nineteen years his junior and the daughter of a successful merchant in Pest. They had five children: a son who died shortly after birth, a daughter who died at the age of 4 months, another son who committed suicide at age 23 (possibly due to gambling debts), another daughter who would remain unmarried, and a third daughter who would have children of her own.
One of the first to respond to Semmelweis's 1848 communications was James Young Simpson
who wrote a stinging letter. Simpson surmised that the English obstetrical literature must be totally unknown in Vienna, or Semmelweis would have known that the English had long regarded childbed fever as contagious and would have employed chlorine washing to protect against it.
Semmelweis's views were much more favorably received in England than on the continent, but he was more often cited than understood. The English consistently regarded Semmelweis as having supported their theory of contagion. A typical example was W. Tyler Smith, who claimed that Semmelweis "made out very conclusively" that "miasms derived from the dissecting room will excite puerperal disease."
In 1856, Semmelweis's assistant Josef Fleischer reported the successful results of handwashings at St. Rochus and Pest maternity institutions in the Viennese Medical Weekly (Wiener Medizinische Wochenschrift
). The editor remarked sarcastically that it was time people stopped being misled about the theory of chlorine washings.
In 1858 Semmelweis finally published his own account of his work in an essay entitled, "The Etiology of Childbed Fever". Two years later he published a second essay, "The Difference in Opinion between Myself and the English Physicians regarding Childbed Fever". In 1861, Semmelweis finally published his main work Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers (German for The Etiology, Concept and Prophylaxis of Childbed Fever).
In his 1861 book, Semmelweis lamented the slow adoption of his ideas: "Most medical lecture halls continue to resound with lectures on epidemic childbed fever and with discourses against my theories. […] The medical literature
for the last twelve years continues to swell with reports of puerperal epidemics, and in 1854 in Vienna, the birthplace of my theory, 400 maternity patients died from childbed fever. In published medical works my teachings are either ignored or attacked. The medical faculty at Würzburg awarded a prize to a monograph written in 1859 in which my teachings were rejected".
In Berlin, the professor of obstetrics, Joseph Hermann Schmidt
, approved of obstetrical students having ready access to morgues in which they could spend time while waiting for the labor process.
In a textbook, Carl Braun, Semmelweis's successor as assistant in the first clinic, identified 30 causes of childbed fever; only the 28th of these was cadaverous infection. Other causes included conception and pregnancy, uremia, pressure exerted on adjacent organs by the shrinking uterus, emotional traumata, mistakes in diet, chilling, and atmospheric epidemic influences. The impact of Braun's views are clearly visible in the rising mortality rates in the 1850s.
Ede Flórián Birly
, Semmelweis's predecessor as Professor of Obstetrics at the University of Pest, never accepted Semmelweis's teachings; he continued to believe that puerperal fever was due to uncleanliness of the bowel.
August Breisky
, an obstetrician in Prague, rejected Semmelweis's book as "naive" and he referred to it as "the Koran of puerperal theology". Breisky objected that Semmelweis had not proved that puerperal fever and pyemia are identical, and he insisted that other factors beyond decaying organic matter certainly had to be included in the etiology
of the disease.
Carl Edvard Marius Levy
, head of the Copenhagen maternity hospital and an outspoken critic of Semmelweis's ideas, had reservations concerning the unspecific nature of cadaverous particles and that the supposed quantities were unreasonably small. "If Dr. Semmelweis had limited his opinion regarding infections from corpses to puerperal corpses, I would have been less disposed to denial than I am. […] And, with due respect for the cleanliness of the Viennese students, it seems improbable that enough infective matter or vapor could be secluded around the fingernails to kill a patient." In fact, Robert Koch
later used precisely this fact to prove that various infecting materials contained living organisms which could reproduce in the human body, i.e. since the poison could be neither chemical nor physical in operation, it must be biological.
At a conference of German physicians and natural scientists, most of the speakers rejected his doctrine, including the celebrated Rudolf Virchow
, who was a scientist of the highest authority of his time. Virchow’s great authority in medical circles contributed potently to the lack of recognition of the Semmelweis doctrine for a long time.
It has been contended that Semmelweis could have had an even greater impact if he had managed to communicate his findings more effectively and avoid antagonising the medical establishment, even given the opposition from entrenched viewpoints.
Beginning from 1861 Semmelweis suffered from various nervous complaints. He suffered from severe depression and became excessively absentminded. Paintings from 1857 to 1864 show a progression of aging. He turned every conversation to the topic of childbed fever.
After a number of unfavorable foreign reviews of his 1861 book, Semmelweis lashed out against his critics in series of Open Letters. They were addressed to various prominent European obstetricians, including Späth
, Scanzoni
, Siebold
, and to "all obstetricians". They were full of bitterness, desperation, and fury and were "highly polemical and superlatively offensive" at times denouncing his critics as irresponsible murderers or ignoramuses. He also called upon Siebold to arrange a meeting of German obstetricians somewhere in Germany to provide a forum for discussions on puerperal fever where he would stay "until all have been converted to his theory." The attacks undermined his professional credibility.
In mid-1865, his public behaviour became irritating and embarrassing to his associates. He also began to drink immoderately; he spent progressively more time away from his family, sometimes in the company of a prostitute; and his wife noticed changes in his sexual behavior. On July 13, 1865 the Semmelweis family visited friends, and during the visit Semmelweis's behavior seemed particularly inappropriate.
It is impossible to appraise the nature of Semmelweis's disorder. It may have been Alzheimer's disease
, a type of dementia
, which is associated with rapid cognitive decline and mood changes. It may have been third stage syphilis
, a then-common disease of obstetricians who examined thousands of women at gratis institutions. Or it may have been emotional exhaustion from overwork and stress.
In 1865 János Balassa
wrote a document referring Semmelweis to a mental institution. On July 30 Ferdinand Ritter von Hebra
lured him, under the pretense of visiting one of Hebra's "new Institutes", to a Viennese insane asylum located in Lazarettgasse (Landes-Irren-Anstalt in der Lazarettgasse). Semmelweis surmised what was happening and tried to leave. He was severely beaten by several guards, secured in a straitjacket
and confined to a darkened cell. Apart from the straitjacket, treatments at the mental institution included dousing with cold water and administering castor oil
, a laxative
. He died after two weeks, on August 13, 1865, aged 47, from a gangrenous
wound, possibly caused by the beating. The autopsy revealed extensive internal injuries, the cause of death pyemia—blood poisoning.
Semmelweis was buried in Vienna on August 15, 1865. Only a few people attended the service. Brief announcements of his death appeared in a few medical periodicals in Vienna and Budapest. Although the rules of the Hungarian Association of Physicians and Natural Scientists specified that a commemorative address be delivered in honor of a member who had died in the preceding year, there was no address for Semmelweis; his death was never even mentioned.
János Diescher was appointed Semmelweis's successor at the Pest University maternity clinic. Immediately mortality rates jumped sixfold to six percent. But the physicians of Budapest said nothing; there were no inquiries and no protests. Almost no one — either in Vienna or in Budapest — seems to have been willing to acknowledge Semmelweis's life and work.
His remains were transferred to Budapest in 1891. On October 11, 1964 they were transferred once more to the house in which he was born. The house is now a historical museum and library, honoring Ignaz Semmelweis.
Semmelweis's advice on chlorine washings was probably more influential than he realized himself. Many doctors, particularly in Germany, appeared quite willing to experiment with the practical handwashing measures that he proposed, but virtually everyone rejected his basic and ground-breaking theoretical innovation—that the disease had only one cause, lack of cleanliness. Professor Gustav Adolf Michaelis
from a maternity institution in Kiel
replied positively to Semmelweis's suggestions—eventually he committed suicide, however, because he felt responsible for the death of his own cousin, whom he had examined after she gave birth.
Only belatedly did his observational evidence gain wide acceptance; more than twenty years later, Louis Pasteur
's work offered a theoretical explanation for Semmelweis's observations—the germ theory of disease
. As such, the Semmelweis story is often used in university courses with epistemology content, e.g. philosophy of science courses—demonstrating the virtues of empiricism
or positivism
and providing a historical account of which types of knowledge count as scientific (and thus accepted) knowledge, and which do not. It has been seen as an irony that Semmelweis's critics considered themselves positivists, but even positivism suffers problems in the face of theories which seem magical or superstitious, such as the idea that "corpse particles" might turn a person into a corpse, with no causal mechanism being stipulated, after a simple contact. They could not accept Semmelweis' ideas of minuscule and largely invisible amounts of decaying organic matter as a cause of every case of childbed fever— ideas which in the absence of a replicative biological mechanism, must have seemed no more chemically likely than homeopathy
. To his contemporaries, Semmelweis seemed to be reverting to the speculative theories of earlier decades that were so repugnant to his positivist contemporaries.
The so-called Semmelweis reflex
— a metaphor for a certain type of human behaviour characterized by reflex-like rejection of new knowledge because it contradicts entrenched norms, beliefs or paradigms — is named after Semmelweis, whose perfectly reasonable hand-washing suggestions were ridiculed and rejected by his contemporaries. There is some uncertainty about the origin and generally accepted use of the expression.
Other legacies of Semmelweis include:
Incidence (epidemiology)
Incidence is a measure of the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator.Incidence proportion is the...
of puerperal fever
Puerperal fever
Puerperal fever or childbed fever, is a bacterial infection contracted by women during childbirth or miscarriage. It can develop into puerperal sepsis, which is a serious form of septicaemia. If untreated, it is often fatal....
could be drastically cut by the use of hand disinfection in obstetrical
Obstetrics
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...
clinics. Puerperal fever was common in mid-19th-century hospitals and often fatal, with mortality at 10%–35%. Semmelweis postulated the theory of washing with chlorinated lime solutions
Calcium hypochlorite
Calcium hypochlorite is a chemical compound with formula 2. It is widely used for water treatment and as a bleaching agent...
in 1847 while working in Vienna General Hospital
Vienna General Hospital
The Vienna General Hospital is the University medical center of the city of Vienna, Austria. The AKH is the largest hospital of Austria and Europe, the second largest hospital in the world, and at 85-m high is one of the tallest hospital buildings in the world...
's First Obstetrical Clinic, where doctors' wards had three times the mortality of midwives' wards. He published a book of his findings in Etiology, Concept and Prophylaxis of Childbed Fever
Etiology, Concept and Prophylaxis of Childbed Fever
Etiology, Concept and Prophylaxis of Childbed Fever is a medical book by Ignaz Semmelweis. It includes studies in hospitals conducted in Vienna in 1847, dealing largely with the field of obstretics. It was translated into English by Kay Codell Carter in 1983....
.
Despite various publications of results where hand-washing reduced mortality
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
to below 1%, Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands and Semmelweis could offer no acceptable scientific explanation for his findings. Semmelweis's practice earned widespread acceptance only years after his death, when Louis Pasteur
Louis Pasteur
Louis Pasteur was a French chemist and microbiologist born in Dole. He is remembered for his remarkable breakthroughs in the causes and preventions of diseases. His discoveries reduced mortality from puerperal fever, and he created the first vaccine for rabies and anthrax. His experiments...
confirmed the germ theory
Germ theory of disease
The germ theory of disease, also called the pathogenic theory of medicine, is a theory that proposes that microorganisms are the cause of many diseases...
. In 1865, Semmelweis was committed to an asylum
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
, where he died of septicemia
Sepsis
Sepsis is a potentially deadly medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues...
, at age 47.
Family and early life
Tabán
Tabán usually refers to an area within the 1st district of Budapest, the capital of Hungary. It lies on the Buda side of the Danube, to the south of György Dózsa Square, on the northern side of Elisabeth Bridge and to the east of Naphegy...
, an area of Buda
Buda
For detailed information see: History of Buda CastleBuda is the western part of the Hungarian capital Budapest on the west bank of the Danube. The name Buda takes its name from the name of Bleda the Hun ruler, whose name is also Buda in Hungarian.Buda comprises about one-third of Budapest's...
, part of present Budapest
Budapest
Budapest is the capital of Hungary. As the largest city of Hungary, it is the country's principal political, cultural, commercial, industrial, and transportation centre. In 2011, Budapest had 1,733,685 inhabitants, down from its 1989 peak of 2,113,645 due to suburbanization. The Budapest Commuter...
, Hungary (then part of the Habsburg
Habsburg
The House of Habsburg , also found as Hapsburg, and also known as House of Austria is one of the most important royal houses of Europe and is best known for being an origin of all of the formally elected Holy Roman Emperors between 1438 and 1740, as well as rulers of the Austrian Empire and...
Empire). He was the fifth child out of ten of a prosperous grocer
Grocer
A grocer is a bulk seller of food. Beginning as early as the 14th century, a grocer was a dealer in comestible dry goods such as spices, pepper, sugar, and cocoa, tea and coffee...
family of Josef and Teresia Müller Semmelweis.
His father, Josef Semmelweis (1778–1846), was born in Kismarton
Eisenstadt
- Politics :The current mayor of Eisenstadt is Andrea Fraunschiel ÖVP.The district council is composed as follows :* ÖVP: 17 seats* SPÖ: 8 seats* Austrian Green Party: 2 seats* FPÖ: 2 seats- Castles and palaces :...
, at that time in Hungary. Josef achieved permission to set up shop in Buda in 1806 and, in the same year, opened a wholesale business with spices and general consumer goods named zum Weißen Elephanten (to the White Elephant) in Meindl-Haus in Tabán
Tabán
Tabán usually refers to an area within the 1st district of Budapest, the capital of Hungary. It lies on the Buda side of the Danube, to the south of György Dózsa Square, on the northern side of Elisabeth Bridge and to the east of Naphegy...
(today's 1-3, Apród Street, Semmelweis Museum of Medical History). By 1810, he was a wealthy man when he married Teresia Müller, daughter of the famous coach (vehicle) builder Fülöp Müller.
Ignaz Semmelweis began studying law at the University of Vienna
University of Vienna
The University of Vienna is a public university located in Vienna, Austria. It was founded by Duke Rudolph IV in 1365 and is the oldest university in the German-speaking world...
in the autumn of 1837, but by the following year, for reasons that are no longer known, he had switched to medicine. He was awarded his doctorate degree in medicine in 1844. After failing to obtain an appointment in a clinic for internal medicine, Semmelweis decided to specialize in obstetrics. Some of his teachers included Carl von Rokitansky
Carl Freiherr von Rokitansky
Baron Carl von Rokitansky , was a Bohemian physician, pathologist, humanist philosopher and liberal politician.-Medical career:...
, Josef Skoda
Josef Škoda
Joseph Škoda was a Czech physician, medical professor and dermatologist. Together with Carl Freiherr von Rokitansky, he was the founder of the Modern Medical School of Vienna.-Life:...
and Ferdinand von Hebra
Ferdinand Ritter von Hebra
Ferdinand Ritter von Hebra was an Austrian physician and dermatologist,...
.
Discovery of cadaverous poisoning
Semmelweis was appointed assistant to Professor KleinJohann Klein
Johann Klein was Professor of Obstetrics at the University of Salzburg and at the University of Vienna. Johann Baptist Chiari was his son-in-law. In Vienna, he was succeeded by professor Carl Braun in 1856....
in the First Obstetrical Clinic of the Vienna General Hospital
Vienna General Hospital
The Vienna General Hospital is the University medical center of the city of Vienna, Austria. The AKH is the largest hospital of Austria and Europe, the second largest hospital in the world, and at 85-m high is one of the tallest hospital buildings in the world...
on July 1, 1846. A comparable position today would be "chief resident." His duties were to examine patients each morning in preparation for the professor's rounds, supervise difficult deliveries, teach students of obstetrics and be 'clerk' of records.
Maternity institutions were set up all over Europe to address problems of infanticide
Infanticide
Infanticide or infant homicide is the killing of a human infant. Neonaticide, a killing within 24 hours of a baby's birth, is most commonly done by the mother.In many past societies, certain forms of infanticide were considered permissible...
of illegitimate children. They were set up as gratis institutions and offered to care for the infants, which made them attractive to underprivileged women, including prostitutes. In return for the free services, the women would be subjects for the training of doctors and midwives. There were two maternity clinics at the Viennese hospital. The First Clinic had an average maternal mortality rate
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
due to puerperal fever of about 10% (actual rates fluctuated wildly). The Second Clinic's rate was considerably lower, averaging less than 4%. This fact was known outside the hospital. The two clinics admitted on alternate days but women begged to be admitted to the Second Clinic, due to the bad reputation of the First Clinic. Semmelweis described desperate women begging on their knees not to be admitted to the First Clinic. Some women even preferred to give birth in the streets, pretending to have given sudden birth en route to the hospital (a practice known as street births), which meant they would still qualify for the child care benefits without having been admitted to the clinic. Semmelweis was puzzled that puerperal fever was rare amongst women giving street births. "To me, it appeared logical that patients who experienced street births would become ill at least as frequently as those who delivered in the clinic. [...] What protected those who delivered outside the clinic from these destructive unknown endemic influences?"
Semmelweis was severely troubled and literally sickened that his First Clinic had a much higher mortality rate due to puerperal fever than the Second Clinic. It "made me so miserable that life seemed worthless". The two clinics used almost the same techniques, and Semmelweis started a meticulous process of eliminating all possible differences, including even religious practices. The only major difference was the individuals who worked there. The First Clinic was the teaching service for medical students, while the Second Clinic had been selected in 1841 for the instruction of midwives only.
| First clinic | Second clinic | ||||||
| Year | Births | Deaths | Rate (%) | Births | Deaths | Rate (%) | |
| 1841 | 3,036 | 237 | 7.8 | 2,442 | 86 | 3.5 | |
| 1842 | 3,287 | 518 | 15.8 | 2,659 | 202 | 7.6 | |
| 1843 | 3,060 | 274 | 9.0 | 2,739 | 164 | 6.0 | |
| 1844 | 3,157 | 260 | 8.2 | 2,956 | 68 | 2.3 | |
| 1845 | 3,492 | 241 | 6.9 | 3,241 | 66 | 2.0 | |
| 1846 | 4,010 | 459 | 11.4 | 3,754 | 105 | 2.8 | |
He excluded "overcrowding" as a cause, since the Second Clinic was always more crowded and yet the mortality was lower. He eliminated climate as a cause because the climate was the same. The breakthrough occurred in 1847, following the death of his good friend Jakob Kolletschka
Jakob Kolletschka
Jakob Kolletschka was Professor of Forensic Medicine at Vienna General Hospital in Austria....
, who had been accidentally poked with a student's scalpel while performing a postmortem examination. Kolletschka's own autopsy
Autopsy
An autopsy—also known as a post-mortem examination, necropsy , autopsia cadaverum, or obduction—is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present...
showed a pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
similar to that of the women who were dying from puerperal fever. Semmelweis immediately proposed a connection between cadaver
Cadaver
A cadaver is a dead human body.Cadaver may also refer to:* Cadaver tomb, tomb featuring an effigy in the form of a decomposing body* Cadaver , a video game* cadaver A command-line WebDAV client for Unix....
ic contamination and puerperal fever.
He concluded 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
Germ theory of disease
The germ theory of disease, also called the pathogenic theory of medicine, is a theory that proposes that microorganisms are the cause of many diseases...
had not yet been developed. Thus, Semmelweis concluded some unknown "cadaverous material" caused childbed fever. He instituted a policy of using a solution of chlorinated lime
Calcium hypochlorite
Calcium hypochlorite is a chemical compound with formula 2. It is widely used for water treatment and as a bleaching agent...
(modern calcium hypochlorite
Calcium hypochlorite
Calcium hypochlorite is a chemical compound with formula 2. It is widely used for water treatment and as a bleaching agent...
, the compound used in today's common household chlorine bleach solution) 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 destroying the causal "poisonous" or contaminating "cadaveric" agent hypothetically being transmitted by this material.
The result was that the mortality rate dropped 90%, comparable to the Second Clinic's. The mortality rate in April 1847 was 18.3%; after handwashing was instituted in mid-May, the rates in June were 2.2%, July 1.2 %, August 1.9% and, for the first time since the introduction of anatomical orientation, the death rate was zero in two months in the year following this discovery.
Efforts to reduce childbed fever
Semmelweis discovered that cases of puerperal feverPuerperal fever
Puerperal fever or childbed fever, is a bacterial infection contracted by women during childbirth or miscarriage. It can develop into puerperal sepsis, which is a serious form of septicaemia. If untreated, it is often fatal....
, a form of septicaemia also known as childbed fever, could be cut drastically if doctors washed their hands in a chlorine solution before gynaecological examinations.
While employed as assistant to the professor of the maternity clinic at the Vienna General Hospital
Vienna General Hospital
The Vienna General Hospital is the University medical center of the city of Vienna, Austria. The AKH is the largest hospital of Austria and Europe, the second largest hospital in the world, and at 85-m high is one of the tallest hospital buildings in the world...
in Austria
Austria
Austria , officially the Republic of Austria , is a landlocked country of roughly 8.4 million people in Central Europe. It is bordered by the Czech Republic and Germany to the north, Slovakia and Hungary to the east, Slovenia and Italy to the south, and Switzerland and Liechtenstein to the...
in 1847, Semmelweis introduced hand washing with chlorinated lime solutions
Calcium hypochlorite
Calcium hypochlorite is a chemical compound with formula 2. It is widely used for water treatment and as a bleaching agent...
for interns who had performed autopsies. This immediately reduced the incidence of fatal puerperal fever from about 10 percent (range 5–30 percent) to about 1–2 percent. At the time, diseases were attributed to many different and unrelated causes. Each case was considered unique, just as a human person is unique. Semmelweis's hypothesis, that there was only one cause, that all that mattered was cleanliness, was extreme at the time, and was largely ignored, rejected or ridiculed. He was dismissed from the hospital for political reasons and harassed by the medical community in Vienna, being eventually forced to move to Pest.
Semmelweis was outraged by the indifference of the medical profession and began writing open and increasingly angry letters to prominent European obstetricians, at times denouncing them as irresponsible murderers. His contemporaries, including his wife, believed he was losing his mind, and in 1865 he was committed to an asylum
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
. In an ironic twist of fate, he died there of septicaemia only 14 days later, possibly from the result of being severely beaten by guards. Semmelweis's practice earned widespread acceptance only years after his death, when Louis Pasteur
Louis Pasteur
Louis Pasteur was a French chemist and microbiologist born in Dole. He is remembered for his remarkable breakthroughs in the causes and preventions of diseases. His discoveries reduced mortality from puerperal fever, and he created the first vaccine for rabies and anthrax. His experiments...
developed the germ theory of disease
Germ theory of disease
The germ theory of disease, also called the pathogenic theory of medicine, is a theory that proposes that microorganisms are the cause of many diseases...
, offering a theoretical explanation for Semmelweis's findings. He is considered a pioneer of antiseptic procedures.
Conflict with established medical opinions
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
s was highly influenced by ideas of an imbalance of the basic "four humours
Four humours
Four Temperaments is a theory of proto-psychology that stems from the ancient medical concept of humorism and suggests that four bodily fluids affect human personality traits and behaviors.- History and development :...
" in the body, a theory known as dyscrasia
Dyscrasia
Dyscrasia is a concept from ancient Greek medicine with the word "dyskrasia", meaning bad mixture.The concept of dyscrasia was developed by the ancient Greek physician Galen , who elaborated a model of health and disease as a structure of elements, qualities, humors, organs, and temperaments...
, for which the main treatment was bloodletting
Bloodletting
Bloodletting is the withdrawal of often little quantities of blood from a patient to cure or prevent illness and disease. Bloodletting was based on an ancient system of medicine in which blood and other bodily fluid were considered to be "humors" the proper balance of which maintained health...
s. Medical texts at the time emphasized that each case of disease was unique, the result of a personal imbalance, and the main difficulty of the medical profession was to establish precisely each patient's unique situation, case by case.
The findings from autopsies of deceased women also showed a confusing multitude of various physical signs, which emphasised the belief that puerperal fever was not one, but many different, yet unidentified, diseases. Semmelweis's main finding — that all instances of puerperal fever could be traced back to only one single cause: lack of cleanliness — was simply unacceptable. His findings also ran against the conventional wisdom that diseases spread in the form of "bad air", also known as miasmas
Miasma theory of disease
The miasma theory held that diseases such as cholera, chlamydia or the Black Death were caused by a miasma , a noxious form of "bad air"....
or vaguely as "unfavourable atmospheric-cosmic-terrestrial influences". Semmelweis's groundbreaking idea was contrary to all established medical understanding.
As a result, his ideas were rejected by the medical community. Other more subtle factors may also have played a role. Some doctors, for instance, were offended at the suggestion that they should wash their hands; they felt that their social status as gentlemen was inconsistent with the idea that their hands could be unclean.
Specifically, Semmelweis's claims were thought to lack scientific basis, since he could offer no acceptable explanation for his findings. Such a scientific explanation was made possible only some decades later, when the germ theory of disease was developed by Louis Pasteur
Louis Pasteur
Louis Pasteur was a French chemist and microbiologist born in Dole. He is remembered for his remarkable breakthroughs in the causes and preventions of diseases. His discoveries reduced mortality from puerperal fever, and he created the first vaccine for rabies and anthrax. His experiments...
, Joseph Lister
Joseph Lister, 1st Baron Lister
Joseph Lister, 1st Baron Lister OM, FRS, PC , known as Sir Joseph Lister, Bt., between 1883 and 1897, was a British surgeon and a pioneer of antiseptic surgery, who promoted the idea of sterile surgery while working at the Glasgow Royal Infirmary...
, and others.
During 1848, Semmelweis widened the scope of his washing protocol to include all instruments coming in contact with patients in labor, and used mortality rate time series
Time series
In statistics, signal processing, econometrics and mathematical finance, a time series is a sequence of data points, measured typically at successive times spaced at uniform time intervals. Examples of time series are the daily closing value of the Dow Jones index or the annual flow volume of the...
to document his success in virtually eliminating puerperal fever from the hospital ward.
Hesitant publication of results and first signs of trouble
Ferdinand Ritter von Hebra
Ferdinand Ritter von Hebra was an Austrian physician and dermatologist,...
, the editor of a leading Austrian medical journal, announced Semmelweis's discovery in the December 1847 and April 1848 issues of the medical journal. Hebra claimed that Semmelweis's work had a practical significance comparable to that of Edward Jenner
Edward Jenner
Edward Anthony Jenner was an English scientist who studied his natural surroundings in Berkeley, Gloucestershire...
's introduction of cowpox inoculations to prevent smallpox.
In late 1848, one of Semmelweis's former students wrote a lecture explaining Semmelweis's work. The lecture was presented before the Royal Medical and Surgical Society in London and a review published in The Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...
, a prominent medical journal. A few months later, another of Semmelweis's former students published a similar essay in a French periodical.
As accounts of the dramatic reduction in mortality rates in Vienna were being circulated throughout Europe, Semmelweis had reason to expect that the chlorine washings would be widely adopted, saving tens of thousands of lives. Early responses to his work also gave clear signs of coming trouble, however. Some physicians had clearly misinterpreted his claims. James Young Simpson
James Young Simpson
Sir James Young Simpson was a Scottish doctor and an important figure in the history of medicine. Simpson discovered the anaesthetic properties of chloroform and successfully introduced it for general medical use....
, for instance, saw no difference between Semmelweis's groundbreaking findings and the British idea suggested by Oliver Wendell Holmes
Oliver Wendell Holmes, Sr.
Oliver Wendell Holmes, Sr. was an American physician, professor, lecturer, and author. Regarded by his peers as one of the best writers of the 19th century, he is considered a member of the Fireside Poets. His most famous prose works are the "Breakfast-Table" series, which began with The Autocrat...
in 1843 that childbed fever was contagious (i.e. that infected persons could pass the infection to others). Indeed, initial responses to Semmelweis's findings were that he had said nothing new.
In fact, Semmelweis was warning against all decaying organic matter, not just against a specific contagion that originated from victims of childbed fever themselves. This misunderstanding, and others like it, occurred partly because Semmelweis's work was known only through secondhand reports written by his colleagues and students. At this crucial stage, Semmelweis himself had published nothing. These and similar misinterpretations would continue to cloud discussions of his work throughout the century.
Some accounts emphasise that Semmelweis refused to communicate his method officially to the learned circles of Vienna, nor was he eager to explain it on paper.
Political turmoil and dismissal from the Vienna hospital
In 1848 a series of tumultuous revolutionsRevolutions of 1848
The European Revolutions of 1848, known in some countries as the Spring of Nations, Springtime of the Peoples or the Year of Revolution, were a series of political upheavals throughout Europe in 1848. It was the first Europe-wide collapse of traditional authority, but within a year reactionary...
swept across Europe. The resulting political turmoil would affect Semmelweis's career. In Vienna on March 13, 1848, students demonstrated in favor of increased civil rights, including trial by jury and freedom of expression. The demonstration was led by medical students and young faculty members and were joined by workers from the suburbs. Two days later in Hungary, demonstrations and uprisings led to the Hungarian Revolution of 1848
Hungarian Revolution of 1848
The Hungarian Revolution of 1848 was one of many of the European Revolutions of 1848 and closely linked to other revolutions of 1848 in the Habsburg areas...
and a full-scale war against the ruling Habsburgs of the Austrian Empire
Austrian Empire
The Austrian Empire was a modern era successor empire, which was centered on what is today's Austria and which officially lasted from 1804 to 1867. It was followed by the Empire of Austria-Hungary, whose proclamation was a diplomatic move that elevated Hungary's status within the Austrian Empire...
. In Vienna, the March demonstration was followed by months of general unrest.
There is no evidence that Semmelweis was personally involved in the events of 1848. It is known that some of his brothers were punished for active participation in the Hungarian independence movement, and it seems likely that the Hungarian-born Semmelweis was sympathetic to the cause. Semmelweis's superior, professor Johann Klein
Johann Klein
Johann Klein was Professor of Obstetrics at the University of Salzburg and at the University of Vienna. Johann Baptist Chiari was his son-in-law. In Vienna, he was succeeded by professor Carl Braun in 1856....
, was a conservative Austrian, likely at unease with the independence movements and alarmed with the other revolutions of 1848 in the Habsburg areas
Revolutions of 1848 in the Habsburg areas
From March 1848 through July 1849, the Habsburg Austrian Empire was threatened by revolutionary movements. Much of the revolutionary activity was of a nationalist character: the empire, ruled from Vienna, included Austrian Germans, Hungarians, Slovenes, Poles, Czechs, Slovaks, Ruthenians,...
. It seems likely that Klein mistrusted Semmelweis.
When Semmelweis's term was about to expire Carl Braun also applied for the position of assistant in the First Clinic, possibly at Klein's own invitation. Semmelweis and Braun were the only two applicants for the post. Semmelweis's predecessor, Breit
Franz Breit (obstetrician)
Franz Breit was an obstetrician and assistant to professor Johann Klein of the maternity clinic at the Vienna General Hospital in Austria. He was appointed to professor and Chair of Obstetrics at University of Tübingen on 20 March 1847 allowing Ignaz Semmelweis to become Assistant to the professor...
, had been granted a two-year extension. Semmelweis's application for an extension was supported by Josef Škoda
Josef Škoda
Joseph Škoda was a Czech physician, medical professor and dermatologist. Together with Carl Freiherr von Rokitansky, he was the founder of the Modern Medical School of Vienna.-Life:...
and Carl von Rokitansky
Carl Freiherr von Rokitansky
Baron Carl von Rokitansky , was a Bohemian physician, pathologist, humanist philosopher and liberal politician.-Medical career:...
and by most of the medical faculty, but Klein chose Braun for the position. Semmelweis was obliged to leave the obstetrical clinic when his term expired on March 20, 1849.
The day his term expired, Semmelweis petitioned the Viennese authorities to be made docent
Privatdozent
Privatdozent or Private lecturer is a title conferred in some European university systems, especially in German-speaking countries, for someone who pursues an academic career and holds all formal qualifications to become a tenured university professor...
of obstetrics. A docent was a private lecturer who taught students and who had access to some university facilities. At first, because of Klein's opposition, Semmelweis's petition was denied. He reapplied, but had to wait until October 10, 1850 (almost years) before finally being appointed docent of theoretical obstetrics. The terms refused him access to cadavers and limited him to teaching students by using leather-fabricated mannequin
Mannequin
A mannequin is an often articulated doll used by artists, tailors, dressmakers, and others especially to display or fit clothing...
s only. A few days after being notified of his appointment, Semmelweis left Vienna abruptly and returned to Pest. It appears that he left without so much as saying good-bye to his former friends and colleagues, a move that may have offended them. According to his own account, he left Vienna because he was "unable to endure further frustrations in dealing with the Viennese medical establishment".
Life in Pest-Buda
Habsburg
The House of Habsburg , also found as Hapsburg, and also known as House of Austria is one of the most important royal houses of Europe and is best known for being an origin of all of the formally elected Holy Roman Emperors between 1438 and 1740, as well as rulers of the Austrian Empire and...
-ruled Austrian Empire
Austrian Empire
The Austrian Empire was a modern era successor empire, which was centered on what is today's Austria and which officially lasted from 1804 to 1867. It was followed by the Empire of Austria-Hungary, whose proclamation was a diplomatic move that elevated Hungary's status within the Austrian Empire...
thwarted the Hungarian independence movement
Hungarian Revolution of 1848
The Hungarian Revolution of 1848 was one of many of the European Revolutions of 1848 and closely linked to other revolutions of 1848 in the Habsburg areas...
, executed or imprisoned its leaders and in the process destroyed parts of Pest. It seems likely that Semmelweis, upon arriving from the Habsburg Vienna in 1850, was not warmly welcomed in Pest.
On May 20, 1851 Semmelweis took the relatively insignificant, unpaid, honorary head-physician position of the obstetric ward of Pest's small St. Rochus Hospital. He held that position for six years, until June 1857. Childbed fever was rampant at the clinic; at a visit in 1850, just after returning to Pest, Semmelweis found one fresh corpse, another patient in severe agony, and four others seriously ill with the disease. After taking over in 1851, Semmelweis virtually eliminated the disease. During 1851–1855 only 8 patients died from childbed fever out of 933 births (0.85%).
Despite the impressive results, Semmelweis's ideas were not accepted by the other obstetricians in Budapest. The professor of obstetrics at the University of Pest, Ede Flórián Birly
Ede Flórián Birly
Ede Flórián Birly was Professor of Theoretical and Practical Obstetrics at the University of Pest. He was one of Semmelweis's principal opponents....
, never adopted Semmelweis's methods. He continued to believe that puerperal fever was due to uncleanliness of the bowel. Therefore, extensive purging was the preferred treatment.
After Birly died in 1854, Semmelweis applied for the position. So did Carl Braun — Semmelweis's nemesis and successor as Johann Klein
Johann Klein
Johann Klein was Professor of Obstetrics at the University of Salzburg and at the University of Vienna. Johann Baptist Chiari was his son-in-law. In Vienna, he was succeeded by professor Carl Braun in 1856....
's assistant in Vienna — and Braun received more votes from his Hungarian colleagues than Semmelweis did. Semmelweis was eventually appointed in 1855, but only because the Viennese authorities overruled the wishes of the Hungarians, as Braun did not speak Hungarian. As professor of obstetrics, Semmelweis instituted chlorine washings at the University of Pest maternity clinic. Once again, the results were impressive.
Semmelweis turned down an offer in 1857 to become professor of obstetrics at the University of Zurich
University of Zurich
The University of Zurich , located in the city of Zurich, is the largest university in Switzerland, with over 25,000 students. It was founded in 1833 from the existing colleges of theology, law, medicine and a new faculty of philosophy....
. The same year, Semmelweis married Maria Weidenhoffer (1837–1910), nineteen years his junior and the daughter of a successful merchant in Pest. They had five children: a son who died shortly after birth, a daughter who died at the age of 4 months, another son who committed suicide at age 23 (possibly due to gambling debts), another daughter who would remain unmarried, and a third daughter who would have children of her own.
Response by the medical community
James Young Simpson
Sir James Young Simpson was a Scottish doctor and an important figure in the history of medicine. Simpson discovered the anaesthetic properties of chloroform and successfully introduced it for general medical use....
who wrote a stinging letter. Simpson surmised that the English obstetrical literature must be totally unknown in Vienna, or Semmelweis would have known that the English had long regarded childbed fever as contagious and would have employed chlorine washing to protect against it.
Semmelweis's views were much more favorably received in England than on the continent, but he was more often cited than understood. The English consistently regarded Semmelweis as having supported their theory of contagion. A typical example was W. Tyler Smith, who claimed that Semmelweis "made out very conclusively" that "miasms derived from the dissecting room will excite puerperal disease."
In 1856, Semmelweis's assistant Josef Fleischer reported the successful results of handwashings at St. Rochus and Pest maternity institutions in the Viennese Medical Weekly (Wiener Medizinische Wochenschrift
Wiener Medizinische Wochenschrift
The Wiener Medizinische Wochensschrift is a medical journal published by Springer Verlag, Vienna. The Österreichische Nationalbibliothek has made old copies available over the Internet....
). The editor remarked sarcastically that it was time people stopped being misled about the theory of chlorine washings.
In 1858 Semmelweis finally published his own account of his work in an essay entitled, "The Etiology of Childbed Fever". Two years later he published a second essay, "The Difference in Opinion between Myself and the English Physicians regarding Childbed Fever". In 1861, Semmelweis finally published his main work Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers (German for The Etiology, Concept and Prophylaxis of Childbed Fever).
In his 1861 book, Semmelweis lamented the slow adoption of his ideas: "Most medical lecture halls continue to resound with lectures on epidemic childbed fever and with discourses against my theories. […] The medical literature
Medical literature
Medical literature refers to articles in journals and texts in books devoted to the field of medicine.Contemporary and historic views regarding diagnosis, prognosis and treatment of medical conditions have been documented for thousands of years. The Edwin Smith papyrus is the first known medical...
for the last twelve years continues to swell with reports of puerperal epidemics, and in 1854 in Vienna, the birthplace of my theory, 400 maternity patients died from childbed fever. In published medical works my teachings are either ignored or attacked. The medical faculty at Würzburg awarded a prize to a monograph written in 1859 in which my teachings were rejected".
In Berlin, the professor of obstetrics, Joseph Hermann Schmidt
Joseph Hermann Schmidt
Joseph Hermann Schmidt was professor of Obstetrics in Berlin, and official of the Prussian cultural ministry.In 1834 he became head of the Paderborn general hospital and eventually also of the Paderborn maternity clinic. He wrote a textbook of obstetrics widely used in Prussia...
, approved of obstetrical students having ready access to morgues in which they could spend time while waiting for the labor process.
In a textbook, Carl Braun, Semmelweis's successor as assistant in the first clinic, identified 30 causes of childbed fever; only the 28th of these was cadaverous infection. Other causes included conception and pregnancy, uremia, pressure exerted on adjacent organs by the shrinking uterus, emotional traumata, mistakes in diet, chilling, and atmospheric epidemic influences. The impact of Braun's views are clearly visible in the rising mortality rates in the 1850s.
Ede Flórián Birly
Ede Flórián Birly
Ede Flórián Birly was Professor of Theoretical and Practical Obstetrics at the University of Pest. He was one of Semmelweis's principal opponents....
, Semmelweis's predecessor as Professor of Obstetrics at the University of Pest, never accepted Semmelweis's teachings; he continued to believe that puerperal fever was due to uncleanliness of the bowel.
August Breisky
August Breisky
Professor August Breisky He studied medicine in Prague. M.D. degree in 1855. Ordinary Professor of Obstetrics and Gynaecology to the Surgical School of Salzburg in 1866. Ordinary Professor of Obstetrics and Gynaecology Medical Faculty of Berne...
, an obstetrician in Prague, rejected Semmelweis's book as "naive" and he referred to it as "the Koran of puerperal theology". Breisky objected that Semmelweis had not proved that puerperal fever and pyemia are identical, and he insisted that other factors beyond decaying organic matter certainly had to be included in the etiology
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
of the disease.
Carl Edvard Marius Levy
Carl Edvard Marius Levy
Professor, Dr. Med. Carl Edvard Marius Levy was professor and head of the Danish Maternity institution in Copenhagen .Levy graduated 1831 from Copenhagen University in Medicine and surgery...
, head of the Copenhagen maternity hospital and an outspoken critic of Semmelweis's ideas, had reservations concerning the unspecific nature of cadaverous particles and that the supposed quantities were unreasonably small. "If Dr. Semmelweis had limited his opinion regarding infections from corpses to puerperal corpses, I would have been less disposed to denial than I am. […] And, with due respect for the cleanliness of the Viennese students, it seems improbable that enough infective matter or vapor could be secluded around the fingernails to kill a patient." In fact, Robert Koch
Robert Koch
Heinrich Hermann Robert Koch was a German physician. He became famous for isolating Bacillus anthracis , the Tuberculosis bacillus and the Vibrio cholerae and for his development of Koch's postulates....
later used precisely this fact to prove that various infecting materials contained living organisms which could reproduce in the human body, i.e. since the poison could be neither chemical nor physical in operation, it must be biological.
At a conference of German physicians and natural scientists, most of the speakers rejected his doctrine, including the celebrated Rudolf Virchow
Rudolf Virchow
Rudolph Carl Virchow was a German doctor, anthropologist, pathologist, prehistorian, biologist and politician, known for his advancement of public health...
, who was a scientist of the highest authority of his time. Virchow’s great authority in medical circles contributed potently to the lack of recognition of the Semmelweis doctrine for a long time.
It has been contended that Semmelweis could have had an even greater impact if he had managed to communicate his findings more effectively and avoid antagonising the medical establishment, even given the opposition from entrenched viewpoints.
Breakdown, death and oblivion
After a number of unfavorable foreign reviews of his 1861 book, Semmelweis lashed out against his critics in series of Open Letters. They were addressed to various prominent European obstetricians, including Späth
Joseph Späth
Joseph Späth was Professor of Obstetrics in Vienna and from 1873 until 1886 he was director of the Second Obstetrical Clinic at the Vienna General Hospital. Ignaz Semmelweis regarded him as a principal opponent...
, Scanzoni
Friedrich Wilhelm Scanzoni von Lichtenfels
Friedrich Wilhelm Scanzoni von Lichtenfels was a German gynecologist and obstetrician who was a native of Prague...
, Siebold
Eduard Caspar Jacob von Siebold
Eduard Caspar Jacob von Siebold was a German professor of gynecology. He worked at Humboldt University of Berlin, University of Marburg and University of Göttingen.- Life and career:...
, and to "all obstetricians". They were full of bitterness, desperation, and fury and were "highly polemical and superlatively offensive" at times denouncing his critics as irresponsible murderers or ignoramuses. He also called upon Siebold to arrange a meeting of German obstetricians somewhere in Germany to provide a forum for discussions on puerperal fever where he would stay "until all have been converted to his theory." The attacks undermined his professional credibility.
In mid-1865, his public behaviour became irritating and embarrassing to his associates. He also began to drink immoderately; he spent progressively more time away from his family, sometimes in the company of a prostitute; and his wife noticed changes in his sexual behavior. On July 13, 1865 the Semmelweis family visited friends, and during the visit Semmelweis's behavior seemed particularly inappropriate.
It is impossible to appraise the nature of Semmelweis's disorder. It may have been Alzheimer's disease
Alzheimer's disease
Alzheimer's disease also known in medical literature as Alzheimer disease is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death...
, a type of dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
, which is associated with rapid cognitive decline and mood changes. It may have been third stage syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
, a then-common disease of obstetricians who examined thousands of women at gratis institutions. Or it may have been emotional exhaustion from overwork and stress.
In 1865 János Balassa
János Balassa
János Balassa Surgeon, university professor, and one of the leading personalities of the Hungarian medical society at the time. He was also an internationally recognized authority within the field of plastic surgery...
wrote a document referring Semmelweis to a mental institution. On July 30 Ferdinand Ritter von Hebra
Ferdinand Ritter von Hebra
Ferdinand Ritter von Hebra was an Austrian physician and dermatologist,...
lured him, under the pretense of visiting one of Hebra's "new Institutes", to a Viennese insane asylum located in Lazarettgasse (Landes-Irren-Anstalt in der Lazarettgasse). Semmelweis surmised what was happening and tried to leave. He was severely beaten by several guards, secured in a straitjacket
Straitjacket
A straitjacket is a garment shaped like a jacket with overlong sleeves and is typically used to restrain a person who may otherwise cause harm to themselves or others. Once the arms are inserted into the straitjacket's sleeves, they are then crossed across the chest...
and confined to a darkened cell. Apart from the straitjacket, treatments at the mental institution included dousing with cold water and administering castor oil
Castor oil
Castor oil is a vegetable oil obtained from the castor bean . Castor oil is a colorless to very pale yellow liquid with mild or no odor or taste. Its boiling point is and its density is 961 kg/m3...
, a laxative
Laxative
Laxatives are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. Certain stimulant, lubricant, and saline laxatives are used to evacuate the colon for rectal and/or bowel examinations, and may be supplemented by enemas under...
. He died after two weeks, on August 13, 1865, aged 47, from a gangrenous
Gangrene
Gangrene is a serious and potentially life-threatening condition that arises when a considerable mass of body tissue dies . This may occur after an injury or infection, or in people suffering from any chronic health problem affecting blood circulation. The primary cause of gangrene is reduced blood...
wound, possibly caused by the beating. The autopsy revealed extensive internal injuries, the cause of death pyemia—blood poisoning.
Semmelweis was buried in Vienna on August 15, 1865. Only a few people attended the service. Brief announcements of his death appeared in a few medical periodicals in Vienna and Budapest. Although the rules of the Hungarian Association of Physicians and Natural Scientists specified that a commemorative address be delivered in honor of a member who had died in the preceding year, there was no address for Semmelweis; his death was never even mentioned.
János Diescher was appointed Semmelweis's successor at the Pest University maternity clinic. Immediately mortality rates jumped sixfold to six percent. But the physicians of Budapest said nothing; there were no inquiries and no protests. Almost no one — either in Vienna or in Budapest — seems to have been willing to acknowledge Semmelweis's life and work.
His remains were transferred to Budapest in 1891. On October 11, 1964 they were transferred once more to the house in which he was born. The house is now a historical museum and library, honoring Ignaz Semmelweis.
Legacy
Semmelweis's advice on chlorine washings was probably more influential than he realized himself. Many doctors, particularly in Germany, appeared quite willing to experiment with the practical handwashing measures that he proposed, but virtually everyone rejected his basic and ground-breaking theoretical innovation—that the disease had only one cause, lack of cleanliness. Professor Gustav Adolf Michaelis
Gustav Adolf Michaelis
Gustav Adolf Michaelis was a German obstetrician who was a native of Kiel. He studied medicine in Göttingen under surgeon Konrad Johann Martin Langenbeck and obstetrician Friedrich Benjamin Osiander , and later was director of the Obstetric Hospital and the School of Midwifery at Kiel...
from a maternity institution in Kiel
Kiel
Kiel is the capital and most populous city in the northern German state of Schleswig-Holstein, with a population of 238,049 .Kiel is approximately north of Hamburg. Due to its geographic location in the north of Germany, the southeast of the Jutland peninsula, and the southwestern shore of the...
replied positively to Semmelweis's suggestions—eventually he committed suicide, however, because he felt responsible for the death of his own cousin, whom he had examined after she gave birth.
Only belatedly did his observational evidence gain wide acceptance; more than twenty years later, Louis Pasteur
Louis Pasteur
Louis Pasteur was a French chemist and microbiologist born in Dole. He is remembered for his remarkable breakthroughs in the causes and preventions of diseases. His discoveries reduced mortality from puerperal fever, and he created the first vaccine for rabies and anthrax. His experiments...
's work offered a theoretical explanation for Semmelweis's observations—the germ theory of disease
Germ theory of disease
The germ theory of disease, also called the pathogenic theory of medicine, is a theory that proposes that microorganisms are the cause of many diseases...
. As such, the Semmelweis story is often used in university courses with epistemology content, e.g. philosophy of science courses—demonstrating the virtues of empiricism
Empiricism
Empiricism is a theory of knowledge that asserts that knowledge comes only or primarily via sensory experience. One of several views of epistemology, the study of human knowledge, along with rationalism, idealism and historicism, empiricism emphasizes the role of experience and evidence,...
or positivism
Positivism
Positivism is a a view of scientific methods and a philosophical approach, theory, or system based on the view that, in the social as well as natural sciences, sensory experiences and their logical and mathematical treatment are together the exclusive source of all worthwhile information....
and providing a historical account of which types of knowledge count as scientific (and thus accepted) knowledge, and which do not. It has been seen as an irony that Semmelweis's critics considered themselves positivists, but even positivism suffers problems in the face of theories which seem magical or superstitious, such as the idea that "corpse particles" might turn a person into a corpse, with no causal mechanism being stipulated, after a simple contact. They could not accept Semmelweis' ideas of minuscule and largely invisible amounts of decaying organic matter as a cause of every case of childbed fever— ideas which in the absence of a replicative biological mechanism, must have seemed no more chemically likely than homeopathy
Homeopathy
Homeopathy is a form of alternative medicine in which practitioners claim to treat patients using highly diluted preparations that are believed to cause healthy people to exhibit symptoms that are similar to those exhibited by the patient...
. To his contemporaries, Semmelweis seemed to be reverting to the speculative theories of earlier decades that were so repugnant to his positivist contemporaries.
The so-called Semmelweis reflex
Semmelweis reflex
The Semmelweis reflex or "Semmelweis effect" is a metaphor for the reflex-like tendency to reject new evidence or new knowledge because it contradicts established norms, beliefs or paradigms...
— a metaphor for a certain type of human behaviour characterized by reflex-like rejection of new knowledge because it contradicts entrenched norms, beliefs or paradigms — is named after Semmelweis, whose perfectly reasonable hand-washing suggestions were ridiculed and rejected by his contemporaries. There is some uncertainty about the origin and generally accepted use of the expression.
Other legacies of Semmelweis include:
- Semmelweis is now recognized as a pioneer of antisepticAntisepticAntiseptics are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction...
policy - Semmelweis UniversitySemmelweis UniversityFounded in 1769, Semmelweis University is the oldest medical school in Hungary. The faculty became an independent medical school after the Second World War and developed into a university teaching medicine, dentistry, pharmacy, health sciences, health management as well as physical education and...
, a university for medicine and health-related disciplines (located in Budapest, Hungary), is named after Semmelweis; and - The Semmelweis Orvostörténeti Múzeum (Semmelweis Medical History Museum) is located in the former home of Semmelweis
- The Semmelweis Klinik, a hospital for women located in Vienna, Austria
- The Semmelweis Hospital in MiskolcMiskolcMiskolc is a city in northeastern Hungary, mainly with heavy industrial background. With a population close to 170,000 Miskolc is the fourth largest city of Hungary It is also the county capital of Borsod-Abaúj-Zemplén and the regional centre of Northern Hungary.- Geography :Miskolc is located...
, Hungary - In 2008 Semmelweis was selected as the motif for an Austrian commemorative coin.
Film
- That Mothers Might LiveThat Mothers Might LiveThat Mothers Might Live is a 1938 short drama film directed by Fred Zinnemann. It won an Academy Award in 1939 for Best Short Subject .- Cast :* Shepperd Strudwick - Dr. Semmelweis * John Nesbitt - Narrator...
, U.S.A. 1938: MGMMetro-Goldwyn-MayerMetro-Goldwyn-Mayer Inc. is an American media company, involved primarily in the production and distribution of films and television programs. MGM was founded in 1924 when the entertainment entrepreneur Marcus Loew gained control of Metro Pictures, Goldwyn Pictures Corporation and Louis B. Mayer...
(Director Fred ZinnemannFred ZinnemannFred Zinnemann was an Austrian-American film director. He won four Academy Awards and directed films like High Noon, From Here to Eternity and A Man for All Seasons.-Life and career:...
) Oscar for the best short film - Semmelweis, Hungary 1940: Mester Film (Director André De TothAndré De TothAndré de Toth was a Hungarian-American filmmaker, born and raised in Makó, Csongrád, Kingdom of Hungary Austro-Hungarian Empire. He directed the 3-D film House of Wax, despite being unable to see in 3-D himself, having lost an eye at an early age. He is known for his gritty B movies in the western...
) - Semmelweis – Retter der Mütter, GDR 1950: DEFA (Director Georg C. Klaren)
- Ignaz Semmelweis – Arzt der Frauen, Western-Germany/Austria 1987: ZDFZDFZweites Deutsches Fernsehen , ZDF, is a public-service German television broadcaster based in Mainz . It is run as an independent non-profit institution, which was founded by the German federal states . The ZDF is financed by television licence fees called GEZ and advertising revenues...
/ORFORFORF may refer to:* ORF , the Austrian public service broadcaster.* Open reading frame, a portion of the genome.* The IATA airport code for Norfolk International Airport in Norfolk, Virginia.* ORF format , Olympus raw image file format....
(Director Michael VerhoevenMichael Verhoeven-Life and work:Verhoeven is the son of German film director, Paul Verhoeven . He married actress Senta Berger in 1966; their son is the actor-director Simon Verhoeven. Together, the couple formed a production company to make films...
) - Semmelweis, the Netherlands 1994: Humanistische Omroep Stichting (Director Floor Maas)
- Docteur Semmelweis, France/Poland 1995 (Director Roger Andrieux)
- Semmelweis (shortfilm), U.S.A./Austria 2001: Belvedere Film (Director Jim BerryJim BerryJim Berry is an American comic strip artist.Berry was born in Chicago on January 16, 1932 and attended Dartmouth University and Ohio Wesleyan.In 1961, Berry began working for the Newspaper Enterprise Association....
) - 12 Monkeys, U.S.A.1995: (Director Terry GilliamTerry GilliamTerrence Vance "Terry" Gilliam is an American-born British screenwriter, film director, animator, actor and member of the Monty Python comedy troupe. Gilliam is also known for directing several films, including Brazil , The Adventures of Baron Munchausen , The Fisher King , and 12 Monkeys...
). A mental patient refers to Semmelweis as example of a sane person unfairly categorized as crazy by his contemporaries, after describing how a waiter dropped his food on the floor in the restaurant and said it was fine because he denied the germ theory of diseaseGerm theory of diseaseThe germ theory of disease, also called the pathogenic theory of medicine, is a theory that proposes that microorganisms are the cause of many diseases...
.
Literature
is the classic reference, in Latin print, not the original Gothic print.- Louis-Ferdinand CélineLouis-Ferdinand CélineLouis-Ferdinand Céline was the pen name of French writer and physician Louis-Ferdinand Destouches . Céline was chosen after his grandmother's first name. He is considered one of the most influential writers of the twentieth century, developing a new style of writing that modernized both French and...
completed his Ph. D. thesis on Semmelweis in 1924. It was published as a fictionalised biography under the title La Vie et l'œuvre de Philippe Ignace Semmelweis in 1936 (English: The Life and Work of Semmelweis, tr. by Robert Allerton Parker, Boston : Little, Brown and Company, 1937/The Life and Work of Semmelweiss: A Fictional Biography, tr. by John Harman, Atlas Press, 2008). - Morton ThompsonMorton ThompsonMorton Thompson was an American writer of newspaper journalism, novels and film screenplays. Amongst his works were a collection of journalistic memoirs called Joe, the Wounded Tennis Player, and the novels Not as a Stranger and The Cry and the Covenant. He was also the inventor of the...
's 1949 novel The Cry and the CovenantThe Cry and the CovenantThe Cry and the Covenant is a novel by Morton Thompson written in 1949 and published by Doubleday. The novel is a fictionalized story of Ignaz Semmelweis, an Austrian-Hungarian physician known for his research into puerperal fever and his advances in medical hygiene...
is based on the life of Semmelweiss.
Drama / Plays
- "Semmelweis" by Jens Björneboe, 1968; Gyldendal Norsk Forlag; Gyldendals moderne skuespillserie, Norway.
See also
- Historical mortality rates of puerperal feverHistorical mortality rates of puerperal feverDr. Ignaz Semmelweis worked at the Vienna General Hospital's maternity clinic on a 3-year contract from 1846-1849. There, as elsewhere in European and North American hospitals, puerperal fever, or childbed fever, was rampant, sometimes climbing to 40 percent of admitted patients...
- Contemporary reaction to Ignaz SemmelweisContemporary reaction to Ignaz SemmelweisDr. Ignaz Semmelweis discovered in 1847 that hand-washing with a solution of chlorinated lime reduced the incidence of fatal childbed fever tenfold in maternity institutions...
- Carl MayrhoferCarl MayrhoferCarl Mayrhofer was physician conducting work on the role of germs in childbed fever....
- The Cry and the CovenantThe Cry and the CovenantThe Cry and the Covenant is a novel by Morton Thompson written in 1949 and published by Doubleday. The novel is a fictionalized story of Ignaz Semmelweis, an Austrian-Hungarian physician known for his research into puerperal fever and his advances in medical hygiene...
- Independent originators of disinfection procedures:
- Oliver Wendell Holmes, Sr.Oliver Wendell Holmes, Sr.Oliver Wendell Holmes, Sr. was an American physician, professor, lecturer, and author. Regarded by his peers as one of the best writers of the 19th century, he is considered a member of the Fireside Poets. His most famous prose works are the "Breakfast-Table" series, which began with The Autocrat...
- Joseph Lister, 1st Baron ListerJoseph Lister, 1st Baron ListerJoseph Lister, 1st Baron Lister OM, FRS, PC , known as Sir Joseph Lister, Bt., between 1883 and 1897, was a British surgeon and a pioneer of antiseptic surgery, who promoted the idea of sterile surgery while working at the Glasgow Royal Infirmary...
- Oliver Wendell Holmes, Sr.
- Semmelweis Frauen-KlinikSemmelweis Frauen-KlinikThe Semmelweis-Frauenklinik is a women's clinic in the 18th district of Vienna known as Währing. It is named after Ignaz Semmelweis....
- Semmelweis UniversitySemmelweis UniversityFounded in 1769, Semmelweis University is the oldest medical school in Hungary. The faculty became an independent medical school after the Second World War and developed into a university teaching medicine, dentistry, pharmacy, health sciences, health management as well as physical education and...
External links
- Sloan Science and Film / Short Films / Semmelweis by Jim Berry 17 minutes
- Extracts from Semmelweis's 1861 book, The Etiology, Concept, and Prophylaxis of Childbed Fever were published in the January 2008 edition of Social Medicine
- BMJ: Ignaz Semmelweis
- Catholic Encyclopedia entry
- Who Named it? Ignaz Philipp Semmelweis
- Tan S Y and Brown J Ignaz Philipp Semmelweis
- Caroline M De Costa, The contagiousness of childbed fever : a short history of puerperal sepsis and its treatment, eMJA The Medical Journal of Australia, MJA 2002 177 (11/12): 668–671
- review, The Fool of Pest, The New York Review of Books, 51:3 (February 26, 2004)
- The Semmelweis Society, an organization dedicated to protecting physicians from "sham peer review"
- Semmelweis's first post-stamp, Hungary, 1932
- Pulse-Project Audio Lecture: Benedek Varga on “The Myth and Cult of Ignaz Semmelweis: Constructing History of Science during the 20th Century”
