Ignas Semmelweis

Here is the tragic story of how the most important practice to stop infection was discovered. It is the practice of washing hands.

Ignaz Semmelweis Ignaz Philipp Semmelweis1 was a Hungarian Obstetrician who made a major contribution to medicine in 1847. As an Obstetrician, Dr. Semmelweis would often find himself in front of women who were having troubles during childbirth; mostly because their babies were not positioned properly.

The optimal birthing position for a preborn baby is to be facing its mother's back, with its head down. This allows the tiny part of the head to lead the way through the mother's birthing canal.

Proper Baby Position Before Birth Every once in a while, a pre-born baby is positioned incorrectly in their mother's womb. An obstetrician can detect this and mechanically adjust the baby to make it easier for the birth to take place. To be effective, an obstetrician needs to feel the belly and reach into a woman's vagina to feel how the baby is positioned.

Dr. Semmelweis's great discovery was that a doctor should not touch a woman's uterus, her vagina or her baby right after handling corpses. Make no mistake 2, this was a major advancement in medicine. Where else could you drop the death rate so much with such a simple and inexpensive practice.

He made the discovery while holding the assistant professor position at the First Obstetrical Clinic of the Vienna General hospital. His duties in this role had him supervise difficult deliveries, teach young obstetricians and maintain the documents for the department.

The Hospital had two clinics for maternity practices, the first to train the male obstetricians and the second to train female midwives.

These types of maternity institutions had been set up all over Europe to address the problems of illegitimate babies being abandoned by their mothers. Expecting mothers could access them free of charge if they agreed to participate in the training of young staff, by giving birth in the hospital. What made it even more appealing was that the newly born infants would be taken care of by the hospital, then dispatched to orphanages, freeing illegitimate mothers of their responsibility.

This policy was set up to attract underprivileged women and prostitutes, and it worked, but not the way that the administration expected it to work. It was known outside of the hospital that going to clinic 1, run by the male obstetricians, was very dangerous. Women had a 1 in 10 chance of dying if they chose to give birth in this clinic. Clinic 2, which was run by the midwives, was 5 times safer than clinic 1.

The condition that was killing the young mothers was called puerperal fever. It is caused by a bacterial infection of the uterus following childbirth. In 1847 the "germ theory of disease" had not been discovered yet. So, they didn't really know what caused puerperal fever at the time.

Strptococcus Pyogenes -- puerperal fever

Dr. Semmelweis was puzzled by how women who had "street births" didn't seem to die of puerperal fever. Many of the women who had been condemned to his clinic, chose instead to give birth outside of the hospital. They were reneging on their part of the deal, but to get around this they claimed that the birth happened en route; on the street. This way they could avoid being killed by doctors and still get access to the free child care provided by clinic 1.

Another piece of the puzzle fell into place following another tragedy. Dr. Semmelweis's friend and colleague died when a medical student accidentally poked him with an instrument following a post mortem examination. When this man's corpse was examined it seemed he died of something very much like a puerperal fever.

So, Dr. Semmelweis linked corpses with puerperal fever. In an attempt to disprove his theory he asked all of this students to wash their hands with a solution of chlorinated lime before examining patients. There was a dramatic result. Clinic 1 ended up as safe as clinic 2.

It was not lost on Dr. Semmelweis that his clinic 1 had been killing more women than it had been helping. He had been breaking a fundamental oath in medicine; first do no harm.

Hippocrates When he wrote about his time prior to his discovery he said it, "made me feel so miserable that life seemed worthless". It was his assumption that other doctors would feel the same about such irresponsible death rates. He was wrong.

At the time medical theory didn't have room for this practice. They thought that disease was a very personal thing and that there couldn't be a possible connection between washing hands and puerperal fever. Like now, doctors, or other professionals, are motivated more by maintaining or elevating their personal status than keeping true to abstract oaths.3 Dr. Semmelweis understood that his practice was saving lives, but he marketed cleanliness as the ONE thing that mattered in medicine. This is partially true, but not absolutely correct.

Then he made another error, he described the mechanism of illness transmission as invisible "cadaverous particles", or "corpse particles". He did this in a time when the culture of medicine was trying to make a clean break from superstition. When one of his contemporaries, read his claim that particles from a corpse can turn you into a corpse, they likened it to the magical kind of thinking that plagued early medicine. Their reading stopped here because in their mind Dr. Semmelweis had lost all credibility.
Semmelweis washing his hands - credit Bettmann/Corbis Dr. Semmelweis was unpopular within his own profession. He would publically berate people who didn't agree with him and he wrote angry letters to prominent obstetricians calling them "irresponsible murders" (which they were). He made a lot of enemies and this didn't help his case. Despite his good empirical results, he was consistently ignored.

All across Europe, doctors continued to kill young mothers, but young mothers were killing doctors too. Women with syphilis were infecting the medical practitioners who touched them. It was not uncommon for obstetricians, especially those who treated prostitutes to become inflicted with syphilis (another bacterial infection). Neurosyphilis can cause erratic behavior, and as Dr. Semmelweis got older his wife and friends became convinced that he was losing his mind.

In 1865, Dr. Semmelweis's personal physician doomed him to a mental institution. Upon being committed, Dr. Semmelweis put up a fight and was beaten down by two of the asylum guards, then placed in a straight jacket. The resulting wounds became gangrenous (another bacterial infection) and he died 14 days after being admitted.

He was replaced by Dr. Janos Diescher at the Pest University where he had been working. Dr. Diescher did not follow the practice of cleanliness or hand washing recommended by Dr. Semmelweis and under his watch, the death rate in his department jumped by 6 fold. There were no inquiries. There were no protests. The physicians of Budapest said nothing.

Twenty years after Dr. Semmelweis's death, Louis Pasteur produced a theoretical explanation of why washing hands saved lives and Dr. Semmelweis was vindicated.
vindicated and placed on a stamp