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Ignaz Philipp Semmelweis​ (born Semmelweis Ignác Fülöp; 1 July 1818 – 13 August 1865) was a Hungarian physician of German extraction​​ now known as an early pioneer of antiseptic procedures. Described as the "savior of mothers", Semmelweis discovered that the incidence of puerperal fever (also known as "childbed 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 proposed the practice of washing hands 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 and Joseph Lister, acting on the French microbiologist's research, practiced and operated, using hygienic methods, with great success. In 1865, Semmelweis was committed to an asylum, where he died at age 47 of pyaemia, after being beaten by the guards, only 14 days after he was committed.

Family and early life

Teresia Müller and Josef Semmelweis, the parents of Ignaz Semmelweis

Ignaz Semmelweis as a child in 1830

Ignaz Semmelweis was born on July 1, 1818 in Tabán, neighbourhood of Buda, Hungary, today part of Budapest. He was the fifth child out of ten of the prosperous grocer family of Josef Semmelweis and Teresia Müller.

His father, Josef Semmelweis (1778–1846), was an ethnic German born in Kismarton, then part of Hungary, now Eisenstadt, Austria. Josef achieved permission to set up a shop in Buda in 1806​ and, in the same year, opened a wholesale business for spices and general consumer goods.​ The company was named zum Weißen Elefanten (at 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 and married Teresia Müller, daughter of the 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. Later, after failing to obtain an appointment in a clinic for internal medicine, Semmelweis decided to specialize in obstetrics.​ His teachers included Carl von Rokitansky, Joseph Škoda and Ferdinand von Hebra.

Discovery of cadaverous poisoning

Semmelweis was appointed assistant to Professor Johann Klein in the First Obstetrical Clinic of the Vienna General Hospital on July 1, 1846.​​ A comparable position today in a United States hospital 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. Two maternity clinics were at the Viennese hospital. The First Clinic had an average maternal mortality rate of about 10% due to puerperal fever (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 among 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 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.

Puerperal fever mortality rates for the First and Second Clinics at the Vienna General Hospital 1841–1846: The First Clinic evidently has the larger mortality rate.

Puerperal fever mortality rates for the First and Second Clinic at the Vienna General Hospital 1841–1846. (Data for more years are available.)

	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, who had been accidentally poked with a student's scalpel while performing a post mortem 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 cadaveric 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 (calcium hypochlorite) for washing hands between autopsy work and the examination of patients. He did this because he found that this chlorinated solution worked best to remove the putrid smell of infected autopsy tissue, and thus perhaps destroyed the causal "poisonous" or contaminating "cadaveric" agent hypothetically being transmitted by this material.

The result was the mortality rate in the First Clinic dropped 90%, and was then comparable to that in the Second Clinic. The mortality rate in April 1847 was 18.3%. After hand washing 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 demonstrated that puerperal fever (also known as childbed fever) was contagious and that this incidence could drastically be reduced by appropriate hand washing by medical care-givers. He made this discovery in 1847 while working in the Maternity Department of the Vienna Lying-in Hospital. His failure to convince his fellow doctors led to a tragic conclusion. However, he was ultimately vindicated.

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% (range 5–30%) to about 1–2%. 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 Budapest.

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, nearly twenty years after his breakthrough, he was committed to an asylum.Plantilla:Where He died there of septicaemia only 14 days later, possibly as 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.

Conflict with established medical opinion

Puerperal fever monthly mortality rates for the First Clinic at Vienna Maternity Institution 1841–1849. Rates drop markedly when Semmelweis implemented chlorine hand washing mid-May 1847 (see rates).

Semmelweis's observations conflicted with the established scientific and medical opinions of the time. The theory of diseases 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 bloodlettings. 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 physical signs, which emphasized 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, feeling 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 labour, and used mortality rates time series to document his success in virtually eliminating puerperal fever from the hospital ward.

Hesitant publication of results and first signs of trouble

Streptococcus pyogenes (red-stained spheres) is responsible for most cases of severe puerperal fever. It is commonly found in the throat and nasopharynx of otherwise healthy carriers.

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 emphasize 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 revolutions 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 demonstrations were 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.​

No evidence indicates Semmelweis was personally involved in the events of 1848. Some of his brothers were punished for active participation in the Hungarian independence movement, and the Hungarian-born Semmelweis likely was sympathetic to the cause. Semmelweis's superior, professor Johann Klein, was a conservative Austrian, likely uneasy with the independence movements and alarmed by the other revolutions of 1848 in the Habsburg areas. Klein probably 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 Joseph 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 (more than 18 months), 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 mannequins only. A few days after being notified of his appointment, Semmelweis left Vienna abruptly and returned to Pest. He apparently 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 Budapest

Wedding portraits of Ignaz Semmelweis and Maria Weidenhoffer (1857)

During 1848–1849 some 70 000 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. Semmelweis, upon arriving from the Habsburg Vienna in 1850, likely 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 Szent Rókus 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 eight 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 declined an offer in 1857 to become professor of obstetrics at the University of Zurich.​ The same year, Semmelweis married Maria Weidenhoffer (1837–1910), 19 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 four 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

Semmelweis's main work: Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers, 1861 (front page)

In his 1861 book, Semmelweis presented evidence to demonstrate that the advent of pathological anatomy in Wien (Vienna) in 1823 (vertical line) was accompanied by the increased incidence of fatal childbed fever. The second vertical line marks introduction of chlorine hand washing in 1847. Rates for the Dublin Rotunda maternity hospital, which had no pathological anatomy, are shown for comparison (view rates).

One of the first to respond to Semmelweis's 1848 communications was James Young Simpson, who wrote a stinging letter. Simpson surmised that the British obstetrical literature must be totally unknown in Vienna, or Semmelweis would have known that the British 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 the United Kingdom than on the continent, but he was more often cited than understood. The British 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 hand washing activities 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 is 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.​

Breakdown, death and oblivion

Semmelweis's 1862 Open Letter to all Professors of Obstetrics

Beginning in 1861, Semmelweis suffered from various nervous complaints. He suffered from severe depression and became 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 a 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."​

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.​

The exact nature of Semmelweis’s affliction has been a subject of some debate. According to K Codell Carter, in his biography of Semmelweis, the exact nature of his affliction cannot be determined. “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 gave the cause of death as 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 6%, 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

Microbial cultures demonstrating the effectiveness of disinfection — without disinfection procedures (A), after washing hands with soap (B) and after disinfection with alcohol (C)

At left, the obverse of a golden coin depicts a bust of Semmelweis as an old man, accompanied by the rod of Asclepius; it bears the inscription "IGNAZ PHILLIP SEMMELWEIS 1818 1865 50 EURO 2008 REPUBLIK ÖSTERREICH". At right, the reverse of the same coin depicts a birds-eye view of the General Hospital in Vienna, inscribed with the text "ALLGEMEINES KRANKENHAUS WIEN"; this face is inset with a tableau of a doctor and student disinfecting their hands.

2008 Austrian commemorative coin picturing Semmelweis (€50 gold coin)

Semmelweis' advice on chlorine washings was probably more influential than he realized. Many doctors, particularly in Germany, appeared quite willing to experiment with the practical hand washing 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' 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' 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' 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.​

Statue of Semmelweis in front of Szent Rókus Hospital, Budapest, Hungary (erected in 1904, work of Alajos Stróbl)

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 ideas were ridiculed and rejected by his contemporaries.

Other legacies of Semmelweis include:

• Semmelweis is now recognized as a pioneer of antiseptic policy
• Semmelweis University, a university for medicine and health-related disciplines (located in Budapest, Hungary), is named after Semmelweis
• 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 Miskolc, Hungary
• In 2008 Semmelweis was selected as the motif for an Austrian commemorative coin.​

Film

• That Mothers Might Live, U.S.A. 1938: MGM (Director Fred Zinnemann) Oscar for the best short film
• Semmelweis, Hungary 1940: Mester Film (Director André de Toth)
• Semmelweis — Retter der Mütter, GDR 1950: DEFA (Director Georg C. Klaren)
• Ignaz Semmelweis – Arzt der Frauen, Western-Germany/Austria 1987: ZDF/ORF (Director Michael Verhoeven)
• 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 Berry)
• 12 Monkeys, U.S.A. 1995: (Director Terry Gilliam). 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 disease.

Literature

• Semmelweis, Ignác; von Györy, Tiberius (1905), Semmelweis's Gesammelte Werke Herausgegeben und zum Theil aus dem Ungarischen Übersetzt [The complete published works of Semmelweis, in part published from Hungarian] (en german), Jena Verlag von Gustav Fischer, p. 604 . is the classic reference, in Latin print, not the original Gothic print.
• Louis-Ferdinand Céline completed his Ph. D. thesis on Semmelweis in 1924. It was published as a fictionalized biography under the title La Vie et l'œuvre de Philippe Ignace Semmelweis in 1936 (English versions: The Life and Work of Semmelweis, tr. by Robert Allerton Parker, Boston : Little, Brown and Company, 1937; Semmelweis, tr. by John Harman, Atlas Press, 2008).
• Morton Thompson's 1949 novel The Cry and the Covenant is a fictionalized account based on the life of Semmelweis.
• Piper, John (2007). Motherkillers. Brighton: Book Guild. ISBN 9781846240874. Consultado el 27 February 2015. , a novel based on the Semmelweis story.
• Kurt Vonnegut praises Semmelweiss at length in his 2005 memoir, A Man Without a Country, portraying his story as a tragic tale of a powerful force for good being ignored, mocked and derided in his own time. Vonnegut called him "my hero" and held his story up as a beneficial example for all mankind.

Drama/plays

• "Semmelweis" by Jens Bjørneboe. Performed in 1977 at Studio Arena Theater in Buffalo, New York with Lewis J. Stadlen, Kathy Bates, and Kim Hunter. Performed in 1978 at Kennedy Center in Washington, D.C. with Colin Blakeley. Performed in 1981 at Hartman Theater in Stamford, Connecticut.
• "What are you fighting for, Dr Semmelweis" by Titus Alexander, 1973. Performed July 1974 at Churchill Theatre, Edinburgh, Scotland, by pupils of the Edinburgh Rudolf Steiner School Dramatic Society, with Simon Scott as Semmelweis with music composed by Mark Edwards. Translated into German as "Um was kämpfen Sie, Dr. Semmelweis?" by Concilia Viegener and performed by a Steiner school in Brazil.

See also

• Contemporary reaction to Ignaz Semmelweis
• Historical mortality rates of puerperal fever
• Independent originators of disinfection procedures:
  • Joseph Lister, 1st Baron Lister
  • Oliver Wendell Holmes, Sr.
• Louis Pasteur widely publicized the germ theory of disease and, as a consequence, the need for medical hygiene
• Carl Mayrhofer
• Museum of Health Care
• Semmelweis Frauen-Klinik
• Semmelweis University
• The Cry and the Covenant

External links

• Wikimedia Commons alberga una categoría multimedia sobre 43trevenque/Taller.

• Wikisource en inglés contiene el artículo de la Encyclopædia Britannica de 1911 sobre Semmelweis, Ignatz Philipp.
• Trabajos por 43trevenque/Taller en el Proyecto Gutenberg
• Error in Template:Internet Archive author: Ignaz Philipp Semmelweis doesn't exist.
• 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
• John H. Lienhard (1991). The Engines of Our Ingenuity. Episodio 622. Ignaz Philipp Semmelweis. NPR. KUHF-FM Houston. 
• 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”

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Ignác Semmelweis
Dr. Ignaz Semmelweis a los 42 años en un grabado de 1860 de Jenő Doby
Información personal
Nacimiento	1 de julio de 1818 Budapest (Hungría)
Fallecimiento	13 de agosto de 1865 Budapest
Información profesional
Ocupación	Médico
Obras notables	La vida de las plantas (1841) De la etiología, el concepto y la profilaxis de la fiebre puerperal (1860)

Ignác Fülöp Semmelweis (Ignacio Felipe Semmelweis, en español) (1 de julio de 1818-13 de agosto de 1865) fue un médico húngaro de origen alemán que consiguió disminuir drásticamente la tasa de mortalidad en un 70 % por sepsis puerperal (una forma de fiebre puerperal)​ entre las mujeres que daban a luz en su hospital mediante la recomendación a los obstetras que se lavaran las manos con una solución de cal clorurada antes de atender los partos. La comunidad científica de su época lo denostó y acabó falleciendo víctima de septicemia a los 47 años en un asilo. Algunos años después Luis Pasteur publicaría la hipótesis microbiana y Joseph Lister extendería la práctica quirúrgica higiénica al resto de especialidades médicas. Actualmente es considerado una de las figuras médicas pioneras en antisepsia y prevención de la infección nosocomial o iatrogenia.

Infancia y juventud

Semmelweis, hijo de un tendero de comestibles de origen germano, nace en Buda, en la orilla derecha del Danubio, en un barrio comercial de la capital húngara de población mayoritariamente alemana. Cursa estudios elementales en el Gimnasio Católico de Buda, y de 1835 a 1837 se forma en la Universidad de Pest, al otro lado del río.

En noviembre de 1837 viaja a Viena por deseo de su padre para licenciarse en Derecho austríaco, pero su participación en una autopsia le hace abandonar el derecho y comienza a cursar estudios en el Allgemeines KrankenHaus, Hospital General de Viena, donde se convertirá en alumno de Joseph Skoda​ (profesor de clínica médica), Carl von Rokitansky​ (profesor de anatomía patológica) y Ferdinand von Hebra​ (profesor de dermatología), tres insignes médicos austríacos. En 1839 se inaugura la Escuela de Medicina de Budapest y regresa a su ciudad natal para continuar allí su formación, pero en 1841 vuelve a Viena, descontento con la enseñanza recibida en Pest.

En 1844 se licencia en Medicina y pasa los dos años siguientes trabajando con Rokitansky y dedicado al estudio de la infección en el campo de la cirugía. Durante este tiempo nacen, a la vez, su recurrente inquietud y su permanente insatisfacción: «Todo lo que aquí se hace me parece muy inútil; los fallecimientos se suceden de la forma más simple. Se continúa operando, sin embargo, sin tratar de saber verdaderamente por qué tal enfermo sucumbe antes que otros en casos idénticos».

En 1846, con 28 años, obtiene el doctorado en obstetricia y es nombrado asistente del profesor Klein, en una de las Maternidades del Hospicio General de Viena. Es el comienzo de una obsesión.

Estatua en Heidelberg (Baden-Württemberg), Alemania.

Contexto médico histórico

Los últimos años del siglo XIX son de gran trascendencia para el desarrollo de la medicina contemporánea. Además de Skoda, Rockitansky y Hebra, despunta la figura de Rudolf Virchow, quién comienza a desarrollar las disciplinas de higiene y medicina social, en los orígenes de la medicina preventiva actual. Es el mismo Virchow el que postula la teoría de Omnia cellula a cellula (toda célula proviene de otra célula) y explica a los organismos vivos como estructuras formadas por células. En 1848 Claude Bernard descubre la primera enzima (lipasa pancreática). En ese año comienza a emplearse el éter para sedar a los pacientes antes de la cirugía y a finales de este siglo Luis Pasteur, Robert Koch y Joseph Lister demostrarán inequívocamente la naturaleza etiológica de los procesos infecciosos.

Antecedentes de la fiebre puerperal

El primer tratado de ginecología fue escrito por Joannes Petrus Lotichius, profesor de la Universidad de Rinteln (Alemania) en 1630. Este estudio sobre la naturaleza de la mujer se tituló originalmente Gynaicologia, apareciendo el cambio de nomenclatura a la actual en 1730.​

A finales del siglo XVIII comienza a extenderse la hipótesis de las «miasmas» como causa de las infecciones, incluida la sepsis puerperal,​ pero hasta 1795 no se comienzan a publicar estudios recomendando medidas higiénicas como el lavado de manos tras asistir a enfermas afectadas de este proceso infeccioso (y antes de atender nuevos partos) o la utilización de ciertos antisépticos antes de reutilizar el instrumental.​

La evidencia es abrumadora y L. J. Boër, a comienzos del siglo XIX, comienza a aplicar normas similares en la Maternidad de Viena consiguiendo reducir la mortalidad materna hasta el 0,9 %. Su sucesor, el doctor Klein, dejará de aplicarlas, por lo que la mortalidad ascenderá hasta el 29,3 % (casi una de cada tres mujeres atendidas durante el parto en esa maternidad morían tras el alumbramiento).​ Oliver Wendell Holmes publica en 1843 On the Contagiousness of Puerperal Fever, donde recomienda expresamente que «un médico dedicado a atender partos debe abstenerse de participar en necropsias de mujeres fallecidas por fiebre puerperal, y si lo hiciera deberá lavarse cuidadosamente, cambiar toda su ropa, y esperar al menos 24 horas antes de atender un parto».

El estamento médico oficial, sin embargo, sigue remiso a aceptar estas conclusiones, y los dos obstetras estadounidenses más importantes de la época (H. L. Hodge y C. D. Meigs) menosprecian y rechazan públicamente las propuestas de Holmes. En este contexto académico, pero a través de su propia línea de investigación, desarrollará Semmelweis su trabajo apenas cuatro años después, en la misma Maternidad de Viena que aún dirigía el Doctor Klein.

LA FIEBRE PUERPERAL EN EUROPA A MEDIADOS DEL SIGLO XIX​​
CIUDAD	CLÍNICA	MORTALIDAD (%)
Viena	Clínica de Klein	40
Berlín	Clínica de Schuld	26
Edimburgo	Clínica de Simpson	22
París	Clínica de Dubois	18

El descubrimiento

Streptococcus agalactiae, el agente causante más frecuente de la sepsis puerperal por contaminación con flora autóctona, a 10000 aumentos. La infección estudiada por Semmelweis se debía a contaminación desde cadáveres con bacterias anaerobias.

Al poco tiempo de empezar a trabajar en la Maternidad de Viena, Semmelweis comienza a observar con preocupación la alta tasa de mortalidad entre las parturientas, entre fuertes dolores, fiebre alta y una intensa fetidez.

En este hospicio se disponía de dos salas de partos: una dirigida por el doctor Klein y otra por el doctor Bartch. En la primera, la mortalidad medida en 1842 había registrado una cifra del 30 %, pero en los primeros meses de 1846, el año en que el joven médico húngaro entra a formar parte de la plantilla, la cifra ronda el 96 %.​ Utilizando un rudimentario método epidemiológico comienza a estudiar las diferencias en ambos pabellones: El de Klein es más frecuentado por los estudiantes de medicina, quienes atendían a las parturientas después de sus sesiones de medicina forense en el pabellón de anatomía. En cambio la sala de partos de Bartch es más utilizada por las matronas, pero cuando los estudiantes visitan su sala la mortalidad también aumenta en esta. Esto le lleva a formular la ingeniosa (y correcta) teoría de que los estudiantes transportan algún tipo de «materia putrefacta» desde los cadáveres hasta las mujeres, siendo ese el origen de la fiebre puerperal.

...Una vez que se identificó la causa de la mayor mortalidad de la primera clínica como las partículas de cadáveres adheridas a las manos de los examinadores, fue fácil explicar el motivo por el cual las mujeres que dieron a la luz en la calle tenían una tasa notablemente más baja de mortalidad que las que dieron a luz en la clínica...

El doctor Klein no está de acuerdo con las conclusiones de Semmelweis: sus propias teorías acerca del problema van desde la brusquedad de los estudiantes a la hora de realizar los exámenes vaginales hasta el hecho de que la mayor parte de ellos sean extranjeros (procedentes de Hungría, sobre todo).

De hecho Klein llega a expulsar a 22 de sus estudiantes, quedándose tan sólo con 20, pero esto no mejora la situación entre las mujeres que acuden a la clínica para dar a luz.​ Se conservan algunas cartas de esta época de Semmelweis a su amigo Markusovsky: «No puedo dormir ya. El desesperante sonido de la campanilla que precede al sacerdote portador del viático, ha penetrado para siempre en la paz de mi alma. Todos los horrores, de los que diariamente soy impotente testigo, me hacen la vida imposible. No puedo permanecer en la situación actual, donde todo es oscuro, donde lo único categórico es el número de muertos».

En octubre de 1846 decide instalar un lavabo a la entrada de la sala de partos y obliga a los estudiantes a lavarse las manos antes de examinar a las embarazadas. El doctor Klein se niega a aceptar esta medida y el día 20 de ese mes despide intempestivamente a su ayudante. A la espera de que Skoda le consiga una plaza en su hospital, emprende un viaje de dos meses por Europa con su amigo Markusovsky. A la vuelta conoce la noticia de la muerte de Jakob Kolletschka, profesor de anatomía, tras producirse una herida durante una disección y desarrollar unos síntomas similares a los de la fiebre puerperal. Este hecho le convence de que la causa son ciertos exudados presentes en los cadáveres:

Este acontecimiento me sensibilizó extraordinariamente y, cuando conocí todos los detalles de la enfermedad que le había matado, la noción de identidad de este mal con la infección puerperal de la que morían las parturientas se impuso tan bruscamente en mi espíritu, con una claridad tan deslumbradora, que desde entonces dejé de buscar por otros sitios.

El rechazo

Por influencia de Skoda es admitido como ayudante en la sala del doctor Bratch. Aún no se conoce la existencia de los microorganismos causantes de las infecciones y sólo puede intuirse la existencia de los mismos a través de sus efectos y del olor que despiden: «Desodorar las manos, todo el problema radica en eso».

A petición suya los estudiantes de la sala del profesor Klein pasan a la sala del profesor Bartch: es mayo de 1847, y ese mes la mortalidad en esta sala sube del 9 al 27 %.

Inmediatamente decide preparar una solución de cloruro cálcico y obliga a todos los estudiantes que hayan estado trabajando en el pabellón de disecciones ese día o el anterior a lavarse antes de examinar a las embarazadas, con lo que la mortalidad desciende al 12 %.

Durante este período realiza un minucioso trabajo descriptivo acerca de los fallecimientos y las circunstancias en que se suceden, consulta los archivos y registros de la Maternidad de Viena desde su apertura en 1784 hasta 1848 y elabora tablas cruzando los datos de partos, defunciones y tasas de mortalidad para esos años.

En junio de ese año diagnostica de cáncer de útero a una mujer que se creía embarazada. Tras examinarla explora a cinco mujeres durante el parto; las cinco morirán por fiebre puerperal, lo que le permite generalizar sus conclusiones: las manos pueden ser vectores de transmisión de sustancias infectantes.

Decide extender la práctica del lavado con cloruro cálcico a cualquiera que vaya a examinar a las embarazadas, y la mortalidad cae al 0,23 %.​

Y sin embargo, por vanidad o por envidia, los principales cirujanos y obstetras europeos ignoran o rechazan su descubrimiento. Llegan a afirmar que no es posible reproducir los resultados de su experimento, y que ha falseado las estadísticas obtenidas.​ Solo cinco profesores le mostrarán apoyo público: Skoda, Rokitansky, Hébra, Heller y Helm. Sin embargo en la corte prevalece la opinión del doctor Klein y el 20 de marzo de 1849 Semmelweis es nuevamente expulsado de la Maternidad.

En palabras del profesor Hebra: «Cuando se haga la Historia de los errores humanos se encontrarán difícilmente ejemplos de esta clase y provocará asombro que hombres tan competentes, tan especializados, pudiesen, en su propia ciencia, ser tan ciegos, tan estúpidos».​

Se traslada de nuevo a su ciudad natal, en plena revolución húngara, y su amigo Markusovsky lo encuentra meses después viviendo en la miseria, con un brazo y una pierna fracturados, y hambriento. Gracias a él es aceptado en la Maternidad de San Roque de Budapest, y pasará los próximos años escribiendo en secreto su principal obra, De la etiología, el concepto y la profilaxis de la fiebre puerperal.

Últimos años

Hospital Semmelweis, en Miskolc, Hungría.

En 1854, tras la muerte de profesor Birly, es nombrado profesor de la Maternidad del clínico de la Universidad de Pest, y a partir de ese momento prácticamente desaparece la mortalidad por sepsis puerperal.

El ambiente hostil le empuja a escribir una carta a todos los profesores de obstetricia:

Carta abierta a todos los profesores de obstetricia.
Me habría gustado mucho que mi descubrimiento fuese de orden físico, porque se explique la luz como se explique no por eso deja de alumbrar, en nada depende de los físicos. Mi descubrimiento, ¡ay!, depende de los tocólogos. Y con esto ya está todo dicho... ¡Asesinos! Llamo yo a todos los que se oponen a las normas que he prescrito para evitar la fiebre puerperal. Contra ellos, me levanto como resuelto adversario, tal como debe uno alzarse contra los partidarios de un crimen! Para mí, no hay otra forma de tratarles que como asesinos. ¡Y todos los que tengan el corazón en su sitio pensarán como yo! No es necesario cerrar las salas de maternidad para que cesen los desastres que deploramos, sino que conviene echar a los tocólogos, ya que son ellos los que se comportan como auténticas epidemias...

Archivo:DBP 1956 244 Semmelweis.jpg

Sello postal alemán en homenaje a Semmelweis.

Este gesto empeora su situación pública y comienza un período de declive intelectual, en el que llega a pegar pasquines por las paredes de su ciudad en los que advierte a los padres de las mujeres embarazadas del riesgo que corren si acuden a los médicos.

Sufre alucinaciones, busca tesoros escondidos en las paredes de su casa y finalmente es internado en un asilo. Algunos autores han sugerido la posibilidad de que Semmelweis hubiera padecido durante estos años algún tipo de demencia precoz, o Alzheimer.

En abril de 1865, tras presentar síntomas de mejoría, es dado de alta. Aprovecha su libertad para entrar en el pabellón de anatomía donde, delante de los alumnos, abre un cadáver y utiliza después el mismo bisturí para provocarse una herida.^{[cita requerida]} Skoda acude a Budapest, pero tras tres semanas de fiebre y los mismos síntomas que los de las mujeres que tantas veces vio morir, él mismo fallece a los 47 años en brazos de su profesor.^{[cita requerida]}

El Hospicio General de Viena es actualmente un edificio rosa con verja negra; en su interior puede verse la estatua de un hombre sobre un pedestal que representa al profesor Semmelweis. Bajo la efigie se ha colocado una placa con la inscripción: «El salvador de las madres».

Obra

• La vida de las plantas (tesis-doctorado, 1841).
• De la etiología, el concepto y la profilaxis de la fiebre puerperal (Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers. Escrita en 1860, publicada en 1861).._. _. ._.

Bibliografía

• Ignaz Semmelweis. Etiología, concepto y profilaxis de la fiebre puerperal. Traducción. El desafío de la epidemiología, problemas y lecturas seleccionadas. OPS 1988.
• Magdalena Fresán. El perdedor iluminado, Ignaz P. Semmelweis. Pangea Editores, México 1991.
• Laín Entralgo, Pedro. Historia de la medicina. Masson-Salvat Medicina, Barcelona, 1978.
• Guthrie D. (1945). Historia de la medicina, Barcelona, Salvat, 1947.
• Louis-Ferdinand Céline. Semmelweis, París, Gallimard, 1952 (trad. española: Juan García Hortelano, Madrid, Alianza, 1968).
• Crónica de la medicina. Plaza y Janés Editores, Bogotá 1995.

A título póstumo, los ganadores del Premio Nobel de Física y Química decidieron entregarle un Premio Nobel en su memoria gracias a sus logros.^[¿quién?]

Enlaces externos

• Wikimedia Commons alberga una categoría multimedia sobre 43trevenque/Taller.
• Breve reseña biográfica
• Biografía comentada
• BMJ: Ignaz Semmelweis
• The Semmelweis Society
• Museo Semmelweis de Budapest.