Page updated 30 September 2006
Ignaz Semmelweis (1818-1865)
Dr. Ignaz Semmelweis was a Hungarian Obstetrician working in the Vienna General Hospital. He was puzzled by the high death rate of mothers from puerperal fever. There were 36 deaths out of 208 deliveries during the month of April 1844. This was said by his colleagues to be due to "an invisible miasma", but Semmelweis noted that of the two maternity divisions in the Hospital which admitted on alternate days, most of the deaths occurred in the first division run by the doctors and few occurred in the second division run by the midwives. Many ideas were investigated. Was there overcrowding or was it the rough male hands and so forth?
Then his friend Kolletschka, who was a pathologist, died suddenly from blood poisoning when a careless student stuck him with a knife during an autopsy of a woman who had died of puerperal fever. The illness which he suffered was the same as the puerperal fever and Semmelweis guessed there was a link. He led his students daily from the autopsy table to the Maternity Ward. He and his students transferred the puerperal fever from the Post Mortem Room to the bedside. He was the killer. The midwives of course did not do autopsies. He also noted that the primiparas with the longer labour and more examinations were more likely to die of fever.
Semmelweis instituted dipping the hands in chlorinated water before going in to the labour ward. The death rate of the mothers dropped immediately from 18 per 100 one month to 1 per 100 the next! The low rate persisted with one interruption when 13 mothers in a row died from puerperal fever. This was because the first patient in the sequence had a carcinoma with a purulent discharge and the doctors had passed the infection down the line.
Professor Klein, irritated by Semmelweis, dismissed him and the new First Assistant did not believe in chlorine water and soon there were 20 deaths every month on the first maternity division.
Semmelweis returned to Budapest and, in 1861, published his Aetiology, Concept and Prophylaxis of Childbed Fever. The style of this work is difficult and his thoughts were not properly ordered. A translation is available (by KC Carter, The University of Wisconsin Press 1983, ISBN 0 299 09360 3). Impatient with the lack of response from his colleagues, he wrote open letters accusing them and calling them murderers. He eventually went mad and was admitted to an asylum just at the time when his ideas were beginning to be accepted. He died a few days after Lister's first operation under antisepsis.
Semmelweis’ ideas were remarkable in that they preceded the germ theory of disease and we now suppose that the likely cause of sepsis and death in the maternity unit was Streptococcus pyogenes, still occasionally seen as a virulent and often fatal cause of post-operative and puerperal sepsis.
The message of this story to doctors and nurses is to wash your hands carefully before you touch a patient otherwise you may transfer infection and the microbiologists may go mad. And nowadays it is easier because you can use alcohol gel instead.
BDG Morgan, MB, FRCS
Consulting Plastic Surgeon (retired)
References
Semmelweis IP. The aetiology, concept and prophylaxis of child birth fever. Transl Carter KC. The University of Wisconsin Press 1983 ISBN 0 299 093603. Madison, London.
Selwyn S. Hospital infection the first 2500 years. J Hosp Infec 1991;18(SupplA):55-64
Newsom SW. Pioneers in infection control. Ignaz Philipp Semmelweis. J Hosp Infect 1993;23:175-87
Jarvis WR. Handwashing-the Semmelweis lesson forgotten? Lancet 1994;344:1311-1312
Rotter ML. 150 years of hand disinfection- Semmelweis' heritage. Hyg Med 1997:22;332-339
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