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MEDICAL
HISTORY
THE MARTYRDOM OF IGNAZ SEMMELWEIS
By Jaime Pankowsky MD, FACS
Before there was Louis Pasteur demonstrating that microbes
caused illnesses, there was Fracastorius (XVI century)
who told us in verse about “seminaria contagiosa”
(infectious seeds in the air). Before there was
Joseph Lister, who introduced antisepsis in the
operating room and in hospitals, there was
Ignaz Semmelweis, who through bitter and
controversial efforts helped save the lives of
thousands of pregnant women exposed to
the risk of post-partum puerperal fever.
He was born in 1818 in Buda (present day
Budapest) at that time part of the Austro-
Hungarian Empire. His parents were ethnic
Germans. He studied medicine at the Univer-
sity of Vienna and graduating in 1845, he ended
up taking a position as assistant to Dr. Johann
Klein, head of the obstetrics department at the Vienna
General Hospital.
The obstetrics department at the Vienna General Hospital took
care of single, mostly, but not always, poor mothers and pregnant
prostitutes. It was divided into two sections: Section 1 was attended
in part by medical students receiving their Obstetrics training, and
the patients were of a somewhat better class position. Section 2,
the poorer clientele, was used to train midwives. Semmelweis , as
assistant to the chief, (today s equivalent to being chief resident),
supervised activities and results in both sections.
He was concerned about the incidence of puerperal fever and
greatly distressed of the mortality caused by it, in those unfortunate grabbed by the guards and locked in.
young women. More puzzling yet, to him, was the fact that inci-
dence and mortality were considerably higher in section 1 than sec-
tion 2. He ruled out age, as the two groups were similar. Same
regarding ventilation and food provided. Section 1 had a mortality
of 10 percent, and some times as high as 30 percent, whereas sec-
tion 2 had generally a mortality of only 3 percent. He was puzzled
and could not find an explanation for this discrepancy.
Then, one of his best friends, the forensic examiner Jakob Kol-
letchka, was pricked by a knife while doing an autopsy. Shortly af-
terwards, Kolletchka developed fever and sepsis, dying of it in short
order. At autopsy, Semmelweis saw the same identical lesions seen
in the women with puerperal fever. He then realized than in section
1, the medical students came directly from doing dissections on ca-
davers to the labor room to attend women in labor. He concluded
the students were carrying invisible “cadaveric particles” that caused
36 San Antonio Medicine • November 2017
the disease in the women.
He ordered that all medical students returning to the
labor and delivery rooms after participating in ca-
daveric dissections, had to wash their hands in
chlorinated water. After one month, the num-
bers of deaths and sepsis began to look alike
in both sections, 1 and 2. But there was
strong opposition to his orders. First, his
chief, Dr. Klein, considered those measures
as a criticism on the way he directed the Ob-
stetrical service. Students and even patients
felt that Dr. Semmelweis was considering
them dirty and complained about him.
The result was that when his contract ex-
pired at the end of the year, Dr. Klein refused
to renew it. Without a job, and unable to find an-
other position, he returned to Budapest.
There, he began writing to many doctors and professors
explaining his finding and urging them to follow his advice. At times,
he became offensive and insulting, calling some of those doctors
murderers of young mothers, if they did not wash their hands be-
fore delivering babies. This did not endear him to many, and he be-
came increasingly obsessed and isolated, having nightmares which
alarmed his wife and friends.
He wrote a book describing his studies and findings in Vienna,
which found very little response and distribution. He wrote it in
Hungarian. But, who reads Hungarian anyway? Finally, a friend and
his wife convinced him to make a trip to relax and somehow tricked
him into going into an asylum (mental institution), where he was
A few weeks later he was dead, supposedly of sepsis, but an au-
topsy performed on him almost one hundred years later, revealed
several broken bones. It is believed now that he was murdered by
the guards in the asylum who beat him to death. His funeral was at-
tended by fewer than half dozen persons. One of them was the fa-
mous pathologist Rokitansky. His wife did not show up.
Today, the Obstetrics hospital in Vienna is named after him. In
Budapest, a statue stands in his honor showing him protecting a
prostrated mother. Too late, too little for a consolation!
Some people call the Semmelweis effect when a new idea is re-
jected off-hand because it contradicts traditional beliefs and con-
ventional wisdom. Fortunately, we see this behavior less and less
in Medicine.