The Hungarian physician Ignaz Semmelweis (1818–1865) graduated in medicine from Vienna in 1844. He then worked in the obstetric wards at the Allegemeines Krankenhaus in Vienna, where he was one of a generation of young medical men trained by the anatomical pathologist Karl von Rokitansky who sought to transform traditional but ineffective treatment methods by attacking difficult clinical problems with logic and mathematical precision. Semmelweis was particularly disturbed by the appalling death rate from puerperal sepsis, or childbed fever. The germ theory of disease was gaining ascendancy at that time, and Semmelweis reasoned that the women must be acquiring the infection from their medical attendants. He observed that these attendants habitually came direct to the obstetric service from autopsies on women who had died of childbed fever—without washing their hands. He initiated a rule that required his staff to take particular care to wash their hands with soap and dip their fingers in a bowl of antiseptic solution before attending women in labor. He presented unassailable proof that observing this regimen reduced deaths from childbed fever in his wards to near zero. Many senior obstetricians, however, regarded his
Semmelweis belatedly published his methods and results in 1864. But by then his intellectual powers were waning, perhaps because of mental illness, and he died of septicemia the following year. Semmelweis's method was accepted immediately in parts of Bavaria as well as in Hungary, and it was developed independently in Boston by Oliver Wendell Holmes, who encountered much the same hostility and opposition from the Boston medical establishment, despite also demonstrating beyond doubt (albeit with less convincing numerical methods) that personal cleanliness by birth attendants could prevent childbed fever.
Only in 1867, when the English surgeon Joseph Lister began using the more cumbersome method of antiseptic sprays in operating rooms (but without the hand washing, at least initially) to control postoperative infection, was the problem of childbed fever effectively controlled in the English-speaking world. Had the obstetricians of the United States, France, and Great Britain heeded the evidence offered by Ignaz Semmelweis and Oliver Wendell Holmes, a whole generation of young women need not have died. (The problem of puerperal sepsis seems to have been less serious in countries where women were not attended by doctors, but supporting facts are scarce.) Semmelweis in particular deserves to be honored as the first to offer solid scientific proof that birth attendants' personal hygiene was absolutely essential to prevent unnecessary deaths from puerperal infection.
JOHN M. LAST
Nuland, S. B. (1981). "The Enigma of Semmelweis—An Interpretation." In The Etiology of Childbed Fever, trans. F. P. Murphy. Birmingham, AL: Classics of Medicine Library.