Ignaz Semmelweis

The doctor who washed his hands

When Ignaz Semmelweis started his medical career at Vienna General Hospital in the mid-19th century, new mothers were dying in droves from childbed fever. 

The leading minds couldn’t pinpoint the problem. It must be the ventilation. The quality of the walls was blamed. Some even suspected breast milk leaks because the pools of pus they found inside victims of childbed fever resembled rancid breast milk.

Semmelweis wasn’t well connected. He wasn’t a standout student. He wasn’t the type of person who would have been voted most likely to succeed. But he had curiosity and dedication to the craft.

Amid all the theorizing, Semmelweis noticed something, the rates of childbed fever differed drastically between the first and second wards of the hospital. The main difference between the wards was the first was staffed by doctors and the second by midwives. The midwives had a fraction of deaths. He tried honing in on what they were doing differently and implementing those practices, but had few results.

The turning point for Semmelweis was when his mentor accidentally pricked himself during a routine autopsy and died of childbed fever within days. That’s when it clicked – cadaver poisoning. The Vienna General Hospital is home to the Medical University of Vienna, and at the time the doctors and professors at the university would regularly dissect the dead to further their research. Semmelweis suspected invisible particles were being transferred by doctors to mothers. 

This was before the germ theory of disease was on anyone’s radar. He didn’t have the whole story, but he had enough to act on. Although Semmelweis couldn’t see the particles, he devised a revolutionary solution – handwashing. A lime solution removed the cadaver smell, and if you didn’t smell like a dead body that meant you weren’t carrying unseen cadaver particles. As part of his standards surgical instruments were washed, doctors wore fresh clothes, and bed sheets were changed more often. 
The results were astounding. Rates of childbed fever in the first ward where the doctors worked dropped dramatically to levels comparable to the second ward where the midwives worked. 

The response from the medical community was equally astounding. Although he had supporters, some of the most prominent medical professionals wouldn’t believe it or couldn’t accept that they were to blame. They were gentlemen – clean and genteel. Doctors didn’t take lives, they saved them. One doctor who learned of Semmelweis’ practices delivered his niece before he started washing his hands. She died of childbed fever a few days later. When he saw how effective Semmelweis’ tactics were at combating childbed fever, the guilt drove him to suicide.

When you’ve built a career and reputation on a belief, it’s hard to let that go. Many of Semmelweis’ peers would have had the work of large chunks of their careers undone by what Semmelweis was proposing. Imagine having a well-researched paper or famous lecture on childbed fever published in a prestigious medical journal, only to be told you’re wrong by some young Hungarian. If what Semmelweis was saying was true, what had once been a point of pride – something you could build a career on – would become a permanent record of your error.

When it came to convincing people, Semmelweis didn’t do himself any favors. He was often defensive and harsh and only grew more unhinged over the years. When he moved back to his native Hungary and took over a maternity ward, cases of childbed fever hit rock bottom. But he was also disliked by the staff. At times, his co-workers sabotaged his work or ignored his protocols and childbed fever would re-emerge to take more lives before Semmelweis could reassert control.

Slowly, Semmelweis began to lose his grip on reality. His moods swung wildly. He would talk to himself or imaginary people. He was a family man with children but began openly sleeping with a prostitute. At a staff meeting when he was asked to give an update on the progress of filling an open position, Semmelweis recited the midwife oath. 

Some believe he was suffering from the symptoms of undiagnosed syphilis. Others say he had a form of early-onset Alzheimer's. Always feeling attacked, and always being on the defensive certainly didn’t help with the stress and paranoia. Whatever the reason, it got so bad his wife consented to have him committed to a mental hospital back in Vienna. 

The day he was admitted to the mental hospital was the last time his wife saw him alive. He was dead within two weeks. The details of his death are murky, but he was likely beaten by the hospital staff when he tried to escape or had a mental breakdown.

Semmelweis and his work were largely forgotten until Louis Pasteur and others identified the microbes behind childbed fever. He was eventually given his due and became a national hero in Hungary. The medical university in Budapest was renamed in his honor.

As tragic as his end was, there’s a lot to learn from Semmelweis' story, which we’ll take a look at over the next few weeks.