Ignac Semmelweis

Ignác Fülöp Semmelweis (1818-1865)

Ignác Fülöp Semmelweis became one of the world’s best-known Hungarian physicians, and “the savior of mothers,” thanks to a discovery he made that was ahead of his time, and which was based on practical observations and conclusions drawn from statistical data. By instructing doctors to wash their hands in a chlorine solution, he was able to dramatically reduce mortality from childbed fever.

In addition to his revolutionary discovery, which was met with resistance from his contemporary peers, he was also a pioneer in experimental etiology, while he also known for performing the first ovarian surgery and the second Caesarean section in Hungary. He published regularly and was also a strong advocate of obstetrics education.

His family wanted him to become a lawyer

Ignác Fülöp Semmelweis was born on July 1, 1818, as the fifth of ten children in the Meindl House (Palota, later Apród utca 1-3) in Tabán, a neighborhood of Buda, today part of Budapest, to his father József Semmelweis, a spice trader, and his mother Terézia Müller, who was of Swabian origin. He went to secondary school at the Cistercian Saint Stephen Gymnasium in Székesfehérvár and the University Catholic Gymnasium located in the Buda Castle, where he received excellent marks, after which he enrolled in a two-year humanities course at the University of Pest. (*At the time, Buda, Pest and Óbuda were separate towns; the three merged in 1873 to create Budapest.)

In 1837, in line with his father’s wishes, who wanted him to become a judge-advocate, he began studying law at the University of Vienna, but switched to medicine later that same year. His decision was influenced largely by the fact that he shared accommodations with medical students, whose studies he found more interesting than his own ones in law. He completed his medical studies in Vienna and Pest and received his doctorate degree in medicine in 1844 in Vienna with a botanically-themed dissertation entitled “Tractatus de Vita Plantarum.” He obtained a degree as an obstetrician that same year and as a surgeon in 1845.

Photo: Ignác Semmelweis’ birthplace, (Apród utca 1-3.) 1906, Semmelweis University, Central Archives

The discovery – 1847

In 1846, Semmelweis was appointed assistant professor at the maternity clinic of the Vienna General Hospital (Allgemeines Krankenhaus), where there were some months in the early 1840s when the mortality rate of childbed fever among women who gave birth was as high as 30%. However, after the practices for medical students and midwives were separated, a difference between the numbers became apparent. At the ward where medical students worked, the average mortality rate was close to 10%, while it was only 3.3% in the midwives’ ward. Semmelweis looked for answers on the autopsy table, as he had earlier worked with Carl von Rokitansky, one of the period’s most famous pathologists. The breakthrough was provided by the death of his friend Jakob Kolletschka, a professor of forensic medicine, who had cut his hand before his death during an autopsy. Semmelweis discovered in Kolletschka’s autopsy report that his friend and the young mothers who had died from childbed fever had similar pathologies. It became clear to him that the cause of the childbed fever was that physicians carrying out autopsies went over to the maternity ward without disinfecting their hands, where they proceeded to examine expectant mothers with these same undisinfected hands. Thus, Semmelweis concluded that it was “cadaverous particles,” the decomposed organic tissue from the autopsy rooms, that was the cause of the deaths. Later he also realized that hands should be washed not just after autopsies, but between each examination of different patients as well.

Illustration: The autopsy room of the Department of Forensic Medicine in 1909, Semmelweis University Central Archives

Childbed fever (puerperal fever)

Certain bacteria and pathogens can get into a woman’s weakened birth canal after she has given birth, where they find a warm, nutrient-rich environment. After the separation of the placenta, they can then even invade the bloodstream through the raw, wounded surface of the interior of the uterus. This may lead to peritonitis, endometritis, or the inflammation of other organs, accompanied by frequent fits of high fever. Without effective treatment, most cases lead to sepsis within a few days, eventually followed by death.

The solution – washing hands with chlorinated lime

After trying several chemicals, Semmelweis finally settled on chlorinated lime in May 1847 as the disinfectant of choice, adding 1 ounce (35 g) of the compound to 2 pounds (840 g) of water, i.e. disinfecting hands with a 4% solution. Hands had to be disinfected following a soap scrubbing with a nailbrush, allowing the strong alkaline effect to take place. The lye dissolved both the layer of fat not removed by the soap, as well as the keratinized layer of the epidermis, which is why the skin turned slick after washing hands for around 4–5 minutes. Due to the effect of the chlorinated lime, even the dirt or microorganisms hidden in the folds or chaps of the skin were removed. Already at the Vienna ward, Semmelweis ordered all physicians, medics and nurses to wash their hands with chlorinated lime, but his policies were very unpopular. The procedure was lengthy and unpleasant, since the disinfection had to be carried out both before and after examinations, following a thorough scrubbing with soap and nailbrush, and the lye sometimes burned the skin on the hands, causing inflammations and chapping. Semmelweis’s discovery was not taken seriously by his colleagues, even though the mortality rate of childbed fever dropped significantly as a result of his policies.

Illustration: scrubbing in, Department of Surgical Research and Techniques, Semmelweis University, Valter Berecz

Conflicts at the Faculty of Medicine in Vienna

Succeeding generations have simplified Semmelweis’s struggles in Vienna as one person tilting at windmills, implying that the progressive, genius assistant professor Semmelweis stood alone against the entire backward medical faculty of Vienna. In reality, however, Semmelweis did have supporters at the university and the conflict that he ended up in the middle of was part of a much larger, more complex intra-faculty dispute. At the time, representatives of older, traditional medicine stood in opposition to those who favored of a new type of medicine based on natural sciences. Archive materials prove that Semmelweis’s teachers and friends fought for him fearlessly, bravely and tenaciously for years in the course of his various petitions and requests, standing by him even when he had already turned his back on Vienna.

Semmelweis’s Instruction

Ignác Semmelweis was appointed head of the maternity clinic (the predecessor of today’s 1st Department of Obstetrics and Gynecology) at the University of Pest in 1855. It was already in this position that he posted his famous instruction, dated May 27, 1861, on all the doors of the department, which by that time had already moved to the Kunewalder House. In this instruction, he ordered that hands must be washed in chlorinated water before all examinations of women preparing for childbirth. “Childbed fever is mostly caused by students examining women in childbirth with fingers dirtied by decayed animal tissue … Consequently, doctors who work with cadavers or the above-mentioned illnesses cannot be allowed into the maternity practice…,” he writes in his Instruction, whose full title is “Instruction to the Medical Students Studying at the Maternity Hospital of the Hungarian Royal University of Pest to Prevent Childbed Fever.”

Photo: Semmelweis’s Instruction (1861)

Semmelweis’s academic work

Semmelweis only published his discovery and the results achieved with aseptic procedures years later, after repeated urging from his friends, first in 1858 in Orvosi Hetilap [Hungarian Medical Journal], edited by Lajos Markusovszky, with the title “The Etiology of Childbed Fever.” His German-language book, Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers [“The Etiology, Concept and Prophylaxis of Childbed Fever”] was published in 1860 in Vienna but dated 1861. This book collects all of his studies from between 1847 and 1861. Following the publication of the book, Semmelweis himself sent a copy to the Council of the Governor-General in Hungary, who asked for the opinion of the medical faculty of the University of Pest, resulting in an official order to implement Semmelweis’s proposals into hospital practice. The Council of the Governor-General, responsible for the administration of the country, sent a general order on September 1, 1862 to every local authority on implementing Semmelweis’s procedures. This was followed by his first and second open letters written to colleagues, also published in German in 1861 and 1862. Due to his new ideas and in particular his passionate tone, his views were rejected and attacked by the majority of the Hungarian, and especially the international, medical community.

Photo: Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers – original copy in the university’s Central Library

The Semmelweis reflex

The Semmelweis reflex or Semmelweis effect is the automatic rejection of facts without consideration, study or experimentation. It is a unique, reflex-like human tendency that automatically rejects new information because it contradicts established norms, beliefs or paradigms. The term gained wide use mostly in English-language areas.

Semmelweis as a pioneer surgeon

Ignác Semmelweis is also notable for his work as a surgeon, with two operations noted especially by professional literature: in 1863, he was the first in Hungary to perform a successful ovariotomy (removal of an inflamed ovary), and the second to perform a Caesarian section on a living woman, on March 19, 1857. For the Caesarian, he asked János Balassa, one of the greatest surgeons of the time and Semmelweis’s colleague, to be his first assistant. The woman was a 23-year-old maiden, a poor seamstress from Buda suffering from rickets, who couldn’t walk until she was six due to her severely deformed pelvis and limbs. She kept her pregnancy secret. Prior to the operation, it became clear that the baby had died in the womb and was in a breech position, thus Semmelweis decided on a Caesarian in order to save the life of the mother. The mother eventually died the day after the operation. Semmelweis’s operation was significant because the next Caesarian was performed only seven years later, while the first Caesarian section in Hungary where both the mother and the baby survived was performed in 1890 by Vilmos Tauffer.

Photo: József Fleischer, an assistant lecturer who observed the operation, wrote about the Caesarian section in several articles in Orvosi Hetilap (1857).

Semmelweis Ignác at the university

Semmelweis was appointed head of the maternity department, which can be considered the predecessor of today’s Department of Obstetrics and Gynecology, on July 18, 1855. He spent six years in this position, which represented the peak of his career. At the time, the department was located in Újvilág utca (today called Semmelweis utca) and operated with crowded wards under bad conditions, and it took him four years to move the department to the second floor of the so-called Kunewalder House (located on what was then called Országút, and today is Múzeum körút). Here they had 28 beds and were able to treat women under much better hygienic conditions. By introducing strict rules on asepsis, Semmelweis was able to prove his earlier observations at the Pest department as well. In addition to his role as director, he was also active in several committees of the university and took on roles as librarian of the department teaching staff’s library and head of the Central Vaccine Institute, which operated under the direction of the university. Semmelweis started his scientific publication activity at the Pest university, and his main works were also written in this period. He helped and supported his friend Lajos Markusovszky in launching Orvosi Hetilap, which is one of the oldest Hungarian medical journals. All of Semmelweis’s Hungarian-language writings were published in this paper.

Photo: The building on the corner of Hatvani utca (from 1894, Kossuth Lajos utca) and Újvilág utca (today Semmelweis utca) where the maternity department was located, with 15 beds. – Tibor Győry: The History of the Faculty of Medicine 1770-1935 (Budapest, 1936)

Semmelweis as educator

As head of the department in Pest, he considered the teaching of obstetrics to be of great importance. Over the course of ten years, he personally gave comprehensive exams to a total of 1960 medical students, prospective surgeons, obstetricians and midwives. As time went on, he gave increasingly higher marks to students, with the average approaching a 4 (on a scale of 1 to 5) by the end, while the failure rate was only 1%. Semmelweis was a dedicated teacher, educating 200 students a year in both Hungarian and German. He placed great emphasis on training young doctors and he had plans to publish textbooks on obstetrics and gynecology, but this was prevented by his illness and death.

Photo: a report book on comprehensive exams with Semmelweis’s handwriting (1862-1867), Semmelweis University, Central Archives

His death

Already years before his death, Semmelweis started exhibiting strange behavior. In addition to his heavy remorse after his discovery, the constant attacks had a serious effect on his worn-down nervous system, which developed into mental illness by July 1865. Semmelweis’s wife turned to Professor Hebra for help, who was their friend in Vienna. With his intervention, Semmelweis was admitted to the Viennese Mental Hospital in the Döbling district on July 31, where he died on August 13. The exact circumstances of his death have been debated by science for decades. Syphilis contracted early in his profession during an autopsy, progressive paralysis (cerebral atrophy of the frontal lobe) that developed from this, and a brutal beating he suffered from the staff in Döbling have all been considered. According to his autopsy report and pathology and radiology tests conducted on his bones in 1963-64, the cause of death was sepsis resulting from lingering osteomyelitis in his right hand – so in effect, he died from the same disease that he discovered the pathology of.

Photo: Ignác Semmelweis’s tomb in Kerepesi Cemetery and the wall of Semmelweis’s birthplace, today the building of the Semmelweis Museum, Library and Archives of the History of Medicine, where his remains have rested since 1964

Taking on the Semmelweis name

The Medical University of Budapest took on the name of its one-time professor Ignác Semmelweis in 1969, on the 200th anniversary of the establishment of the faculty of medicine, thus becoming the Semmelweis University of Medicine. This is where the emblematic SOTE acronym comes from, short for the university’s Hungarian name, although this nomenclature is no longer correct, as the new name of the institution as of 2000 – when various other institutions were integrated and thus the university’s scope of operations also expanded – is Semmelweis University. Naming the university after Semmelweis took place almost 50 years ago as the result of a lengthy process. A total of 14 years passed from when the first proposal was made to when the decree-law was passed. First to propose the name change in 1955 was Dr. Imre Zoltán, the head of the 2nd Department of Obstetrics and Gynecology, and he was later able to add more weight to his initiative when he became rector of the institution. The decree on the changing of the name was passed precisely on the university’s bicentennial, on November 7, 1969.

Photo: honorary certificate on the university’s name change

Ignác Semmelweis’s descendants at the university

Ignác Semmelweis does not have any descendants who bear his name. Descendants of his who are living today are only the progeny of his daughter Antónia, who was one when her father died. Of Antónia’s five children, one of her daughters Marietta Lehoczky married Tivadar Hüttl, a surgeon, in 1916 and gave birth to twin boys, but she died shortly after childbirth. The grandmother, Antónia Semmelweis provided help in raising the two boys, named Tivadar and Kálmán. Kálmán was an artillery lieutenant who died in World War II. His brother, following in the footsteps of his father, also become a doctor. The sons of Dr. Tivadar Hüttl, professor of surgery, i.e. the great-grandsons of Ignác Semmelweis, Dr. Kálmán Hüttl, a professor, and Dr. Tivadar Hüttl, a senior lecturer, currently work at the university’s Városmajor Heart and Vascular Center.

Photo: Antónia Lehoczkyné Semmelweis with her two grandsons, Tivadar and Kálmán Hüttl, on the balcony of their apartment in Lónyai utca (with the family’s permission)

The legacy of Semmelweis at the university

Semmelweis is commemorated by many works of art on the university premises. Probably the most emblematic of all is the full-figure statue that stands in the courtyard of the Inner Clinical Center, created by the sculptor Béla Domonkos, which was unveiled on October 22, 2004. In 1884, in the tradition of creating portraits of professors, Mór Thán painted an oil painting of Ignác Semmelweis that can be seen today in the Senate Hall. The Ceremonial Hall of the Theoretical Building at Nagyvárad tér has a bronze bust of Semmelweis, which was created by Dr. András Soós using a facial reconstruction procedure. Semmelweis’s one-time department, today’s 1st Department of Obstetrics and Gynecology, commemorates its former professor with a full-figure upright statue located on its pediment (1898), a relief sculpture and a bust in the courtyard, while reliefs can also be found in the 1st Department of Pathology and Experimental Cancer Research, as well as in the Semmelweis Salon. Among others, the university also honors the Semmelweis name with one of its most significant scientific events, the Semmelweis Symposium, as well as with the Ignác Semmelweis scientific award, established in 1959.