Ignaz Philipp Semmelweis (German: [ˈɪɡnaːts ˈzɛml̩vaɪs]; Hungarian: Semmelweis Ignác Fülöp [ˈsɛmmɛlvɛjs ˈiɡnaːts ˈfyløp]; 1 July 1818 – 13 August 1865) was a Hungarian doctor and scientist of German heritage. He was an early leader in developing methods to prevent infections during medical care and was called the "saviour of mothers." Postpartum infection, also known as puerperal fever or childbed fever, refers to any bacterial infection of the reproductive system after childbirth. In the 19th century, this condition was common and often deadly. Semmelweis showed that infections could be greatly reduced if healthcare workers in obstetrical clinics washed their hands. In 1847, he suggested using chlorinated lime solutions for handwashing at Vienna General Hospital’s First Obstetrical Clinic. At that time, doctors’ wards had three times more deaths than midwives’ wards. After implementing handwashing, the maternal death rate dropped from 18% to less than 2%. He published his findings in a book titled Etiology, Concept and Prophylaxis of Childbed Fever in 1861.

Although his research was important, Semmelweis’s ideas did not match the scientific and medical beliefs of his time. His work lacked a clear explanation for why handwashing reduced deaths, and some doctors were upset by the suggestion that they should wash their hands. They mocked him for his ideas. In 1865, Semmelweis became more vocal about his findings, and his colleagues believed he had a mental breakdown. They sent him to an asylum. While there, he was beaten by guards. He died 14 days later from a gangrenous wound on his right hand, possibly caused by the beating.

Semmelweis’s discoveries were widely accepted only after his death. Later, Louis Pasteur proved the germ theory of disease, which explained Semmelweis’s findings scientifically. Joseph Lister, using Pasteur’s research, applied clean practices in medicine and achieved great success.

Family and early life

Ignaz Semmelweis was born on July 1, 1818, in the Tabán neighborhood of Buda, which was part of the Kingdom of Hungary in the Austrian Empire. He was the fifth of 10 children in a wealthy family that owned a grocery store, József Semmelweis and Teréz Müller.

His father, József Semmelweis, was an ethnic German born in Kismarton, Kingdom of Hungary (now Eisenstadt, Austria). His mother, Teréz Müller, was also an ethnic German from Buda. In 1806, József Semmelweis received citizenship in Buda and opened a business that sold large amounts of spices and general consumer goods. The business was named "Zum weißen Elefanten" (At the White Elephant) and was located in the Meindl House, which is now the Semmelweis Museum of Medical History at 1–3 Apród Street, Budapest. By 1810, József had become wealthy and married Teréz Müller, the daughter of a coachbuilder named Fülöp Müller.

In the autumn of 1837, Ignaz began studying law at the University of Vienna but later switched to medicine. He received his doctor of medicine degree in 1844. After not being offered a position in a clinic for internal medicine, Semmelweis focused on obstetrics. His teachers included Carl von Rokitansky, Joseph Škoda, and Ferdinand von Hebra.

Work on cause of child bed fever mortality

Semmelweis was given the job of assistant to Professor Johann Klein in the First Obstetrical Clinic of the Vienna General Hospital on July 1, 1846.

There were two maternity clinics at the hospital. The First Clinic had a death rate of about 10% among women due to a disease called puerperal fever. The Second Clinic had a death rate of less than 4%. Women often begged to be admitted to the Second Clinic because the First Clinic had a bad reputation. Semmelweis wrote about women who begged on their knees to avoid being sent to the First Clinic.

Some women intentionally gave birth in the streets, pretending they had already delivered their babies on the way to the hospital. This allowed them to avoid being admitted to the First Clinic, where the risk of infection, birth problems, and death was much higher.

Semmelweis was confused by the fact that women who gave birth on the street rarely got puerperal fever. This made him wonder what protected those who delivered outside the clinic.

He was troubled by the difference in death rates between the two clinics. He looked for reasons and ruled out overcrowding, as the Second Clinic was always more crowded. He also ruled out climate, since both clinics were near each other. He tried changing the position in which mothers gave birth and suggested that the practice of priests giving last rites in the clinic might frighten women after childbirth, leading to fever.

In 1847, Semmelweis’ thinking changed after his friend Jakob Kolletschka died. Kolletschka was accidentally cut with a scalpel during a postmortem examination. His autopsy showed signs similar to those seen in women who died from puerperal fever. This led Semmelweis to connect the disease to contamination from dead bodies.

He proposed that doctors and medical students carried "cadaverous particles" on their hands from the autopsy room to the patients they examined in the First Clinic. This explained why midwives in the Second Clinic, who did not work with dead bodies, had much lower death rates.

At the time, the germ theory of disease was not widely accepted in Vienna. Semmelweis believed that an unknown "cadaverous material" caused the fever. He started a new rule requiring doctors and students to wash their hands with a solution of chlorinated lime (calcium hypochlorite) after autopsies and before examining patients. He chose this solution because it removed the bad smell of infected tissue, which he thought might destroy the harmful "poisonous" material.

The death rate in the First Clinic dropped by 90% after this change. Before the new handwashing rules, the death rate in April 1847 was 18.3%. After the rules began in mid-May, the rate dropped: 2.2% in June, 1.2% in July, and 1.9% in August. For two months in the year following this discovery, the death rate was zero for the first time since the hospital began using anatomical studies.

Efforts to reduce childbed fever

Semmelweis believed that cleanliness was the main cause of disease, but many people at the time did not agree with his idea. His suggestions were ignored, laughed at, or dismissed. He was fired from his hospital job because of political reasons and faced criticism from doctors in Vienna. Eventually, he moved to Budapest.

Semmelweis was angry that doctors did not listen to him. He wrote many letters to European doctors, calling some of them irresponsible for not protecting patients. His friends and family thought he was becoming mentally unstable. In 1865, about 20 years after his discovery, he was sent to a mental institution called the Landesirrenanstalt Döbling. He died there 14 days later, possibly because he was hurt by guards. His ideas about cleanliness became widely accepted only after his death, when scientists like Louis Pasteur explained the germ theory of disease. Semmelweis is now known as a pioneer of antiseptic practices.

Semmelweis’s findings did not match the medical beliefs of his time. Doctors believed that diseases were caused by an imbalance of the body’s "four humors," and treatments included bloodletting. Medical books said each illness was unique and required individual attention. Autopsies of women who died from puerperal fever showed many different symptoms, leading doctors to think it was not one disease but many.

Some scientists say that new ideas from unknown researchers are often ignored, which can slow scientific progress. Semmelweis’s ideas were not accepted by the medical community. Some doctors were upset that he suggested they should wash their hands, as they felt it insulted their social status.

At the time, Semmelweis’s work had no scientific explanation. This changed in the 1860s and 1870s when scientists like Louis Pasteur, Joseph Lister, and Robert Koch developed the germ theory of disease.

In 1848, Semmelweis expanded his hand-washing rules to include all medical tools used on patients. He used data over time to show that his methods nearly eliminated puerperal fever in the hospital.

By late 1847, reports of Semmelweis’s work (and similar findings by Oliver Wendell Holmes Sr. in the United States) began spreading across Europe. Semmelweis and his students wrote to hospital directors about their discoveries. In 1847 and 1848, a doctor named Ferdinand von Hebra shared Semmelweis’s findings in a major Austrian medical journal, comparing its importance to Edward Jenner’s discovery of cowpox vaccination.

In late 1848, one of Semmelweis’s students gave a lecture about his work in London. A review of the lecture was published in The Lancet, a respected medical journal. Later that year, another student published a similar article in a French publication.

As news of the sharp drop in deaths in Vienna spread, Semmelweis hoped his hand-washing method would be widely used to save lives. However, some doctors misunderstood his work. Others claimed his ideas were not new, pointing to a 1843 paper by Oliver Wendell Holmes Sr. that also suggested childbed fever could spread from person to person.

Semmelweis warned against all decaying organic matter, not just infections from people with childbed fever. This confusion happened partly because Semmelweis had not published his work himself, only his students and colleagues had shared it. Misunderstandings about his research continued for many years.

Some accounts say Semmelweis did not want to share his ideas with the medical community in Vienna or write them down.

In 1848, revolutions broke out across Europe, including in Vienna and Hungary. These events affected Semmelweis’s career. Though he was not directly involved, his family members were punished for participating in the Hungarian independence movement. His superior, Johann Klein, was a conservative Austrian who likely opposed the revolutions and distrusted Semmelweis.

When Semmelweis’s contract ended in 1849, another doctor, Carl Braun, was chosen for his position instead of Semmelweis. Semmelweis tried to get a teaching position at the university but was denied for over a year because of Klein’s opposition. Finally, in 1850, he was appointed as a lecturer in "theoretical" obstetrics, but was not allowed to work with cadavers or use real patients. After learning of his appointment, Semmelweis left Vienna suddenly and returned to Pest (now Budapest), possibly to avoid further conflict with the medical community.

Between 1848 and 1849, about 70,000 troops from the Habsburg Empire were involved in the revolutions, which caused widespread political and social changes in Europe.

Breakdown and death

After receiving many negative reviews of his 1861 book, Semmelweis wrote several open letters to criticize his opponents. These letters were sent to important European doctors, including Späth, Scanzoni, Siebold, and to "all obstetricians." The letters were very argumentative and extremely offensive, at times calling his critics irresponsible murderers or ignorant people. He also asked Siebold to organize a meeting of German obstetricians in Germany to discuss puerperal fever, where he would stay until everyone agreed with his ideas.

In mid-1865, Semmelweis’s public behavior became difficult for his friends to manage. He began drinking heavily, spent more time away from his family, and his wife noticed changes in his behavior. On 13 July 1865, during a visit to friends, Semmelweis acted in a way that was considered inappropriate.

The exact cause of Semmelweis’s illness has been debated. According to K. Codell Carter, in his biography of Semmelweis, the cause cannot be determined. In 1865, János Balassa wrote a document suggesting Semmelweis be sent to a mental institution. On 30 July, Ferdinand Ritter von Hebra tricked Semmelweis into going to a Viennese asylum in Lazarettgasse (Landes-Irren-Anstalt in der Lazarettgasse) under the pretense of visiting a new institute. Semmelweis realized what was happening and tried to leave. He was beaten by guards, tied in a straitjacket, and locked in a dark cell. Treatments at the asylum included cold water and castor oil, a laxative. Semmelweis died on 13 August 1865, at age 47, from a gangrenous wound on his right hand, possibly caused by the struggle. The autopsy listed the cause of death as pyemia (blood poisoning).

Semmelweis was buried in Vienna on 15 August 1865. Few people attended the funeral. Short reports about his death appeared in some medical journals in Vienna and Budapest. Although the Hungarian Association of Physicians and Natural Scientists required a commemorative speech for members who died in the previous year, no speech was given for Semmelweis. His death was not even mentioned.

János Diescher became Semmelweis’s replacement at the Pest University maternity clinic. Immediately, the death rate at the clinic rose to 6%, but doctors in Budapest said nothing. Very few people in Vienna or Budapest seemed willing to recognize Semmelweis’s work.

His remains were moved to Budapest in 1891. On 11 October 1964, they were moved again to the house where he was born, at 1-3 Apród utca. This house is now a museum of medical history, honoring Ignaz Semmelweis.

Legacy

Semmelweis' advice about using chlorine to clean hands had a bigger impact than he expected. Many doctors, especially in Germany, were willing to try hand washing as he suggested. However, almost everyone ignored his important discovery that disease was caused by a lack of cleanliness. Gustav Adolf Michaelis, a professor at a maternity hospital in Kiel, supported Semmelweis' ideas but later committed suicide because he felt responsible for the death of his cousin, who he had examined after childbirth. Some believe his niece's death also led to his despair.

It took many years for Semmelweis' observations to be widely accepted. More than twenty years later, Louis Pasteur's research on germs provided a scientific explanation for Semmelweis' findings. Because of this, Semmelweis' story is often used in university classes about the philosophy of science to discuss how scientific knowledge is accepted or rejected. C. Hempel, for example, wrote about Semmelweis in his book on the philosophy of natural science, saying that Semmelweis' work followed a scientific method similar to modern research. His critics believed they were following a scientific approach called positivism, but their rejection of his ideas showed the weaknesses of that approach when faced with ideas that seemed strange, like the belief that "corpse particles" could cause disease through simple contact. To his contemporaries, Semmelweis' ideas seemed to return to old, unscientific theories that they strongly disliked.

Because his ideas were mocked and ignored, a cognitive bias called the Semmelweis reflex was named after him. This describes a human tendency to reject new information that challenges long-held beliefs or assumptions.

Semmelweis is now recognized as a pioneer of antiseptic practices. His legacy includes:

• Semmelweis University, a medical school in Budapest, Hungary.
• The Semmelweis Museum of Medical History, located in his birthplace.
• The Semmelweis Klinik, a women's hospital in Vienna, Austria.
• The Semmelweis Hospital in Miskolc and Kiskunhalas, Hungary.
• A 2008 Austrian commemorative coin featuring Semmelweis.
• A minor planet, 4170 Semmelweis, named after him.
• Postage stamps issued by Hungary in 1932 and 1954.
• A Google Doodle in 2020 to promote handwashing during the COVID-19 pandemic.
• The Ignác Semmelweis Prize, Hungary's top medical award.
• A bust of Semmelweis unveiled at Queen Mary University of London in 2023.

Films and books about Semmelweis include:
– That Mothers Might Live (1938), a film directed by Fred Zinnemann.
– Semmelweis (1940), a Hungarian film directed by André de Toth.
– Semmelweis – Retter der Mütter (1950), an East German film.
– Ignaz Semmelweis: Gynecologist (1989), a German-Austrian-Hungarian film.
– Semmelweis (1994), a Dutch film.
– Docteur Semmelweis (1995), a French-Polish film.
– Semmelweis (2001), a short film from the U.S. and Austria.
– Semmelweis (2023), a Hungarian film directed by Lajos Koltai.

Books and other works include:
– A 1905 collection of Semmelweis' writings.
– A fictionalized biography by Louis-Ferdinand Céline, published in 1936.
– A novel by William Forstchen featuring a doctor inspired by Semmelweis.
– The Cry and the Covenant (1949), a novel by Morton Thompson.
– Motherkillers (a novel by John Piper).
– Genius Belabored: Childbed Fever and the Tragic Life of Ignaz Semmelweis (by Theodore G. Obenchain).
– The Brief Happiness of Ignaz Semmelweis (a 2022 novel by Péter Gárdos).

Other works include:
– An Enemy of the People by Henrik Ibsen, a play about a doctor facing rejection.
– Semmelweis, an opera by Raymond J. Lustig and Matthew Doherty.
– Semmelweis by Jens Bjørneboe, performed in the 1970s.
– What are you fighting for, Dr Semmelweis (a play by Titus Alexander).
– Semmelweis (a BBC Radio 4 play by Peter Russell).
– Dr Semmelweis, a play by Stephen Brown starring Mark Rylance, which opened in 2022 and 2023.