Ignaz Philipp Semmelweis (1816–1865), an unfortunate Hungarian obstetrician, elucidated the basic pathology of puerperal sepsis through careful postmortem examinations and astute clinical observations. Born July 1, 1818, in Buda, Hungary, Semmelweis received his Doctorate in Medicine in 1844 and in Surgery in 1845. After special training in obstetrics, he also received the degree of Master of Midwifery.

In the 1840s, pregnant women among the poorer segments of society had a mortal fear of the lying-in wards of Vienna's General Hospital, Allgemeine Krankenhaus, where Semmelweis started his practice. While the well-to-do opted for home delivery, poor women faced the dreaded scourge of motherhood, “childbed fever,” which struck within a week or two of delivery and included lower abdominal pain, peritonitis, high fever, delirium, and shock. The First Obstetric Clinic at Allgemeine Krankenhaus had a death rate higher than 10%, much higher than the 3% in the Second Clinic. While identical in all other respects, medical students were assigned to the First Clinic and midwives to the Second.

Semmelweis' postmortems showed pathology suggestive of “blood poisoning” in mothers and their dead babies. One day, when one of his friends succumbed to an infection from a small scalpel wound incurred during an autopsy, Semmelweis found his answer. Postmortem examination of the friend revealed the same pathologic changes seen in victims of childbed fever. Semmelweis determined that medical students coming to the First Clinic were transmitting cadaveric matter into the pregnant women by failing to wash their hands in between performing vaginal and postmortem examinations. Midwives did not attend autopsy sessions and also paid attention to personal cleanliness.

Semmelweis was filled with guilt, for he too had dissected many cadavers and unknowingly sent many women prematurely to the grave. Yet, he was quick to implement changes to correct the problem. Students and physicians wishing to examine women were required to wash their hands in chlorinated lime water and to scrub their fingernails with a handbrush before entering the ward.

This new policy elicited fierce protests, but the statistics were compelling. While 18% of women entering the obstetric clinic died during April 1847, the death rate declined to less than 3% in a few months. This proved to Semmelweis that the cause of childbed fever originated in cadaveric matter.

Much to his dismay, the death rate at the clinic subsequently shot up again during 1 week, with 11 out of 12 women dying despite precautions. Again, the explanation became apparent to the observant Semmelweis. The first patient examined in the ward had a foul discharge. Deducing that infection could be transmitted from live patients as well as from cadavers, Semmelweis instituted another level of precaution. Students were now required to wash their hands before each examination. This new policy caused an even bigger uproar, but the death rate fell again.

Obstetricians vehemently opposed Semmelweis' views and his director refused to reappoint him. While Oliver Wendell Holmes had preceded Semmelweis in affirming that women in labor should never be attended by physicians or students who had been conducting postmortem examinations or who were attending patients with puerperal fever, Semmelweis recognized puerperal fever as blood poisoning or septicemia.

His words unheeded, Semmelweis suddenly fled from Vienna to Budapest and instituted his precautions at St Rokus Hospital in Pest. In 1861, Semmelweis published an important treatise, Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers (The Cause, Concept, and Prophylaxis of Childbed Fever). He also published the scathing criticism, “Open Letters to Sundry Professors of Obstetrics.”

With continuing bitter resistance from the obstetrical community, Semmelweis eventually became mentally deranged and was placed in an asylum. Ironically, he died of blood poisoning in 1865 from an infection contracted from a small finger wound incurred during an operation. While he failed to win acceptance from the obstetrical community during his lifetime, Semmelweis' concepts became accepted in 1879, years after his death.

Dr Ignaz Semmelweis. Illustration by Venita Jay, MD, FRCPC

Dr Ignaz Semmelweis. Illustration by Venita Jay, MD, FRCPC