Imagine you’ve been a pioneering medical doctor, but you’ve had a nervous breakdown and are being sent to an asylum for treatment. Despite all the work you’ve done, your innovations in medical treatment have not been recognized and accepted by the contemporary medical community. In fact, the medical establishment has more or less ridiculed you and tried to run you out of the profession. The stress has been too much and now you’re in the hands of the staff at a mental asylum.
But it’s 1865, and the treatment for a nervous breakdown was more or less like being sent to a prison. The guards at this particular asylum have beat you severely in an attempt to get you to comply with asylum “treatment.” This treatment kills you within two weeks, and you’re only 47 years old.
It’s hard to imagine someone packing more into a short life than Ignaz Semmelweis, to have a more tragic ending, and yet to have proven so right in the end. He’s our Man Crush Monday for this week and, although well-known now in his native Hungary and among experts in the history of his medical field, the germ theory of disease, he deserves more historical attention, at least as far as this Professor is concerned.
Born to a prosperous merchant family in Hungary in 1818, Ignaz Semmelweis got his medical degree in Vienna, Austria in 1844. He eventually practised specialized in obstetrics, the study of pregnancy and childbirth, and worked at the Vienna General Hospital, starting in 1846. Two maternity clinics had been set up there to offer free medical care to poor women and to try to combat infanticide, which was a problem because a great many poor women (and prostitutes) used it as a tragic solution to the problem of unwanted pregnancies. The clinics also served to train medical students and midwives in how to best deliver children and care for new mothers.
The problem was that the clinic that trained doctors, the “First Clinic,” had a high incidence (10%) of mothers dying from “childbed fever.” The incidence of death from “childbed fever” was much lower (4%) in the “Second Clinic,” however. That Second Clinic concentrated on the training of midwives. Midwives only worked in with pregnancy and childbirth, and were not trained as medical doctors. Those trained medical doctors who delivered babies, however, also dealt with all sorts of other medical problems. Part of those doctors’ training was to dissect and study corpses of those who had recently died.
Remember, this was in the 1840s and 1850s, before the germ theory of infection was discovered and accepted. So the rate of maternal death in the medical doctors’ clinic, Clinic 1, versus the rate of maternal death in the clinic run by midwives, Clinic 2, was a troubling issue in the medical community. It seemed inexplicable that a clinic run by common midwives would have a higher survival rate than a clinic run by gentlemen doctors.
The relatively poor survival rate of the doctors’ clinic became a fairly well-known fact to the public, even women at the margins of society who were desperately in need of help. Often, poor Viennese women would ask not to be sent to the doctors’ clinic, where they feared they would catch childbed fever. They begged to be admitted to the midwives’ clinic, because they had heard of the higher survival rate there. In fact, some desperate women resorted to giving birth in the street rather than enter the doctors’ clinic.
The rising incidence of street births drove Semmelweis to consider the childbed fever problem seriously. He studied all the practices in both clinics carefully, but could not understand why the midwife one was so much safer. Each clinic followed exactly the same medical procedures. The only difference was that doctors delivered babies in Clinic 1 and midwives delivered babies in Clinic 2. Semmelweis couldn’t identify the reason for higher childbed deaths in Clinic 1, until the answer started to reveal itself after an accident. One of Semmelweis’s doctor colleagues died after getting a small cut from a scalpel during a post-mortem examination and training session in the hospital’s morgue. Semmelweis did the autopsy on the dead doctor, and found almost identical pathology that had been causing the deaths of the mothers in Clinic 1.
Eventually, Semmelweis theorized that medical doctors and medical students were carrying “cadaverous particles” or “cadaverous matter” (that is, “germs”) with them on their hands from the autopsy room to the maternity Clinic 1 where they delivered babies. This was the only difference he could find between the treatment environments in Clinic 1 with the medical doctors, and Clinic 2 with the midwives. The midwives, obviously, had not been examining dead bodies as part of their medical training, and weren’t carriers of anything that could give mothers “childbed fever.”
Semmelweis thought that the only way to combat the “cadaverous matter” that travelled to the doctors’ maternity clinic was for those doctors and medical students to clean and disinfect their hands carefully and extensively. Ordinary soap and water proved to be ineffective and so Semmelweis came up with a chlorinated lime and water solution that successfully killed the germs from the cadavers.
Clinic 1 started using this disinfecting method in mid-1847 and the mortality rate from childbed fever dropped to zero within two months.
Despite the obvious success of this disinfection method, Semmelweis couldn’t convince most of the medical community in Vienna, and Europe generally, that germ-transmission was the cause of childbed fever. Most doctors believed that other factors, such as an “imbalance in the four humours” in the body, uncleanliness of the mothers themselves, and the general poor health of women in the free maternity clinics were to blame. Semmelweis published findings and tried to get his new methods adopted, but was, more or less ridiculed by the medical establishment. Many doctors thought that handwashing was beneath them because it implied that men of their social status could be unclean.
The other major obstacles to the adoption of Semmelweis’s methods included what is now called “belief perseverance,” the psychological reluctance to accept new ideas and to reinforce belief in traditional explanations — doubling down on old ideas, essentially. This led to what was later described as the “Semmelweis Reflex” — rejecting new ideas automatically, almost as a reflex, whenever they come out. It was as if something like Semmelweis’s new hand-washing protocol threatened the whole history of doctors’ training in Europe.
He left the Vienna hospital in 1849 and went home to Budapest, where he worked in similar hospitals and had similar success with his new techniques.
Semmelweis and some of his followers continued to publish the results of their new procedures. But the reaction of most of the medical establishment at the time was so hostile and so personal toward Semmelweis himself that it began to affect his own mental health. By the late 1850s, Semmelweis became extremely depressed, and may have been suffering from a case of early-onset Alzheimer’s Disease. The stress of being so extensively rejected and ridiculed by his professional colleagues drove him to the nervous breakdown I mentioned at the beginning of this episode.
By 1865, the breakdown was causing him to act in very extreme, almost maniacal, ways. His family and a couple of personal doctors sort of tricked him into going into a mental asylum, and when he tried to leave or escape, the guards began to beat him severely. They eventually put him in a straight-jacket and had him placed in solitary confinement for periods of time. He died within two weeks, from the gangrene he got from one of the wounds he suffered from the guards’ beatings.
The doctors who replaced him at the hospital in Budapest did not continue Semmelweis’s treatments, and death from childbed fever crept up again to their pre-Semmelweis levels.
Only in the late 1860s and through the 1870s did Semmelweis’s ideas and treatments begin to be recognized. Louis Pasteur in France and, later, Joseph Lister in Britain proved the “germ theory of disease.” They faced similar opposition from their own medical establishments, but by that time, the evidence they had mounted, combined with that of Semmelweis, had been tested and retested and finally gained acceptance by the end of the 19th century.
Semmelweis’s genius and sacrifice was gradually accepted and celebrated in the 20th century. Budapest is now home to Semmelweis University, which specializes in medicine and health policy. There is a Semmelweis Clinic for women in Vienna. There are statues to him in Budapest, Vienna, Toronto, and Tehran. His image has appeared on coins and stamps in his native Hungary, where he is now regarded as a national hero.
Buzzkillers should read Dr. Theodore Obenchain’s wonderful study of Semmelweiss’s life and work, entitled “Genius Belabored: Childbed Fever and the Tragic Life of Ignaz Semmelweis.” It’s available on the Buzzkill Bookshelf.
And as a Buzzkill Bonus you also go to our YouTube Channel. In addition to the video of this episode, we have put a copy of a Hollywood short-subject film made about Ignaz Semmelweis’s work. From 1838 and entitled “That Mothers May Live,” it celebrates Semmelweis’s contribution to medicine and medical history. Go to YouTube.com, search for Professor Buzzkill, and subscribe to our channel while you’re there.
Talk to you next week.
Theodore G. Obenchain, Genius Belabored: Childbed Fever and the Tragic Life of Ignaz Semmelweis.
Identifies Semmelweis’s rightful place in the pantheon of scientists and physicians whose discoveries have saved the lives of millions. Obenchain’s biography of Semmelweis offers unique insights into the practice of medicine and the mindsets of physicians working in the premodern era. This fascinating study offers much of interest to general readers as well as those interested in germ theory, the history of medicine and obstetrics, or anyone wishing to better understand the trajectory of modern medicine.