Searching for Semmelweis

Searching for Semmelweis

My father’s hero was not a baseball player, movie star, or president. It was Ignaz Semmelweis, a 19th-century Hungarian physician. For my dad, a professor of infectious diseases, choosing Semmelweis made a lot of sense. Not only had Semmelweis discovered the cause of outbreaks of deadly puerperal (childbed) fever among women, but he had railed against a conservative medical profession that refused to believe him.

So when I began research for a book on my father’s medical career, I returned to the story of Semmelweis. It turns out a lot of other people were doing so also—including Benedek Varga, the General Director of the Semmelweis Medical History Museum in Budapest, Hungary, and co-curator of a recent exhibition on him. Like Varga, I found it nearly impossible to separate the man from the myths that have emerged over the century and a half since Semmelweis’s death. But maybe that is not so bad.

Some information is not in dispute. Semmelweis was born to a wealthy grocer and his wife in Budapest in 1818. He graduated from the medical school of the University of Vienna in 1844 and took a position in the obstetrics clinics of the Vienna General Hospital in 1846.

Semmelweis’s attention was quickly drawn to the problem of puerperal fever, a severe disease that killed women in the hours or days after childbirth—now known to be due to a bacterial blood infection. Semmelweis observed that the rate of puerperal fever in the clinic run by medical students and physicians was about 20%; conversely, it was less than 2% in the clinic run by the hospital’s nurse midwives.

Semmelweis and his colleagues were well aware of the pathological changes found in the bodies of the victims of puerperal fever. They just did not know what caused the disease. Then, one day in 1847, Semmelweis had an epiphany. One of his pathologist colleagues, Jakob Kolletschka, who had cut his finger with a scalpel during a dissection and subsequently died of a febrile illness, had nearly identical findings on his own autopsy as did the women who died of puerperal fever. Both Kolletschka and the women, Semmelweis deduced, were dying from some type of “putrid organic matter” that was being spread from diseased bodies to healthy ones. The death rate was lower for women attended by the nurse midwives, he surmised, because they did not participate in autopsies.

It was one thing to make this claim but quite another to prove it. Here, too, Semmelweis proved ahead of his time. He devised an experiment in which medical students and physicians washed their hands with a solution of chlorine prior to any contact with the parturient women. As Semmelweis suspected, the mortality rate plummeted—to the same low rate as in the nurse midwife clinic.

It is here when the story of Semmelweis becomes complicated. Rather than celebrating his findings, obstetricians in Vienna and elsewhere disputed them, rejecting the heretical notion that puerperal fever was spread by medical personnel through direct physical contact. They continued to believe that the disease spread through “miasms”, clouds of invisible matter that patients encountered in the environment. Semmelweis did not publish his findings and, by 1850, had returned to Budapest after being bypassed for a permanent job in Vienna.

The tale of Semmelweis generally picks up in the late 1850s when he finally began to publish his work, first in a series of papers and then in his 1861 book entitled The Etiology, Concept, and Prophylaxis of Childbed Fever. When these works were again met with scepticism, he grew angry, writing blistering retorts in which he mocked and chastised his critics. These criticisms were so plentiful that Semmelweis even collected them in an 1862 pamphlet.

Meanwhile, Semmelweis was deteriorating mentally. In addition to a worsening memory, he was alternating between periods of depression and episodes of anger and paranoia. Increasingly distressed at his deterioration, his family had him committed to a psychiatric institution in 1865. 2 weeks later, he was dead of a blood infection, probably resulting from an injury inflicted by the hospital guards. In most tellings of his story, Semmelweis is a tragic hero, a “saviour of mothers” who made the ultimate self-sacrifice, dying for his cause. Rather than being celebrated for discovering that puerperal fever was an infectious disease, he is ridiculed and has to leave Vienna. Forced to defend himself, he goes insane and dies a miserable death.

My father readily accepted this version of Semmelweis’s life. As an infectious diseases physician and head of his hospital’s committee to prevent nosocomial infections, he was practically obsessed with hand washing before entering patients’ rooms. I also suspect that my father was drawn to the image of Semmelweis as a misunderstood underdog. My father spent much of his career fighting with hospital hierarchy to implement better infection control policies and to improve patient-centred care. He, too, often felt beaten down when these efforts proved futile. When I was a teenager, my father presented me with Morton Thompson’s 1949 novel, The Cry and the Covenant, based on Semmelweis’s life. The book underscored—and in turn reinforced—the standard story of Semmelweis as a tragic hero. My dad probably gave the book because he wanted me to become a doctor but also because of its lessons about fighting for what you think is right.

Rather than simply telling the standard Semmelweis story again, the new exhibition—first in Budapest and now in Rome—asked why this version of the Hungarian doctor’s life gained ascendancy. Entitled Semmelweis: The Icon, it takes as a starting point that what we know about Semmelweis says as much about those discussing the man as what actually happened in his life. This type of historical inquiry has become much more commonplace in the past several decades. For a long time, the historical profession prided itself on its supposed objectivity.

What historians did was to go to archives, undertake research, and then draw conclusions. Without entirely rejecting these goals, historical scholarship now emphasises how “facts” may not be so straightforward. Beginning immediately after events take place, those describing them begin to spin them in ways that reflect both their personal biases and the historical era in which they live. Certain aspects of events may be emphasised and others ignored. “Historical narrative”, the historian David Lowenthal has written, “is not a portrait of what happened but a story about what happened”.

This same process occurred in the case of Semmelweis, according to Varga, whose exhibition is full of iconic images of Semmelweis, in paintings and on stamps and coins. The exhibition tells the story of how Joseph Lister, the late 19th-century English surgeon who popularised disinfection before operations, supposedly once stated that “Without Semmelweis, my work would be in vain. New surgery owes the most to the great son of Hungary.” In fact, as is explained, Lister never said that, actually stating that he had not been influenced by Semmelweis’s work, although he had great admiration for the man. Another display quotes a physician from 1906 who dubiously asserted that the “strain of fighting for the victory of his doctrine had gradually undermined” Semmelweis’s nervous system. Some versions of Semmelweis’s story even falsely claimed that—like Kolletschka—he had died of the same disease that had killed the women in the old Vienna clinic.

In fact, the very building that originally housed the exhibition—Budapest’s Semmelweis Medical History Museum—is part of the myth-making process. The museum is located in the house where Semmelweis was born, thus underscoring the importance of the man to Hungarian medicine. The museum was named for Semmelweis, as was the Medical University of Budapest and the main hospital in Miskolc, Hungary. As early as 1884, the Royal Society of Physicians in Budapest attempted to generate international recognition for itself by portraying Semmelweis as exemplifying what Varga calls “the excellence of 19th-century Hungarian medical thought”.

And why does Varga believe that the mythical version of Semmelweis became so entrenched? One reason, he suggests, is that Hungary has embraced Semmelweis as mirroring its own melancholic history, in which it lost much of its land after World War 1, was invaded by the Nazis in 1944, and lived under Soviet domination and repression from the late 1940s to 1991. A second reason has to do with assumptions that people have made about Semmelweis’s mental health. Hearing that he died in a psychiatric institution has led some biographers and scholars to focus on his mental health and reflexively connect it with his futile crusade for justice. The reality, however, is more complicated. As Varga points out, Semmelweis spent many happy years back in Budapest after losing his job in Vienna. He might even have had Alzheimer’s disease or some other type of organic dementia at the end of his life, a point that the historian of medicine Sherwin Nuland raised in his 2004 book on Semmelweis. Nuland also suggested that due to his stubbornness and his self-righteousness, Semmelweis was his own worst enemy, at least partly responsible for his unfortunate fate.

Althought we might not know the “truth” about Semmelweis, learning the history of the history of Semmelweis (what historians call historiography) has its own great value. The myths that emerged about Semmelweis remind us of the ongoing cultural currency of several ideas: that doctors should fully devote themselves to saving their patients’ lives; that they should be willing to fight the establishment to do so; and that they might even make substantial personal sacrifices along the way. Indeed, these are the reasons that my father became a physician and why he first told me the story of Semmelweis.

The Lancet, Volume 383, Issue 9913, Pages 210 – 211, 18 January 2014


Semmelweis: The Icon is showing at the Hungarian Academy in Rome, Italy, until Jan 31, 2014

Further reading:

Carter and Carter, 1994 Carter KC, Carter BR. Childbed fever: a scientific biography of Ignaz Semmelweis. Westport, CT: Praeger, 1994.

Lerner, 2014 Lerner BH. The good doctor: a father, a son and the evolution of medical ethics. Boston: Beacon Press, 2014.

Lowenthal, 1986 Lowenthal D. The past is a foreign country. Cambridge: Cambridge University Press, 1986.

Nuland, 2004 Nuland SB. The doctors’ plague: germs, childbed fever and the strange story of Ignac Semmelweis. New York: W W Norton, 2004.

Thompson, 1949 Thompson M. The cry and the covenant. New York: Doubleday, 1949.

Departments of Medicine and Population Health, New York University School of Medicine, New York, NY 10016, USA

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