Ignaz Semmelweis: A physician-hero

Recently, I had my photo taken with Ignaz Semmelweis. Not with the man himself, but with his statue. Although his is not a household name, the man is a physician-hero.

Born in 1818 in the city of Buda, Hungary, Semmelweis became an obstetrician and worked in the First Obstetrical Clinic in Vienna, Austria. There were two clinics in Vienna General Hospital that alternated admitting pregnant women. Semmelweis observed that the clinic managed by physicians differed from the clinic run by midwives in the frequency of "childbed fever.” This condition-now known as puerperal fever-was much more common in the physician-run First Clinic than in the midwife-run Second Clinic. The disease had a high mortality rate, and the death rate of pregnant women in the First Clinic was about 10% to 20%, compared with 2% to 4% in the Second Clinic.

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Semmelweis noted that physicians, not the midwives, examined patients at autopsy during the day, and he conjectured that something on the physicians' hands was responsible for causing the fevers and deaths. He experimented with having his doctors dip their hands into a solution of lime (calcium hydroxide) and showed that the rates of fever and death in the First Clinic quickly plummeted by 90% or more. He then ordered that the obstetrical instruments be immersed in the solution.

As word of his innovation spread, Semmelweis expected that he would be congratulated and his intervention adopted broadly. Instead he was ignored, criticized, and ridiculed. Many physicians, of course, were angry that he made them look bad by pointing out the high complication rate of physicians relative to the midwives, while others noted that he had no satisfactory explanation for his findings (Louis Pasteur would not propose his germ theory of disease until decades later). He was forced out of his hospital in Vienna.

Semmelweis relocated to Hungary, where he repeated his study of the efficacy of lime, obtaining the same results and virtually eliminating the disease from his hospital. His success in the clinics still did not translate into acceptance by his colleagues, and Semmelweis became anxious and depressed. He reportedly used every conversation as an opportunity to rant against his fellow obstetricians who did not accept his findings. At the age of 47 he was placed in an insane asylum, and within two weeks, staff members beat him to death.

Today, we know about bacterial infection and that Strep pyogenes is the most common cause of puerperal sepsis. We accept the value of hand hygiene and instrument sterilization. Today, we are well schooled in the importance of honoring the results of clinical trials, whether or not the results and explanations conform to our expectations. Today, the statue of Ignaz Semmelweis stands in the beautiful campus of a fine medical school that bears his name (and where, incidentally, the first femtosecond laser-assisted cataract surgeries were performed).

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The vindication, statues, and honors came too late for Ignaz Semmelweis to know of them. Time ultimately proved him a hero for fearlessly advancing some unpopular truths and saving the lives of many women when it would have been much better for his career to remain silent.

Standing under towering century-old trees, Semmelweis has a message for today’s young physicians: the right thing is to pursue truth wherever it leads, even if it means challenging orthodoxy and comes at high personal cost.