2018 marks the 200th anniversary of the birth of Ignaz Semmelweis, a legendary figure in both Hungarian and international medicine, known as one of the forefathers of medical hygiene.
In his essay below, Dr. László Rosivall, former Rector of Budapest’s Semmelweis University and President of the Semmelweis Memorial Committee, reflects on the life, work, and legacy of the Hungarian medical giant.
This essay has been translated from the original Hungarian.
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“My teachings exist to be spread by the teachers of medical science, for every doctor and nurse to act on behalf of every last village barber, and every last village babe; my teachings exist to remove the nightmare of the delivery ward, to save the wife for her husband, the mother for her child.”
–Ignaz Semmelweis
July 1st of 2018 will mark the 200-year anniversary of the birth of Hungary’s most well-known physician, Ignaz Semmelweis, who was born in a house in the Castle district of Buda, which still stands today as the Semmelweis Medical History Museum.
Who was Semmelweis, and why did he become so famous? Semmelweis was a surgeon and obstetrician, a teacher of theoretical and of practical obstetrics at the Pesti Királyi Magyar Tudományegyetem (the Royal Hungarian University of Sciences in Pest, today known as ELTE). He is the one who is recognised as the saviour of mothers and newborns, who was able to conquer disease, but was unable to convince his era of the importance of his discoveries. He is the doctor we will always be proud of.
The reader of this article may wonder why we should, why it is worthwhile to, honor and celebrate Semmelweis in the 21st century. We must do so because his teachings are valid to this day, and his example is one that we should all follow. To this very day, major medical journals continue to publish articles whose chief revelations are that “Noncompliance with hand hygiene guidelines remains a collective challenge…”
But why do we have to look to the past, why isn’t it enough to look forward and build the future? Semmelweis’ life story is full of lessons that can act as a guide to us today, lessons which are virtually eternal. Healthy development is deep-rooted; for this reason, whoever understands, and spreads knowledge of these roots, which are the past, is helping to build the future!
At the Semmelweis Memorial Committee’s request, the government proclaimed 2018 as the 200th anniversary of Semmelweis’ birth and János Áder, the President of the Republic of Hungary, agreed to serve as the chief patron of the celebration.
Years ago, the United Nations Educational, Scientific and Cultural Organization (UNESCO) proclaimed Semmelweis’ 100th anniversary in 1965 as the Semmelweis Memorial Year. In 2014, Ignaz Semmelweis’ discoveries relating to puerperal fever (known as “childbed fever”) in 1847 and 1861 were added to the UNESCO World Heritage List. 2015 marked the 150th anniversary of Semmelweis’ death, and was chosen by UNESCO as one of the anniversaries worthy of celebration in that year. For this year’s memorial, there will be many scientific meetings, celebrations, and the publication of a memorial book. This specially-bound commemorative book, bearing Semmelweis’ portrait on the cover, will introduce readers to the history of the famed doctor’s family from the 18th century to the present, and will also include discussions of old stories and past events that have never before been published.
It contains the important events in his unusual life, his discoveries and all their useful results. The books attempts to unravel and make understandable all of the to-this-day incomprehensible reactions of countries and schools to his discoveries, and to find the reasons behind these reactions. It explores the personality of Semmelweis and the circumstances surrounding his death. Many contemporary Hungarian and foreign experts discuss the great doctor’s beliefs and thoughts. A sculptor describes the experience of creating a statue of Semmelweis, and the translator of his book discusses the difficulties of its translation, while an American composer writes about what Semmelweis means to him. The book also reveals how the statue, cast in bronze, made its way to Tehran in 2015, and how, after many complications, the great work was unveiled by Viktor Orbán, and went on to become legendary in Iran. From time to time, young Iranian doctors, who studied medicine in Hungary and speak Hungarian, take a trip to visit the statue.
Hungarian Prime Minister Viktor Orbán (center-left) unveiling a statue of Ignaz Semmelweis in the Iranian capital of Tehran in 2015 (Photo: nephrologia.hu)
The Hungarian edition of the book will be published on July 5th. A meeting between the Hungarian Academy of Sciences and Semmelweis University, with President János Áder in attendance, will be held to celebrate its publication. The English edition will be published in the fall, in the month of science. The Magyar Posta (Hungarian Postal Service) will release a Memorial Stamp, and the National Bank of Hungary will issue a commemorative medal. An opera by American composer Ray Lustig titled “Semmelweis” will make its way to the stage, and a play of the same name, written in 1958 by the world famous Jens Bjørneboe, will be shown at the National Theatre. In memory of Semmelweis, a statue will be unveiled at the university that bears his name, and with the help and recommendation of the Semmelweis Committee, there will be more such statues in other parts of the world as well, in cities such as Tokyo, Berlin, Boston, Lund, Maribor, Komárom, Prague, and Marosvásárhely. Secondary school students can take part in the four-day Semmelweis competition, where they can compete with the help of Semmelweis University medical students. There will be memorial walks and runs for the university’s Alumni and the ‘Circle of Friends.’ In addition, in February Semmelweis University will be offering an optional, PhD course in both Hungarian and English, which will be open to those outside of the university as well. Recognizing and understanding Semmelweis, life story, his teachings, and the fate of those teachings, is an absolutely necessary professional, and human, responsibility for every doctor and medical practitioner.
Semmelweis’ scientific discovery appears, especially from a modern perspective, to be very simple. He realized that doctors and midwives, while internally inspecting expecting mothers, carried bacteria on their hands that could cause fatal illness or septicemia. If this discovery was so simple, however, then why did it trigger fierce, decades-long arguments, start international disputes, and cause an overwhelming resistance to its theory and against the preventative measure of chlorinated hand-washing as a solution? At first glance, this is especially strange because decades earlier, in 1814, János Zsoldos, the “first proper doctor” in Veszprém County, wrote in his book that it was an unmistakable rule that before a birth and before delivery the midwives should wash their hands with alkaline and soapy water:
“The surgeon should be particularly careful that with a wounded hand they should not touch rotten flesh, or a sticky wound; and at all times they should wash both themselves and cleanse their barber tools. Our wounded bodies directly siphon in the poison. The surgeon can cause harm to themselves when they do not clean both themselves and their devices. How many times has a pernicious throat, gonorrhea, or rectal problem been prevented because of washing?”
“The midwife should keep herself clean and not touch the expecting mother with a wounded hand. They are to wash their hands with vinegar after every birth, and then with soap; if the mother has sticky discharge then coat hands with fresh oil, butter, or lard before the birth, and after the birth they are to wash their hands with ash-laden water, alkaline water, and then finally soapy water, and that is how they should go to the next patient, and there too they are to rinse their hands in soft, briny, and warm water first.”
Valuable scientific discoveries rewrite, again and again, views and deep-rooted traditions that have been accepted in the past; for this reason, such changes are met with resistance even from experts in the field. Human ignorance, personal interest, group interests, and deep-seated prejudices may create great resistance to advancement in scientific areas, such as mathematics, even though math is incomparably more exact than medicine. Just think of János Bolyai and non-Euclidean geometry!
With his simple, but eye-opening scientific discovery, Semmelweis managed to overcome disease, but failed to convince his contemporaries. So much so, that perhaps the most notable medical figures of the era, and one of the founders of surgical asepsis, Joseph Lister, was seen, almost 40 years after the declaration of Semmelweis’s doctrines in 1885, as having “barely left his car, carried out surgeries with abundant use of carbolic acid without having washed his hands prior to, or during the surgery.”
‘Ignaz Semmelweis washing his hands in chlorinated lime water before operating’ (Image via NPR – Bettmann/Corbis)
Semmelweis devoted his life to understanding and preventing puerperal fever, because it was painful for him to experience it every day, and from the statistics he clearly saw that the life expectancy of parents in the hospital and in the hands of doctors was far worse than that of home births. In a cruel twist of fate though, while he was searching for the cause of the illness, he likely caused more mothers-to-be to die than his colleagues. He had to deal with many attacks during his life, as well as both purposeful and accidental misunderstandings of his work. Many, many years later, in the modern day, people around the world are turning more and more to Semmelweis: books, plays, and movies have been made about him, some more truthful than others. We, as the future generation, owe so much to his work and struggle. That is why it is our responsibility to proudly proclaim his truth with a clear heart and honest recognition, as we continue to commit to the struggle of taking more precautions and creating an environment where going to the hospital will not leave you in a worse state than staying at home.
Studies and Life Purpose
Ignaz Philipp Semmelweis was born on July 1, 1818 in Buda, in the royal free city, near the busy base of the only bridge on the Danube, as the fifth child of a German-born bourgeois family. Interestingly, it is quite telling of the type of life in Buda at that time that, of the 10 children in the family, 7 had different surnames appear on their birth certificates. Ignatius was registered as Semelvais. The names of the brothers were variously written as: Zemelveiss, Zemelveisz, Szemelveis, Szemelveisz, Semelveis, and Semelvaisz. The “w” and double “m” are not present in any iteration.
Ignaz went to the royal Catholic high school, where he was a distinguished student. He was proficient in his Hungarian language studies. He was nice, talented and a good athlete, having once swam across the Danube, and was a great dancer as well. At his father’s wish, he began his studies at the law school in Vienna in 1837. After completing his first year, however, he transferred into the faculty of medicine. We are not sure as to why he did, but perhaps the Hungarian medical student community in Vienna had a role in his decision, or perhaps it was his love for people. In any case, in 1844 he officially became a physician.
Originally, he wanted to be an internist, but he could only find a job at the obstetrics ward. From 1844 he was an “aspirans externista”, and later accepted a post as an assistant teacher. Following his 28th birthday, he was appointed as a regular assistant lecturer at the Department of Obstetrics at the University of Vienna. In 1844, he obtained his obstetrician qualification, and in 1845 he obtained a degree in surgery. Excluding a six month hiatus (from 1846 to 1847) he worked until 1849 in one of the world’s largest birthing wards. He taught, healed and worked in administration. He was an extremely diligent and conscientious physician. Describing his time in Vienna, Semmelweis wrote
“From the day that I decided to dedicate my life to childbirth, from 1844 until I moved to Pest, in 1850, before the teacher’s morning visit, I checked every female corpse for my gynecological training, daily, in the hospital’s dissection room. Thanks to the goodness of professor Rokitansky, who blessed me with his friendship, for which I cannot even express my gratitude, I had permission to access all the female corpses, if they were not already predetermined for a purpose, so that I could dissect them, to gain experience in my examinations and to inspect my findings.”
Within his first few days of working at the ward, he had been shocked to find that there were months where nearly every third mother was lost to puerperal fever after giving birth.
Background Information: Description and Causes of Puerperal Fever (“Childbed Fever”)
This dangerous, fever-inducing, but rare, birth-related illness has long been known. Hippocrates, Galen, Avicenna, and many others had mentioned the illness in their writings. It was thought that the inhibition of the newborn cleansing process, the retention of “lochia” (febris lochialis—the discharge from the uterus after birth), starting to rot in the uterus poisoned the body. It made its appearance in the 17th century, and the 18th, appearing in home births. However, with the spread of post-mortem examinations at medical facilities, it rose to almost-epidemic levels in the 19th century. A lot of speculation was put forth as to the cause of the illness. There was an idea put forth that the disorder of milk distributed through the lower tract during the birth caused peritonitis, or an abdominal infection. The “phlogistic” theory found that inflammation and illness of abdominal organs were the cause. It was assumed that inflammation of the uterus or intestines was caused by “impurity” of the hospital “miasma” remaining in them. In England, the “contagionist” theory proposed that the disease could be passed on and contracted. It was thought that the illness was airborne, and as a defense hospital rooms were often aired out and ventilated, and disinfection of the rooms was ordered, carried out with calcium hypochlorite. There were some who considered typhoid disease (“Puerperal Typhus”) as the root cause of Childbed Fever. In 1843 Boston physician Oliver Wendell Holmes Sr., an anatomy specialist at Harvard University (and father of the future US Supreme Court Justice of the same name) had already proposed rigorous preventive measures. Amongst other measures, if a physician was present at
“the autopsy of a baby with puerperal fever, he would have to take a full bath, change all his clothes, and stay away from the maternity ward for 24 hours, in fact, even more. It is advisable to extend this precaution to cases of simple peritonitis as well.“
Nevertheless, in the continent’s maternity wards, the currently birthing mother, the feverish, and the healthy pregnant women were all together in one room, next to each other. At that time, the bed linens weren’t changed regularly when new patients were admitted, and the effectiveness of the washing, and its cleanliness, was often suspect.
By Dr. László Rosivall
Translated by Gergely Edward Nagy and Tom Szigeti
Images via NPR and nephrologia.hu
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