Semmelweis and Handwashing (1847): Fighting Childbed Fever

Semmelweis and handwashing refers to the reform introduced in May 1847 by the Hungarian doctor Ignaz Semmelweis in the First Obstetrical Clinic of the Vienna General Hospital. By requiring doctors and medical students to wash their hands in a chlorinated lime solution before examining women in labour, he cut deaths from childbed fever dramatically. Although his results were striking, his explanation was rejected by much of the medical establishment, and he died in 1865 before germ theory vindicated him.

Background: two clinics, two death rates

Ignaz Philipp Semmelweis was born in 1818 in Buda, then part of the Kingdom of Hungary within the Habsburg monarchy. After studying medicine in Vienna, he became an assistant in the First Obstetrical Clinic of the Vienna General Hospital in July 1846.

The hospital’s maternity service had two clinics, which admitted women on alternate days. The First Clinic was used to teach medical students; the Second taught midwives. Year after year, far more women died of childbed fever in the First Clinic. Women knew this, and some begged not to be admitted to it. Semmelweis also noticed that women who gave birth on the way to the hospital, in so-called street births, rarely developed the fever.

Childbed fever, or puerperal fever, is an infection after childbirth. Semmelweis compared the clinics systematically. They used similar methods and served women from the same social backgrounds, so overcrowding, diet or religion could not explain the difference. He also noted, from hospital records, that deaths in the clinic had risen after the 1820s, when teaching based on pathological anatomy and routine autopsies became central to Viennese medicine.

Doctors at the time attributed it to many possible causes, including atmospheric influences, overcrowding, emotional shock and “miasma”, or bad air.

The death of Kolletschka

In March 1847 Semmelweis’s colleague Jakob Kolletschka, a professor of forensic medicine, was accidentally cut by a student’s scalpel during an autopsy and died soon afterwards. His illness resembled the fever that killed mothers in the clinic.

Semmelweis reasoned that “cadaverous particles” from corpses had entered Kolletschka’s blood. The doctors and students of the First Clinic regularly went straight from dissecting bodies to examining women in labour, while midwives did not perform autopsies. He concluded that the particles were carried on their hands, which still smelled of the dissecting room after washing with ordinary soap.

The handwashing order of May 1847

From mid-May 1847 Semmelweis required everyone examining patients in the First Clinic to wash their hands in a solution of chlorinated lime (calcium hypochlorite), chosen because it removed the smell of decay. Later the rule was extended to instruments.

The results were immediate. In April 1847 the clinic’s monthly mortality had been around 18 per cent. In the following months it fell to about 1 to 2 per cent, and in March and August 1848 no mother died at all. Later he extended his theory to include decaying matter from living patients, after a cluster of deaths followed examination of a woman with an infected cancer.

By the numbers

Rejection

Semmelweis’s chief, Professor Johann Klein, was hostile to the idea, and Semmelweis’s appointment was not renewed in 1849. Supporters such as the dermatologist Ferdinand von Hebra and the physician Josef Škoda publicised the findings, and Semmelweis lectured to the Vienna Medical Society in 1850. Yet many leading obstetricians in Europe rejected his explanation. Critics pointed out that childbed fever also broke out in hospitals and homes where no autopsies were performed, and many continued to blame the atmosphere or a combination of local conditions. After Semmelweis left, handwashing in the First Clinic was not consistently enforced, and mortality there rose again in the following years.

There were several reasons. His theory blamed doctors for their patients’ deaths. It conflicted with the dominant view that the fever had many causes. Semmelweis was slow to publish, and his eventual book was long and polemical. Political tensions after the revolutions of 1848, in which Semmelweis’s sympathies were seen as liberal and Hungarian, may also have harmed his career in Vienna.

Later life in Pest

In 1850 Semmelweis left Vienna abruptly for Pest. From 1851 he ran the obstetric department of St Rochus Hospital, where his methods kept mortality below 1 per cent, and in 1855 he became professor of obstetrics at the University of Pest.

In 1861 he published his book on the cause and prevention of childbed fever, followed by angry open letters to critics, calling some of them murderers. His behaviour became increasingly erratic. In July 1865 he was taken to an asylum near Vienna, where he died on 13 August 1865, probably of an infection from wounds received there.

Key people

• Ignaz Semmelweis (1818–1865): assistant in the First Clinic who introduced chlorinated lime handwashing.
• Jakob Kolletschka (1803–1847): professor of forensic medicine whose death after an autopsy wound prompted Semmelweis’s theory.
• Johann Klein (1788–1856): head of the First Clinic, who opposed Semmelweis and did not renew his post.
• Ferdinand von Hebra (1816–1880) and Josef Škoda (1805–1881): Viennese physicians who publicised and defended his findings.

Myths and facts

• Myth: Semmelweis discovered germs. He did not identify any microorganism; his “cadaverous particles” were an unspecified material.
• Myth: He was the first to suspect doctors spread the disease. Alexander Gordon of Aberdeen in 1795 and Oliver Wendell Holmes in Boston in 1843 had argued that childbed fever was carried by attendants.
• Myth: Everyone ignored him. Several prominent Viennese doctors supported him, and some hospitals adopted similar measures, though acceptance remained limited.

Timeline

• 1818, 1 July: Semmelweis is born in Buda.
• 1846, July: He becomes assistant in the First Obstetrical Clinic in Vienna.
• 1847, March: Jakob Kolletschka dies after an autopsy wound.
• 1847, May: Chlorinated lime handwashing is introduced.
• 1849, March: Semmelweis’s assistantship ends.
• 1850: He lectures to the Vienna Medical Society and moves to Pest.
• 1861: He publishes his book on childbed fever.
• 1865, 13 August: Semmelweis dies in an asylum near Vienna.

Later vindication

Semmelweis’s conclusions were confirmed only after his death, as germ theory developed. In 1867 Joseph Lister published his method of antiseptic surgery using carbolic acid. In 1879 Louis Pasteur told the French Academy of Medicine that he had found a chain-shaped microbe, now known as streptococcus, in women suffering from puerperal fever. Hospitals gradually adopted antiseptic, then aseptic, routines in obstetrics, and deaths from childbed fever fell. Antibiotics in the twentieth century reduced them further.

Why it matters

Semmelweis showed with careful statistics that a simple act of hygiene could save many lives, decades before Pasteur and Koch established germ theory and Joseph Lister introduced antiseptic surgery. He is now regarded as a pioneer of infection control, and hand hygiene remains one of the most effective ways of preventing infections in hospitals.

His legacy is widely honoured, especially in Hungary. The medical university in Budapest has borne his name since 1969, and the house in Buda where he was born is now a museum of medical history. Modern public-health campaigns, such as the World Health Organization’s “Clean Care is Safer Care” initiative launched in 2005, continue the lesson he drew from the clinics of Vienna.