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The Semmelweiss Mystery

Posted Jan 11 2009 3:46pm

1865 was a very bad year for Ignaz Semmelweiss.

He had been hounded out of his position at Vienna General Hospital over the radical notion that doctors were causing deaths by refusing to wash their hands when treating mothers in childbirth. His own guilt over the numerous puerperal fever deaths that he had unintentionally caused himself and his ostracism by the medical community in Vienna led to his moving to Budapest in 1850 and building up a private practice instead. Since his published findings were largely ignored in the medical journals, he decided to write a book to outline his ideas.

The book carefully laid out his case for medical hygiene including the statistics proving that puerperal fever was linked to poor hygiene and refuting all the criticisms that he had faced from the medical community. What he didn't anticipate was the vicious reception of his book, Etiology, Understanding and Prevention of Childbed Fever when it came out in 1861. Most reviewers savaged Semmelweiss and physicians accused him of trying to undermine how they ran their hospitals.

Semmelweiss became increasingly unhinged by the hostile criticism and began suffering extreme mood swings which alarmed his wife and family. He wrote letters to many of his critics accusing them "teachings founded on the dead bodies of women murdered through ignorance". While essentially accurate, his rantings did little to win doctors to his cause. His bizarre behaviour, coupled with alcoholism, absent-mindedness, and emotional outbursts antagonized everyone around him.

In mid-1865, Anna Semmelweiss, afraid that her husband was on the verge of a nervous breakdown, decided to act. She and a friend, Ferdinand von Hebra, told Semmelweiss that they were taking him to a spa in Grafenberg where he could recuperate. When their train reached Vienna, von Hebra offered to show Semmelweiss the hospital where he was working. The hospital actually turned out to be the Lazarettgasse insane asylum where Semmelweiss was overpowered and forcibly committed. The document authorizing his involuntary stay in the asylum had been signed by three physicians (none of whom were psychiatrists). Two weeks later, Ignaz Semmelweiss was dead at the age of 47.

The official cause of Semmelweiss' death was given as infection caused by a wound to his finger. Despite evidence to the contrary (the autopsy and Anna's own report of the condition of her husband's body contradicted the official explanation), there was no investigation. The fact that Semmelweiss had died in an insane asylum seemed disgrace enough (and reinforced the negative opinion of the doctors who had criticized him). The funeral was very small with not even his own family being there (his wife later explained that she was too ill to attend). The sad story of Dr. Ignaz Semmelweiss had seemingly come to an end. The fact that puerperal fever cases at the hospitals where he had worked increased dramatically passed without comment.

Although some doctors were sufficiently impressed by Semmelweiss' work to introduce chlorine washing into their practice, they were in the definite minority. It would take another twenty years before Louis Pasteur proposed a germ theory of disease that provided a theoretical framework for Semmelweiss' claims. Joseph Lister, inspired by Pasteur and Semmelweiss (among others), launched a new era of antiseptic practice that revolutionized medicine. Ignaz Semmelweiss was belatedly recognized as a medical pioneer, except for the troublesome question of what had caused the death of the man of later know as "the saviour of mothers".

There were numerous speculations and lurid theories advanced including the possibility of syphilis or even early-onset Alzheimer's disease. It would not be until 1977 when Hungarian physician Georg Sillo Seidl uncovered documents concerning Ignaz Semmelweiss' hospital stay.

These documents showed that he had been subjected to fairly extreme "treatments" while in the hospital due to his repeated attempts to be released. In addition to being tied in a straitjacket and doused in cold water, he was also confined in a darkened cell and forcibly given laxatives. Based on inconsistencies in the hospital records (which were likely altered after Semmelweiss' death) Sillo Seidl came to the lurid conclusion that Semmelweiss was murdered as part of a conspiracy by his in-laws and several "prominent Hungarian physicians". It would take another twenty years for a more balanced interpretation to be advanced. Available autopsy results showed evidence of severe beatings with injuries to Semmelweiss' arms, hands and chest.The extent of the injuries were consistent with being tied down and stomped as he was being restrained. Basically, Ignaz Semmelweiss died of being left untreated after being beaten by hospital attendants. The reason why this was covered up afterward seems obvious. Semmelweis_stamp_Austria_1965[1]

Today, Ignaz Semmelweiss is remembered as one of Austria's heroes (with his own postage stamp, no less) and a medical pioneer. A large maternity hospital in Vienna is now known as Semmelweiss Klinik and visitors to Budapest can see the statue in his honour as well as his house (now a museum).

Troubling questions still remain concerning the tragic circumstances of his death and why his conclusions had been ignored for so long. As an ethnic Hungarian, Ignaz Semmelweiss' status as an outsider seemed to undermine his credibility and, despite the clear evidence that he compiled, doctors refused to accept that they were killing their own patients. That Semmelweiss didn't live to see himself vindicated seems tragic enough but the fact that the widespread rejection of his findings led to the unnecessary deaths of countless mothers is probably the greatest tragedy of all.

To recognize the importance of the Semmelweiss case, the Semmelweiss Society was founded in the 1980s. Its public mandate focuses on exposing "the sham peer review of medical professionals, nurses, and physicians when they are wrongfully accused of acts that could result in the loss of their clinical privileges". The Society also investigates incidents of medical malpractice and harassment of "whistle-blowers" who expose malpractice incidents.

It's a fitting legacy (even if some doctors are still not washing their hands.)

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