Cleaveland: Pioneering physician a protector of women

From the Chattanooga Times Free Press
By: Clif Cleaveland, MD

Childbirth in early 19th-century Europe often ended tragically for mothers and their babies. Puerperal or "childbed" fever complicated many births in hospitals. Hungarian physician Ignaz Philipp Semmelweis laid the foundation for ending the epidemic. This month marks the bicentennial of his birth on July 1, 1818.

Semmelweis grew up in a German-speaking family in what is now Budapest. In college, he switched from law to medical studies, earning his doctorate from the University of Vienna in 1844. Following training in obstetrics, he accepted an appointment in 1847 as an assistant in the university's maternity hospital, which was the largest in the world.

At that time, midwives delivered most babies at home. Maternity hospitals treated poor women and women facing complicated deliveries.

Maternity services in Vienna's hospital were split between a doctor-run division, which included medical students, and a second, smaller service directed by midwives. High mortality for mother and baby characterized the doctors' service, where up to 20 percent of deliveries resulted in death of newly delivered women. Fever, worsening abdominal pain, copious, cloudy vaginal drainage and kidney failure — the hallmarks of childbed fever — developed in the mother during the first two days of delivery. Death soon followed. Many of the newborn of the affected mothers died. Autopsies showed abscess formation and severe swelling and inflammation of pelvic and abdominal organs.

Care on the midwives' service was generally safe and free of the febrile complication. Maternal mortality seldom exceeded 1 percent.

Dr. Semmelweis studied the two services. He considered and discounted variables such as overcrowding, birth procedures and noise. There was one crucial difference. He observed that physicians and students often came directly from performing autopsies to deliver a child without washing their hands. On the midwife service, attention was paid to cleanliness throughout the delivery. Midwives had no contact with cadavers.

A further clue arose when one of the doctor's colleagues died of a rapidly progressive, febrile illness soon after nicking himself during an autopsy of a victim of childbed fever.

Analyzing his evidence, Semmelweis concluded that invisible particles transported from autopsy to delivery room caused the devastating outbreaks of illness on the doctor-run maternity ward. He placed bowls of chlorinated water, similar to very dilute Clorox, at the bedside of each woman in labor and insisted that doctors rinse their hands and instruments in the solution before undertaking a delivery. Mortality on the doctors' service immediately fell by more than 90 percent. During some months, no mother died.

Word of this successful control of childbed fever rapidly spread as it was publicized in letters and lectures. Dr. Semmelweis lectured the Medical Society of Vienna on his findings. English physicians adopted Semmelweis' recommendations more readily than their colleagues on the continent.

Dr. Semmelweis encountered opposition at his hospital. Senior physicians considered childbed fever a natural risk of labor and delivery. Other prominent continental physicians criticized his findings in lectures and letters. Word-of-mouth gradually led to wider adoption of Semmelweis' recommendations.

Semmelweis fiercely defended his work. Because of his outspokenness and his liberal politics, his appointment to the hospital staff was not renewed. He returned to Hungary to accept a job at the University of Pest where he rose to professor of obstetrics in 1855. His sterile procedures were standard for all deliveries. Mortality on the maternity service was negligible.

In 1861, he finally published a book that explained the cause and prevention of childbed fever. Despite lingering opposition to his recommendations, the lives of countless women and their babies would be saved by the sterile procedures he devised.

Because of progressively erratic behavior, Dr. Semmelweis was committed to a mental hospital in 1865. He died soon afterward of a probable bacterial infection.

Experiments by Louis Pasteur in the early 1860s defined the germ theory of disease. Scottish surgeon Joseph Lister applied these findings to sterile surgery. Lister gave credit to Semmelweis for his pioneering work in combating infection in hospital settings.

We now know that childbed fever represented bacterial infection introduced during child delivery by dirty hands and unclean instruments. Ignaz Semmelweis combined observation, analysis and stubborn insistence on sterile techniques to reverse a deadly epidemic. Obstetrical units should celebrate his legacy on this anniversary of his birth.

Clif Cleaveland, M.D., is a retired internist and former president of the American College of Physicians. Email him at