Ignác Semmelweis was always an outsider. Born in Budapest, Hungary, in
1818, to a grocer, he would always speak German with a Buda-Swabian
accent, reinforcing his role as a Hungarian interloper in Austria. He
transferred to Vienna to complete medical school, and after two years of
wrangling for a residency position, Semmelweis landed in the newfound
department of obstetrics. Biding time, Semmelweis volunteered in the
pathology division of Carl von Rokitansky, focusing on autopsies of
women who had perished of gynecological diseases and operations.
Alongside Morgagni, Louis, and Virchow, Rokitansky was the one of the
major physicians who established Austria and the German nations as the
new leaders of medicine by adopting the anatomic pathological basis of
disease—the recognition that diseases (and the symptoms they generate)
are organ-based. Semmelweis absorbed Rokitansky’s methods of analysis
and observation, and armed with the cognitive tools to untangle the
mysteries of disease, he solved the enigma of puerperal fever, paving the
way for the eventual understanding of germs.
Arriving at the Vienna General Hospital, Semmelweis would have noted
the Wiener Gebärhaus, a maternity wing to accommodate single women
who were discreetly admitted through a dedicated private entrance. The
“Pregnant Gate” was the entrance from the Rotenhausgasse, a narrow
alleyway that today faces Austria’s National Bank. In the 1800s, the
Pregnant Gate was the covert entrance that was accessed by laboring
women, sometimes wearing “a mask or veil, and [were] unrecognizable as
they wanted.”^1 Once admitted, the women were directed to one of two
divisions: the First Division where deliveries were carried out by doctors
and medical students, and the Second Division, where midwives and
students of midwifery performed the duties. Assignment was based upon
the day of the week, which included weekend admissions to the First
Division. With obstetrics gaining a foothold as a separate specialty, a
specialized division to handle the deliveries of Vienna’s unwed mothers
seemed to be a blessing for all parties involved. The newcomer
Semmelweis discovered the horrifying reality that women cared for in the
First Division were dramatically more likely to perish from puerperal
fever than those attended to by midwives in the Second Division.
Puerperal fever would strike in the hours following childbirth, initially
causing painful swelling and redness of the birth canal, followed by
severe, agonizing inflammation of the skin, and eventual systemic