Disinfection of hands with chlorinated lime in a maternity ward
A mandatory washing of hands in a solution of chlorinated lime before examining women in labour: doctors and students came to labouring women from hands that had just been at work in the dissecting room, bringing particles of decaying organic matter.
The measure was introduced in May 1847 by the Hungarian Ignaz Semmelweis, assistant in the First Obstetrical Clinic of the Vienna General Hospital. Mortality in the clinic fell from 18.3 per cent in April 1847 to 2.0 per cent over the period from June 1847 to February 1849.
The measure worked some thirty years before germ theory explained why. To accept it meant giving up the two explanations then prevailing, the miasmatic one and the doctrine of an epidemic constitution; Semmelweis set out his evidence only in 1861, and he was not vindicated in his lifetime. In 1865 he died of sepsis in the Lower Austrian asylum to which he had been committed two weeks earlier.
Why this date
exact: washing of hands in a solution of chlorinated lime was introduced in mid-May 1847 in the First Obstetrical Clinic of the Vienna General Hospital (Stang, Standl, Poole 2022). The evidence was set out in full only in 1861, in the book Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers, thirteen years after the observations. The axis value is 1847, the year of first application, not the year of the book.
What it grew from
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The lying-in hospital: childbirth as an observed, repeated and counted event
prerequisite for · Confidence: high
The lying-in hospital created at once both the object of observation and the means of seeing it: it produced the hospital outbreaks of childbed fever, and it produced the continuous clinic registers and the structure in which two clinics, one for doctors and one for midwives, received comparable streams of women. Without this the comparison of mortality on which Semmelweis's whole conclusion rests would have been physically impossible.
Dispute: What is disputed is not the existence of the link but its sign. In one and the same sentence de Costa writes that lying-in hospitals were «undoubtedly beneficial» to some women in obstructed labour and that it was their crowding and frequent examinations that caused epidemics of sepsis for two centuries. The institution is thus at once the cause of the disease and the cause of the disease becoming visible. A separate reservation about scope: the institutional details (two clinics, allocation by day, delivery in exchange for consent to serve as teaching material) are documented for the Viennese establishment (Loudon, Pawlowsky, Stang), while their extension to the lying-in hospital in general rests on de Costa's general statement.
Link sources
- de Costa C. «Childbed fever: A major cause of maternal mortality», O&G Magazine 11(1) (RANZCOG) (2009) Verified 20 Sep 2026, quotation assembled from fragments
These institutions were undoubtedly beneficial to some women in obstructed labour or with malpresentations ... However, overcrowding in dirty wards, as well as the complete lack of knowledge of the existence of bacteria and the need for antisepsis, meant that frequent vaginal examinations in labour and the use of unsterile instruments caused epidemics of puerperal sepsis throughout the ensuing two centuries.
- Loudon I. «Ignaz Phillip Semmelweis' studies of death in childbirth», Journal of the Royal Society of Medicine 106(11), 461-463 (2013), 461 Verified 20 Sep 2026
Doctors and medical students were taught in the first clinic, midwives in the second, and patients were allocated to the clinics on alternate days.
- Loudon I. «Ignaz Phillip Semmelweis' studies of death in childbirth», Journal of the Royal Society of Medicine 106(11), 461-463 (2013), 461 Verified 20 Sep 2026
The large numbers of deliveries (from 1840 through 1846 there were 42,795 births and 2977 maternal deaths in the two clinics) meant that chance could confidently be excluded.
- Pawlowsky V. «Secretly Pregnant», 650 plus (2024) Verified 20 Sep 2026
All others had to be available for medical instruction in return for the admission of their children to the Foundling Hospital.
- Stang A., Standl F., Poole C. «A twenty-first century perspective on concepts of modern epidemiology in Ignaz Philipp Semmelweis' work on puerperal sepsis», European Journal of Epidemiology (2022) Verified 20 Sep 2026
Beginning in 1840, medical students and junior physicians were educated in Clinic 1, midwives in Clinic 2.
"Verified" means that on that day the quotation was found at the address given, word for word. No date means we have not been able to open the source yet, not that the quotation is wrong. "Assembled from fragments" means the words do not stand together on the page: we found each fragment separately and joined them with an ellipsis.
- de Costa C. «Childbed fever: A major cause of maternal mortality», O&G Magazine 11(1) (RANZCOG) (2009) Verified 20 Sep 2026, quotation assembled from fragments
Other links
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"Airs, Waters, Places": disease from air, waters and locality
refuted by · Confidence: high
Semmelweis explained childbed fever not by corrupted air but by particles of decaying organic matter carried on the hands from the dissecting room, so that to accept his conclusion meant giving up the miasmatic explanation and the doctrine of an epidemic constitution; Viennese and German physicians preferred to keep the older explanations.
Dispute: Historians dispute not the clash with the miasmatic explanation itself but the reasons why contemporaries did not give way. Schreiner (2020) names both versions at once: on one side attachment to the older theories and Semmelweis's place in the Viennese hierarchy, on the other his own manner of arguing, to the point of calling colleagues murderers. Tulodziecki (2013) goes further and holds that the resistance had rational grounds and that Semmelweis's own reasoning was weaker than is usually assumed.
Link sources
- Stang A., Standl F., Poole C. «A twenty-first century perspective on concepts of modern epidemiology in Ignaz Philipp Semmelweis' work on puerperal sepsis», European Journal of Epidemiology (2022) Verified 20 Sep 2026
Acceptance of Semmelweis' discovery therefore meant that the two prevailing theories of the etiology of PS, miasmatic theory (“a bad component in the air”) and atmospheric-cosmic-telluric conditions (Galenic hypothesis), had to be denied
- Schreiner S. «Ignaz Semmelweis: a victim of harassment?», Wiener Medizinische Wochenschrift 170, 293-302 (2020), 302 Verified 20 Sep 2026
they preferred the old-fashioned genius epidemicus, atmospheric influence, climate theories, and the miasma
- Tulodziecki D. «Shattering the Myth of Semmelweis», Philosophy of Science 80(5), 1065-1075 (2013) Verified 20 Sep 2026
This widespread agreement has also given rise to a puzzle: why Semmelweis's views were rejected for so long. I aim to dissolve both this puzzle and the standard view of Semmelweis by showing that, contrary to prevailing opinion, Semmelweis was not the excellent reasoner he has been assumed to be.
"Verified" means that on that day the quotation was found at the address given, word for word. No date means we have not been able to open the source yet, not that the quotation is wrong.
Further reading
Not evidence: these carry no quotation and support nothing we wrote. They are books and scans to read next.
- Stang A., Standl F., Poole C. «A twenty-first century perspective on concepts of modern epidemiology in Ignaz Philipp Semmelweis' work on puerperal sepsis», European Journal of Epidemiology (2022) Verified 20 Sep 2026
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Holmes: «The Contagiousness of Puerperal Fever», a compilation of cases against the profession
parallel to · Confidence: medium
Holmes and Semmelweis arrived at the same conclusion about the carrier independently of one another, neither aware of the other's work, and both were rejected by their profession.
Dispute: Mutual ignorance is asserted by a single source found, Caroline de Costa. No second historian asserting it directly could be found, and the paper by Lane, Blum and Fee (American Journal of Public Health 100(6), 2010, pp. 1008-1009), devoted precisely to the pair Holmes and Semmelweis, proved inaccessible, so its position is not taken into account here. Separately: the question of Semmelweis's later acquaintance with the English literature is not settled by this quotation, which concerns only the moment of discovery.
Link sources
- de Costa C. «Childbed fever: A major cause of maternal mortality», O&G Magazine 11(1) (RANZCOG) (2009) Verified 20 Sep 2026
The two men worked independently, neither aware of the other's findings.
- Shaikh S. «"The Contagiousness of Puerperal Fever" (1843), by Oliver Wendell Holmes», Embryo Project Encyclopedia, Arizona State University (2017) Verified 5 Oct 2026
Obstetricians, including Charles D. Meigs, a physician of obstetrics and professor at Jefferson Medical College in Philadelphia, Pennsylvania, contended that Holmes's argument was flawed and referred to him as a sophomoric writer.
"Verified" means that on that day the quotation was found at the address given, word for word. No date means we have not been able to open the source yet, not that the quotation is wrong.
- de Costa C. «Childbed fever: A major cause of maternal mortality», O&G Magazine 11(1) (RANZCOG) (2009) Verified 20 Sep 2026
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Lister: the antiseptic principle in surgery (as an outgrowth of the refutation of spontaneous generation)
parallel to · Confidence: medium
Washing the hands in chlorinated lime and Lister's antisepsis solved the same problem, the chemical destruction of the carrier of infection, but on the available evidence they did so independently: Lister derived his method from Pasteur's work on fermentation and became acquainted with the Viennese physician's teaching and practice only in his later years.
Dispute: All the evidence cited comes from a single article by Kadar (2024), including the quotations from the Wangensteens, Lister and Simpson. Whether Lister knew of the Viennese work when he introduced antisepsis remains disputed. In favour of independence is the judgement of the Wangensteens, quoted by Kadar (2024): Lister became acquainted with Semmelweis's teaching and practice only in his later years, having neglected them at the outset of his own work, and Lister's own account derives the method from Pasteur. Against it is the fact that Semmelweis's results were printed in English as early as 1850 by James Simpson in Edinburgh, and so were available to a British surgeon. No statement by Lister himself about when exactly he learned of Semmelweis is quoted by the historians.
Link sources
- Kadar N. «Semmelweis and Lister: Restoring Balance to Their Historiographies», Clinics of Surgery 11 (2024) Verified 25 Sep 2026
Lister gained an acquaintance with the teachings and practices of Semmelweis that he had neglected at the inception of his own life's mission.
- Kadar N. (2024) Verified 25 Sep 2026
How different Lister's antiseptic wound practices might have been had he become fully alert at the outset of his important work to the significance of Semmelweis's ideas of the prevention of wound infection.
- Kadar N. (2024) Verified 25 Sep 2026, quotation assembled from fragments
when it had been shown by the researches of Pasteur that the septic property of the atmosphere depended, not on the oxygen or any gaseous constituent, but on minute organisms suspended in it...it occurred to me that decomposition in the injured part might be avoided without excluding the air, by applying as a dressing some material capable of destroying the life of the floating particles.
- Kadar N. (2024), 3 Verified 25 Sep 2026
The mortality altered and diminished immensely and immediately from the time (May 1847) that the assistant-physician, Dr. Semmelweiss (sic), prevented students from touching parts of the autopsies, and directed all of them to wash their hands in a solution of chorine before and after every vaginal examination.
"Verified" means that on that day the quotation was found at the address given, word for word. No date means we have not been able to open the source yet, not that the quotation is wrong. "Assembled from fragments" means the words do not stand together on the page: we found each fragment separately and joined them with an ellipsis.
- Kadar N. «Semmelweis and Lister: Restoring Balance to Their Historiographies», Clinics of Surgery 11 (2024) Verified 25 Sep 2026
Node sources
- Stang A., Standl F., Poole C. «A twenty-first century perspective on concepts of modern epidemiology in Ignaz Philipp Semmelweis' work on puerperal sepsis», European Journal of Epidemiology (2022) Verified 20 Sep 2026
After introduction of chlorine washing (mid May 1847), the PSMR during the period June 1847 through February 1849 in Clinic 1 was 2.0% (122/6,189)
- Stang A., Standl F., Poole C. (2022) Verified 20 Sep 2026
the two prevailing theories of the etiology of PS, miasmatic theory (“a bad component in the air”) and atmospheric-cosmic-telluric conditions (Galenic hypothesis), had to be denied without the introduction of a new pathology-based theory
- Semmelweis I. «Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers», Pest, Wien, Leipzig: C.A. Hartleben (1861) Verified 20 Sep 2026
Die Aetiologie, der Begriff und die Prophylaxis des Kindebettfiebers. Pest, Vienna, Leipzig: C.A. Hartleben; 1861
- Schreiner S. «Ignaz Semmelweis: a victim of harassment?», Wiener Medizinische Wochenschrift 170, 293-302 (2020), 293 Verified 20 Sep 2026
Badly abused, he died from sepsis caused by open wounds and a dirty straightjacket 2 weeks later
- «Ignaz Semmelweis», Science History Institute (2023) Verified 20 Sep 2026
was committed to a mental institution in Oberdöbling, outside Vienna, where he died in 1865
"Verified" means that on that day the quotation was found at the address given, word for word. No date means we have not been able to open the source yet, not that the quotation is wrong.
Further reading
Not evidence: these carry no quotation and support nothing we wrote. They are books and scans to read next.