In a modern hospital, great care is taken to sterilize medical instruments and not to transfer infections between surgical patients. At one time, however, such antiseptic measures were not simply unknown to doctors, but actively fought against. The story of the man who tried to implement life-saving cleansing procedures at hospitals – encountering insurmountable resistance from the physicians at these establishments – is a fascinating tale of rejection of evidence in favor of rank dogmatism.
Ignaz Semmelweis was a Hungarian-born physician born in 1818. He studied medicine at the University of Vienna, specialized in obstetrics, and found his first job in the First Obstetrical Clinic of the Vienna General Hospital.
Now, in an 19th-century European hospital, giving birth was a dangerous affair. The chance of dying of the disease known as puerperal fever, an infection of the reproductive trat after childbirth, was very high. In fact, the average mortality rate of mothers at the First Clinic was 10%, with almost all of those deaths from puerperal fever. Women often preferred to give birth while being driven (by horse-drawn carriage) to the hospital rather than give birth within, and these so-called “street births” resulted in fewer cases of puerperal fever than births in the hospital.
Besides the First Obstetrical Clinic, Vienna General Hospital also had a Second Clinic that had a much lower death rate than the first one. Only about 4% of women giving birth in the Second Clinic died from puerperal fever, and Semmelweis wanted to know both why a difference in death rates existed between the two clinics and why women giving birth in the streets might have lower death rates from puerperal fever than those in the hospital.
At the time Semmelweis was working at the hospital, germ theory was only just beginning to get a foothold in the general body of scientific knowledge. Physicians had little idea that tiny organisms that they could not see could wreak havoc on a person’s body. The beliefs that foul odors or evil spirits caused disease were still widespread. Thus, explaining the difference in death rates between the two clinics was not as easy as it would be for an individual who knows about the existence of germs.
Semmelweis got one major clue about the cause of puerperal fever when he observed a colleague die of sepsis after accidentally stabbing himself with a scalpel he was using to examine a cadaver. Semmelweis noted that the symptoms this unfortunate man experienced were similar to those of the women in the clinic dying of puerperal fever.
He then noted that in the First Clinic, the medical students who attended to the women had often been engaging in cadaver dissections not long before going to work in the Obstetrical department. On the other hand, the Second Clinic only trained midwives who were not also working with dead bodies, and were thus not exposed to potential corpse contaminants.
Semmelweis’ proposed theory for the difference in death rates between the clinics was that the physicians from the First Clinic had “cadaverous particles” on their hands that infected the women, whereas the midwives in the Second Clinic did not.
To get rid of these “cadaverous particles,” Semmelweis instituted a policy of hand-washing using a solution of calcium hypochlorite, chosen for its ability to eradicate the stench of infected cadaver tissues.
As a result of making the physicians was their hands before working with women giving birth, death rates in the First Clinic declined by 90%. In fact, there were 0 deaths for two separate months in the year after Semmelweis implemented the practice.
One would think that for enacting a simple policy that saved numerous lives, Semmelweis would have been hailed as a hero, but in case you haven’t noticed, the world that we live in makes no sense. The doctors with which he worked at the Vienna General hospital strongly disliked being told to wash their hands. They believed that they were far too noble to spread deadly contaminants to their patients. Some of them wore the filthy clothes stained with the blood from their patients as a source of status and pride.
Although Semmelweis imagined that his practices would be adopted across all of Europe, he was instead derided and mocked in the medical community. A major attack of his opponents was that he had no scientific explanation for why hand-washing would reduce incidence of puerperal fever, an explanation that would have been impossible without an understanding of germ theory,
Semmelweis grew more and more distraught as he argued for his hand-washing policy for many difficult years. He sent increasingly angry letters to obstetricians and other members of the medical community, decrying them as murderers for refusing to listen to him. His behavior became more and more erratic, concerning his friends and family members. He grew so desperate and insane that he took to approaching young couples in the street and begging them to have their doctor wash his hands if they planned to have a child.
He was confined to an insane asylum in 1865 at the age of 47, where he was wounded in the struggle to put him in a straight jacket. The wound became gangrenous and he died of blood poisoning 14 days afterwards – a similar affliction that he spent his career to trying to prevent.
In the time immediately following his death, there was barely any acknowledgement from the medical community as to the significance of Semmelweis’ work. After his death a new physician took over for Semmelweis at the First Clinic, and when death rates increased by 6x now that the clinic was free to go back to its old ways, no one said “you know, maybe that guy was right.”
But history, fortunately, has treated Semmelweis more kindly. Two decades later, microbiologist and chemist Louis Pasteur provided the scientific explanation needed to illuminate why hand-washing reduced puerperal fever deaths. Eventually, the idea of medical professionals washing their hands or sterilizing equipment to prevent the transfer of germs became widely accepted.
Today, the Semmelweis Effect refers to the human tendency to reject new knowledge if it goes against established paradigms or beliefs. You can probably think of quite a few modern examples, because humans will be humans, whatever the century.
Green Humanist 