IGNAZ SEMMELWEIS: THE UNSANITARY AND MURDEROUS DOCTORS WHO REFUSED CHANGE

Photo of Ignaz Semmelweis by Brittanica

It is 1846, A spectre is haunting Europe – the spectre of a disease. All the powers and knowledge of medicine have entered into a rescue alliance to exorcise this spectre: doctors & patients, hospitals and churches, academics & mythical.

But no form of exorcising seems to drive out this disease.  The disease is causing havoc; ravaging and wrecking the lives of women in Europe.  Shortly after giving birth, women would exhibit symptoms consisting of fever, Lower abdominal pain and bad smelling vaginal discharge and within 24 hours this disease would thrush them straight to their graves. Child Birth was a death warrant.

The diseases came to be known as Child-bed fever (Puerperal fever). In medical school students would be told “the causes of this disease is so complex that a human could not understand it, the disease is due to forces of nature too powerful for a human to do anything about it.” Humans were rendered helpless.

Ignaz Semmelweis a doctor at Vienna General Hospital is determined to stop this merciless murderer.

Vienna General Hospital had two sections of maternity – Clinic one operated by Doctors & Clinic Two operated by midwifes. Semmelweis noted that the Doctors Clinic, with competent and qualified professionals had a mortality rate of about 16% and that of the midwife a mortality rate of 2%. This was a big margin of clinics in same locality.

The situation was so bad that pregnant women would beg on their knees to be admitted to the Midwife clinic to avoid being taken to the Doctors clinic. In some cases, pregnant women preferred to give birth in the streets than be admitted in the Doctors clinic.

The doctors blamed the high morality to miasma (bad air). But Semmelweis could not accept this explanation because both clinics were located at the same place and the air was the same.

He decided to investigate the reason for the big margin. He decided to question every theory put forward. Why did the doctors section have more death than the Midwife section?

He observed there was speculation that the ventilation system in both clinics caused the difference in air. On investigation the ventilation was in fact the same.

He observed that the birthing position of women in the midwife section was different from that of the doctors. He introduced the same birthing position to the doctors section. No change.

He observed in the Midwife section there was prayers with a priest every day. He introduced the same in the Doctors section. No change.

He note that every morning a bell would be rung in the midwife section. He introduced the same in the Doctors section. No change.

He observed there was a difference in schedule in both sections. The midwife would operate their sections the whole day while the doctors would carry out autopsies in the morning on dead bodies and in the afternoon they would come to the maternity ward to assist pregnant women in delivery of children.

During this period one doctor pricked his finger with a scalpel while carrying out an autopsy on a cadaver of a woman who had died of child bed fever. The doctor then died a few days later.

When an autopsy was done on the dead doctor body the same observation that was made on women who had died of child bed fever were observed on this dead doctor cadaver.

Graph by Brent Dykes

Semmelweis concluded that there must be a relationship between the death of the doctor, the pricked finger and the infected autopsy. He reasoned that the disease must have been transmitted into his body through the pricked finger. The disease was somehow transmitted by human to human contact. Therefore, to prevent transmission and stop death on women, he instructed doctors to wash their hands after carrying out the autopsy with chlorinated lime before they go to help women in the maternity wards.

When he informed doctors of his findings he was laughed at, dismissed and ignored but he persisted.

His hand washing instruction was finally reluctantly implemented and the mortality rate in the hospital plunged down. In the doctors hospital it went to as low as 1.0% and in the midwife section to almost 0%.

The disease problem solved? Sadly no.

Doctors could not believe how a simple solution, as hand washing could solve a big problem that kills thousands and thousands of women.

More so, by telling doctors to wash their hands, it was implied that he was suggesting that the doctors were murdering their own patients all along; they themselves were the problem, they were the “irresponsible murderous” of their own patients.

In opposition to Semmelweis suggestion of hand washing Doctor Charles Meigs wrote a furious defense to ridicule Semmelweis stating, “Doctors are gentlemen… and a gentleman’s hands are clean.” In short, Dr. Charles would rather see women die, than see men put their pride and ego down.

John Cline, an old doctor, and strong believer in old medicine teaching criticized Semmelweis and considered him to be challenging the established order and said to him, “Keep yourself to what is old, for that is good. If our ancestors have proved it to be good, why should we not do as they did? Mistrust new ideas. I have no need of learned men; I need faithful and obedient subjects. He who would serve me must do what I command.”

Graph by Brent Dykes

Semmelweis ideas of hand washing were totally disregarded even after the evidence of low mortality rate. The doctors returned to their old practices and abandoned hand washing; mortality rates shot up, thousands of women continued to die in the hands of the “clean gentlemen’s hands.”

Semmelweis,  faced with great opposition from fellow doctors maintained his push with the  idea of hand washing and vigorously advocated for hospitals to observe hand washing and educated mothers not to accept to be assisted during delivery by a doctor who had not washed his hands.

Other doctors considered him a threat to the profession, his reputation was soiled, he lost his job and ultimately committed to a mental asylum where it is suspected he was beaten by guards, suffered a wound that would be infected leading to his death.

His funeral was unattended and fellow doctors refused to give him the commemorative service given to all doctors as was the norm at the time.

Years later, long after his death, in the late 1850s Louis Pasteur came up with the Scientific Germ Theory, which proofed the existence of germs with capacity to cause infections and in fact Ignaz Semmelweis was right all along and in deed hands could be sanitized by hand washing. Finally Semmelweis ideas were accepted and the people realized the horrible mistake they had made by rejecting Semmelweis ideas and how more lived would have been saved if they had adopted these ideas earlier on.

Semmelweis was a man ahead of his time. It is impressive of how he could deduce this hand washing idea at a time when infection by germs was unknown and Germ Theory had not been invented. He would be nicknamed as the savior of women and father of infection control.

Ignaz Semmelewis experience is a case study to all who want to establish a new order. Change is never easy.

The people who benefit from the maintenance of status quo will oppose any one who wants to challenge this status. The corrupt will not accept the accountability agenda. The warlords will not accept peace. The unjust will not accept an effective judiciary. The oppressor will not easily let go the oppressed.  But we can always speak the truth, for truth is truth even if only one individual states it and in the fullness of time it shall defend its self like a loose lion.

Truth will always be offensive to the social order.

Ignaz Semmelweis led to the phrase “Semmelweis reflex” to refer to the tendency to reject new ideas and new knowledge because it contradicts established ideas, norms and belief. All truth begins as blasphemies and human nature has always got in the way to resist new ideas and thoughts.

As pioneer of change we should continuously and consciously be aware of this Semmelweis reflex. Questioning the social order and its integrity is not an easy task. People are often indoctrinated with existing and established dominant doctrines and norms.  When exposed to new information and norms, it will often be interpreted based on these established norms which will lead to biased, predetermined and prejudiced conclusions rejecting the new information and ideas.

New wine cannot be placed in old wine skin. Our task is to be mentally ready not only to accept all new wine, but to also question it without bias or fear and use it for the good of all.

And as Barack Obama would put it, “change requires more than just speaking out -- it requires listening, as well.  In particular, it requires listening to those with whom you disagree, and being prepared to compromise… And democracy requires compromise, even when you are 100 percent right.  This is hard to explain sometimes.  You can be completely right, and you still are going to have to engage folks who disagree with you.  If you think that the only way forward is to be as uncompromising as possible, you will feel good about yourself, you will enjoy a certain moral purity, but you’re not going to get what you want.  And if you don’t get what you want long enough, you will eventually think the whole system is rigged.  And that will lead to more cynicism, and less participation, and a downward spiral of more injustice and more anger and more despair.  And that's never been the source of our progress.  That's how we cheat ourselves of progress.”