The Cost of Defending Truth

Few of us would ever question if washing our hands is a good idea. When the government issues recommendations telling us to do it more, we might feel a surge of rebellion, but the science still makes sense. We also understand the concept of sterilization even if not many of us work in an environment where it is critical. It is hard to imagine a time when this wasn't understood, but here is the interesting story of a man who was instrumental in its discovery.

Ignaz Semmelweis was one of the earliest pioneers of antiseptic procedures. He was born July 1, 1818 in what is now Budapest, Hungary, the fifth child of a wealthy grocer. He attended Catholic schools throughout his youth, then enrolled in the University of Vienna at nineteen years old to study law. After one year of law school, he switched to studying medicine for reasons lost to history. He graduated with a doctor’s degree of medicine in 1844. After failing to obtain an appointment for internal medicine, Semmelweis decided to specialize in obstetrics. He received his first appointment on July 1, 1846 at the Allgemeines Krankenhaus (Vienna General Hospital). He was First Assistant (equivalent to Chief Resident in the United States) in the First Obstetrical Clinic under Professor Johann Klein.

At the time, a sickness called childbed fever ran rampant through all maternity clinics in Europe. Mortality rates for women admitted to these clinics often exceeded 10 percent. The Vienna Hospital had two maternity clinics. The First Clinic is where medical students studied, while the Second Clinic was for midwife training only. The First Clinic's mortality rate averaged 10 percent while the Second Clinic's was less than 4 percent. The clinics admitted on alternate days, but women begged to be admitted to the Second Clinic, due to the bad reputation of the First Clinic. Some women even preferred to give birth in the street rather than be admitted to the First Clinic.

Semmelweis took this issue seriously. Of the women begging not to be admitted to the First Clinic, he commented that it “made me so miserable that life seemed worthless.” He noticed that the women who had street births seldom contracted this fever. He analyzed the techniques of the First Clinic compared with the Second Clinic and the only significant difference was the staff. The First Clinic also had an autopsy room where the medical students performed postmortem examinations.

Semmelweis's breakthrough came in 1847 after the death of a good friend who was accidentally cut with a scalpel during a postmortem examination. The friend's autopsy showed he had died from a pathology similar to the one women had been dying from. Semmelweis assumed a connection between the autopsies and childbed fever. Students were performing autopsies, then examining patients with bare hands after washing their hands with only soap and water.

He concocted a chlorinated lime solution with which everyone was required to wash their hands before examining patients. The results were dramatic. In April of 1847 the mortality rate at the First Clinic was 18.3 percent, and by June the rate had dropped to 2.2 percent after hand washing became mandatory in May. Initially, the chlorinated lime was only used between the autopsy room and the labor ward. After the mortality rate spiked in October, it became mandatory between patients as well. In 1848 the yearly rate was only 1.27 percent. In fact, during two months of 1848, no one died from childbed fever in the First Clinic.

One would think that with his amazing results, Semmelweis would have been a celebrity. Unfortunately, this was not the case. The chlorinated lime washing provided impressive results but the germ theory of disease was not accepted at the time so even Semmelweis didn't fully understand why the washing program worked so well. He suspected at first it was some sort of “cadaverous material” from the autopsies that caused the fever. After tracing mortality rate spikes in late 1847, he concluded that any source of “decaying animal organic matter” could cause this fever. This conclusion was contrary to the conventional wisdom that said that childbed fever had numerous causes. One of Semmelweis's contemporaries believed that the fever was caused by uncleanliness of the bowel and extensively used bloodletting as a treatment for it.

Clearly, Semmelweis also did a poor job of properly communicating his findings to the rest of the medical community throughout Europe. The first few papers published in the medical journals on his methods were written by students of his. With a few exceptions, the prominent doctors and professors rejected his conclusions. His results, which lacked scientific explanation, led some doctors to feel their social status as gentlemen was jeopardized by the idea that their hands might be unclean. As time went on and the medical community refused to accept his ideas, Semmelweis became forceful and combative. He published a book in 1861 that got mostly negative reviews, after which he lashed out at his critics in open letters calling them irresponsible murderers and ignoramuses.

Semmelweis's term at the Vienna Hospital expired March 20, 1849 and due to political turmoil between Austria and Hungary, he lost his position to another doctor. He tried getting a teaching position but due to frustrations in dealing with the Viennese medical establishment, he moved to Hungary in October of 1850. In May of 1851 he took over as head physician of a small hospital in Budapest. From 1851–1855 only eight patients out of 933 died from childbed fever under his care. In 1855 Semmelweis was appointed professor of obstetrics at the University of Pest.

The lack of acceptance in the established medical community began affecting Semmelweis adversely by 1861. He had various nervous complaints and severe depression. He turned every conversation to the topic of childbed fever. By the middle of 1865, his public behavior had become exasperating and embarrassing to his associates. By then he was also indulging in alcohol and other vices. On July 30, 1865 a friend lured him into an insane asylum, where a doctor had written a document to have Semmelweis admitted without his knowledge. Realizing what was going to happen, Semmelweis tried to leave but was restrained and severely beaten by several guards. He died two weeks later from a gangrenous wound likely caused by the beating from the guards.

Sometimes we can learn the most from extremes. This account provides two extremes for handling new ideas. On one side are the entrenched experts who control the conversation and decide what is acceptable thought. On the other is a young whipper-snapper convinced that his idea will change the world. From our point of view it would be easy to criticize the medical community for not accepting his breakthrough discovery. When I consider my own tendencies, it is easier to see what happened. Clearly, human nature enjoys pointing out the shortcomings of others but is very resistant to the possibility of personal shortcomings.

Some twenty years or so after the death of Ignaz Semmelweis, the germ theory of disease was developed. At some point the medical community realized that this lunatic doctor actually knew what he was doing. Today, he is considered a hero but at his death few wanted to associate with him.

I find this story both fascinating and sad. Here is a man who made a life changing discovery but died at a young age after losing his mind trying to prove he was right. Also, because of the medical establishment’s arrogance, hundreds and maybe even thousands of women continued to die from an easily preventable cause. It seems so sad.

Obviously, there were some who accepted his ideas because not only had he done well at his last hospital position, he was also then given a teaching position at the university. His students accepted what he taught them. In the end, his obsession with those who disagreed with him cost him his family, his friends, and ultimately his life. If he would have kept his focus on the patients he was saving and the students who were learning his methods this story could have ended so differently.