Of all the lessons that life hands us, one of the toughest is that you can be right about something but still come up holding the smelly end of the stick. Typically this is learned early in life, but far too many of us avoid this harsh truth well into adulthood. And in those cases where being right is literally a matter of life or death, it’s even more difficult to learn that lesson.
For Ignaz Semmelweis, a Hungarian physician-scientist in the mid-19th century, failure to learn that being right is attended by certain responsibilities had a very high cost. Ironically it would also save the lives of countless women with a revolutionary discovery that seems so simple today as to be self-obvious: that a doctor should wash his hands before seeing patients.
Anything But First Clinic
When Semmelweis was born in the Hungarian city of Buda in 1818, medicine was only just emerging from the accumulated misconceptions and malpractices of the Renaissance period and the Dark Ages before that. Bloodletting, although falling out of favor as the physician’s therapy of choice, was still practiced, despite the fact that the “four humours” that the procedure sought to balance had largely been abandoned as an explanation for health and disease in favor of “miasmas,” or bad air. Physicians were finally beginning to apply Enlightenment-age advances and scientific methods to the problem of diagnosing and treating disease – but only just barely.
Semmelweis, the son of a wealthy merchant, took a circuitous route to medicine through the study of law, but by 1846 he had won an appointment to the obstetrics ward of Vienna General Hospital. It was a less than prestigious posting, and not his first choice, but Semmelweis threw himself into the routine of a busy physician in an institution set up specifically to serve the impoverished classes of Viennese society, for whom infanticide seemed a reasonable method of birth control.
To stem this practice, the hospital offered free care to pregnant women, with the predictable effect of overwhelming the physicians of the obstetrics clinic. To deal with the overflow, a second obstetrics clinic was established, staffed entirely by midwives. The two clinics quickly developed opposite reputations among the people of Vienna. While Second Clinic was seen to be as safe as any place dealing with childbirth in the 19th century could be, First Clinic was widely known to be a death sentence: women who delivered there were as likely as not to die there.
As a staff member of First Clinic, Semmelweis was painfully aware of this reputation, and undertook a study of the problem. He found that while the statistics were not quite as bad as the word on the street had it, they were still appalling: fully 13% of women who delivered in the First Clinic died as a result of postpartum infection, whereas the Second Clinic rate for the same complication was a mere 2%. This seemed to fly in the face of the facts; after all, First Clinic was staffed by physicians, far more learned and skilled than the mere midwives of Second Clinic. Surely that fact alone should have skewed the results in the other direction. What could be happening?
Funeral for a Friend
Desperate for an explanation, Semmelweis began an exhaustive investigation of both clinics. He performed autopsies on women who had died from so-called “childbed fever” or “puerperal fever” in an attempt to understand what killed them. He noted that women who gave birth outside the hospital but were later admitted did not suffer the same disparity in infection rates, a finding that suggested that the actual process of giving birth was exposing First Clinic patients to puerperal fever.
Thinking that the methods used might be to blame, he ordered the two clinics to switch procedures. This did nothing to the mortality rate and served only to annoy the hospital staff and to earn Semmelweis a demotion. It would not be the first time his arrogance would put him at odds with the Vienna medical establishment, and it certainly wouldn’t be the last.
Semmelweis’ breakthrough came through a seemingly random tragedy. His friend Jakob Kolletschka, a professor of forensic medicine, had been leading a student through an autopsy in the bare-handed fashion that was standard practice at the time. The student accidentally jabbed Kolletschka’s finger with a scalpel, and within days the doctor was dead. Semmelweis reviewed his friend’s autopsy records and discovered that he had suffered from exactly the same symptoms of the women who had died from puerperal fever. Could the cadaver Kolletschka was dissecting have been the source of the infections?
In a flash, Semmelweis could see the answer. Only doctors performed autopsies, and generally did them in the morning before seeing patients in First Clinic. It seemed likely that the physicians themselves were transmitting a causative agent between the autopsy suite and the birthing rooms of First Clinic. And it seemed like they were doing so with their bloody bare hands.
In a repeat of the move that led to his demotion, Semmelweis ruled that all First Clinic physicians must wash their hands with chlorinated lime or calcium hypochlorite, similar to common household bleach, to rid themselves of “cadaverous particles.” His First Clinic colleagues chafed at the idea — literally, as bleach is quite irritating to the skin. But they also grumbled that it was unthinkable that saintly physicians could be carriers of contagion, a theory for which Semmelweis had offered no evidence. And to make matters worse, he curried further disfavor by actively enforcing his new rule, monitoring their hygiene and calling out scofflaws.
No Good Deed Goes Unpunished
Despite the unpopularity of his new rules, the statistics were clear: as soon as hand washing was instituted, First Clinic’s mortality rate plummeted 90%. Within a few months, mortality from puerperal fever had dropped to zero. Semmelweis had been proven right, and he was saving lives.
Sadly, it was not to last. He had never been able to explain exactly how hand washing worked. It would be a few years before Pasteur formulated the Germ Theory of Disease, and so Semmelweis lacked the framework to explain his breakthrough. He just knew that it worked, and his stubborn insistence that physicians unquestioningly follow his rules grated on the establishment enough to earn him a dismissal from his post. He returned to Hungary and eventually became head of obstetrics at the hospital in Pest, where his hygiene rules drastically reduced the mortality from puerperal fever yet again. Meanwhile, back in Vienna, business returned to usual at First Clinic, and mortality skyrocketed.
For reasons unknown, Semmelweis had always refused to publish his results or even to deliver public lectures. He was eventually convinced to write a book, The Etiology, Concept, and Prophylaxis of Childbed Fever. It was part rambling history of his findings and part instruction manual for hospital hygiene, but most disturbingly, the second half was a vicious screed against those who had doubted him and his results. He went so far as to call out all those who failed to heed his rules murderers.
His book failed commercially, and he grew increasingly unstable, to the point of random crying jags in public and accosting young couples in the street to beg them to make sure their doctor washed his hands if they ever had a child. In 1865, his wife and family, concerned for his mental health, convinced him to take a holiday in Austria. When they arrived in Vienna, his wife suggested they visit an old friend at his hospital. But instead of a friendly face, Semmelweis was greeted by burly orderlies bearing a straitjacket. He had been duped into being committed to an insane asylum. Within a few days, he would be dead, possibly from injuries sustained during an escape attempt, possibly by a brutal beating at the hands of guards. In either case, he died an ironic death; his autopsy revealed death by septicemia, essentially the same disease he had spared countless women with his hand washing procedure.
Semmelweis died without ever learning of Germ Theory, which would have explained that bacteria were the mysterious “cadaverous particles” being transmitted to First Clinic patients on the filthy hands of their doctors. He died thinking that his labors had been wasted and his procedure would never be accepted by the establishment. He was at least partially to blame for this through his brusque manner, arrogant insistence that everyone obey his rules without explanation, and failure to communicate his results. That does not make his fate any less cruel, but the fact remains that he did save lives using science, and his stubbornness did eventually change medicine for the vastly better.