What about Semmelweis and medicine’s shameful handwashing history?

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Another one: The fact that cleaning your hands would prevent the spread of disease was ignored and ridiculed for about 50 years…

Jan-Kristian Markiewicz / Originally posted on The Tomato Effect

Answer:

Oh that’s a great Tomato Effect example! Everyone should know about Ignaz Phillip Semmelweis. Quoting from the Proceedings of the Royal Society of Medicine:

“Many men have been endowed with clear intellects and hearts full of love for their fellow men, with the enthusiasm of humanity, and they have been enabled to achieve some signal service for the human race in their day and generation; but in the whole history of medicine there is only one Semmelweis in the magnitude of his services to Mankind, and in the depths of his sufferings from contemporary jealous stupidity and ingratitude.”

Let me set the scene: The year was 1846. The place, Viennese General Hospital, the largest of its kind in the world. Semmelweis gets a job as obstetrical assistant. He notices that three times as many women are dying at the hands of the medical students than at the hands of the midwifery students from puerperal fever, commonly known at the time as, “the black death of the childbed.” Semmelweis describes:

“In the medical school division the mortality from puerperal fever was so terrifying that this division became notorious….There were heart-rending scenes when [pregnant] patients knelt down, wringing their hands, to beg for a transfer [to the midwifery division]….”

Why the discrepancy? The food and ventilation was the same in both divisions. If anything, surgical skill was better in the medical school and overcrowding less. The idea at the time was that the excess mortality was due to the emotional strain of being examined by male students, since the midwives were all female. So the elders of the Medical School met in council and proceeded to exclude the foreign students from the hospital on the ground that they were, “rougher in their examination than the Viennese.” Death rates didn’t change.

Before Lister, before Pasteur, Semmelweis made the connection between the autopsies the medical students were doing and the “examining finger which introduces the cadaveric particles.” In May 1847 he required every medical student to wash his hands with a chlorine solution before making an examination and the death rate plummeted. For the first time in the history of the Vienna Hospital, the mortality rate at the medical school fell below that of the school of midwives.

Knighted, no doubt, for the discovery of the century? Hardly. Historians believe his doctrine was unpalatable to colleagues since it implied that the obstetricians were the cause of death. He shared this knowledge with his superiors. From the Proceedings: “The suggestion was unheard of! Indeed, it was sheer impertinence to suggest that the Accoucheur to the Imperial household should carry contagion upon his hands.” Semmelweis was summarily dismissed.

So he lectured, he wrote papers; he continued to be ridiculed. Doctors regarded antisepsis as a poor joke. His successor in Vienna publicly stated that the doctrine was “discredited and universally rejected.” Semmelweis wrote a book, The Cause, Nature, and Prevention of Puerperal Fever, expecting it to save thousands of lives, but it was ignored.

So he turned from academics to polemics. He started to publish open letters to midwifery professors:

“Your teaching… is based on the dead bodies of… women slaughtered through ignorance. If… you continue to teach your students and midwives that puerperal fever is an ordinary epidemic disease, I proclaim you before God and the world to be an assassin….”

By the summer of 1865 he had taken to the streets of Budapest thrusting circulars into the hands of startled pedestrians:

“The peril of childbed fever menaces your life! Beware of doctors for they will kill you…. Unless everything that touches you is washed with soap and water and then chlorine solution, you will die and your child with you!”

Semmelweis, at the age of 47, the father of three young children, was committed to an insane asylum in Vienna. He attempted to escape, but was forcibly restrained by several guards, secured in a straight jacket, and confined in a darkened cell. The asylum guards beat him severely.

Quoting from the Bulletin of the History of Medicine, “He was not in the asylum for long. Thirteen days after admission he was dead.” From the autopsy report: “It is obvious that these horrible injuries were… the consequences of brutal beating, tying down, trampling underfoot.”

Image Credit: Flickr / USA.gov

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  • http://www.facebook.com/deborah.pageau.1 Deborah Pageau

    Shortly after Semmelweis’s death, Mahatma Gandhi was born who as an adult is quoted as saying “First they ignore you, then they laugh
    at you, then they fight you, then you win.”

  • Twinkle

    THANKS Dr. Greger for publishing that about Semmelweis. I was not aware of his story before you wrote that — and you’re right, EVERYONE ought to be taught about Semmelweis, because his story has so much to teach us about the tyranny of dogma. Semmelweis’ plight says a lot about the dangers of a “mob mentality” and the potential depravity of human nature (in all fields — not just in medicine). We are raised to believe the Pollyanna notions that “Good will always triumph over evil,” “Everything is God’s will,” and “people get what they deserve” (“you reap what you sow”), but Semmeweis’ life is a cautionary tale — more proof that all too often, good people are forced to suffer cruelty and injustice and persecution. (“No good deed goes unpunished.”) Like you said, he should have been knighted for his efforts, but instead he was ridiculed and shunned. I kept waiting for the Hollywood ending, when you would tell us that he was finally vindicated and praised — but instead the father of three was beaten to death. So sad. That could not have been “God’s will” — men were to blame for that. More proof that we cannot just leave it to God or the Cosmos to “right the wrongs” — more proof that we have to make an effort to fight injustice. I wish I could say THANKS to Dr. Semmelweis — but at least I can thank Dr. Greger for shining a light on his story in 2013.

    • Genro

      Perhaps we need look at it from a less Western-centric viewpoint. Semmelweis, Ghandi and the woman who is scrubbing your floors, and you, are merely repeat incarnations, pushing us all to greater enlightenment. There will always be evil. Begin with your own mind….and continue to push towards ‘the light’ ‘the truth’ ‘the ultimate’ and just laugh when you are beaten, betrayed and maligned, for truly in the so-called “real” world of materialism, the poor, beaten, betrayed and maligned are the kings. The poor truly shall inherit the earth.

    • DarylT

      I suspect there was a lot more going on. In that era it was the social order and hierarchy was held to be the highest good, I imagine that anyone that stepped out of line like this was apt to be pushed back into place, and suggesting to others’ they’ve been killing people would not only threaten their own social standing and their pride but also make you a pariah. This is more about powerful cultural forces than dogma.

  • DarylT

    I shall bring this up next time someone is explaining how religion repressed Galileo and the way forward was the new ‘enlightened’ world of science.
    I guess it’s not that simple.