Semmelweis and Sinning Against the Paradigm

Ignaz Philipp Semmelweis (1 July 1818 – 13 August 1865) was a Hungarian-born German physician who noticed that the doctors in the  Vienna General Hospital‘s First Obstetrical Clinic had three times the morality rate for recently delivered mothers compared to the women who gave birth with a midwife in attendance. The women under the doctors’ care were contracting “ childbed fever” (puerperal fever) and dying, but were going home safe and happy with their newborns if the midwives were their obstetrical providers. Why? No one had come up with germ theory yet, so Semmelweis was stymied, until the death of his friend Jakob Kolletschka. Dr. Kolletschka died after an accidental scalpel cut he got during an autopsy became infected. Decomposing bodies were somehow able to make you sick! Semmelweis thought that perhaps, just maybe, it was a bad idea to deliver babies covered in bits of cadaver. Thus, in 1847 Semmelweis told doctors to start washing their hands before delivering babies to see if that worked out better the mothers. You know, like those ignorant know-nothing midwives did? However, mere soap wasn’t properly medical enough, so instead the doctors would use chlorinated lime solutions like the fancy professionals they were. I have to admit, I think this was a great idea because I am big fan of harsh astringents when it comes to medical practitioners touching France, let alone the Netherlands.

Lo and behold, it worked!

“The mortality rate in April 1847 was 18.3%. After hand washing was instituted in mid-May, the rates in June were 2.2%, July 1.2%, August 1.9% and, for the first time since the introduction of anatomical orientation, the death rate was zero in two months in the year following this discovery.”

Yay! He had figured out a way to save women’s lives! For the first few years, that seemed to be grand. In fact, the worse thing that was happening was that doctors in other countries were being a little snooty, especially the English who claimed that Semmelweis wasn’t really saying anything noticeably different from the America doctor Oliver Wendell Holmes, who had noted puerperal ‘contamination’ from doctors going from patient to patient in 1843. Then, as happened to Holmes, some of the hard-core medical big-wigs went on the warpath. How dare they be asked to WASH their hands or their instruments? Who were these radical twits who thought cleanliness was some sort of medical issue? Fools!

It went downhill fast for Semmelweis after that. He was drummed out of the obstetrical clinic and denied a lecturer’s position because he was Hungarian and the Hungarians were having riots because they wanted the Austrians to stop oppressing them. He went back to Hungary, which opened him up to charges of ingratitude by the Austrian medical establishment, because they had apparently not yet discovered the concepts of either hypocrisy or irony. He started to get very tired of the English saying his work was derivative while getting the whole thing wrong and attributing the contamination to “miasmas” rather than cadaver particles on the doctor’s hands. He was also ready to tear his hair out over the rest of Europe ignoring his work and killing hundreds of thousands of women via nasty, corpse-covered fingers. He wrote several open letters that were not ‘polite’ about the ignorant stupidity of refusing to wash your freaking hands. So, of course, the medical and scientific community admitted he was right.

Ha! Just kidding! They mocked his ideas and railed against them and hounded him and disrespected him and taught medical students that he was wrong, wrong, wrong.

By the time Semmelweis published his book Etiology, Concept and Prophylaxis of Childbed Fever in 1861 he was under serious attack. He tried fighting back, based on the fact he was provably and demonstrably correct and the hidebound authorities were full of malarkey, but reality and proof could not save him from the efforts to discredit him. Semmelweis actually started having a nervous breakdown. He was being literally driven crazy by the refusal of his fellow doctors to admit washing their hands was a good idea and their constant assaults on his reputation and theories. Later, biographers started to wonder if maybe he had contracted syphilis from one of the many prostitutes he had treated at the free clinic in Vienna, but I think the crappy way he was treated could have broken him without any help from a pathogen.

So what happened to this brilliant medical pioneer who saved thousands of women from an agonizing death?

“In 1865, János Balassa wrote a document referring Semmelweis to a mental institution. On July 30, Ferdinand Ritter von Hebra [who had supported Semmelweis and whom Semmelweis trusted] lured him, under the pretense of visiting one of Hebra’s “new Institutes”, to a Viennese insane asylum located in Lazarettgasse … Semmelweis surmised what was happening and tried to leave. He was severely beaten by several guards, secured in a straitjacket, and confined to a darkened cell. Apart from the straitjacket, treatments at the mental institution included dousing with cold water and administering castor oil, a laxative. He died after two weeks, on August 13, 1865, aged 47, from a gangrenous wound, possibly caused by the beating. The autopsy gave the cause of death as pyemia—blood poisoning.”

Semmelweis’s biggest sin was that he had challenged the paradigm and moved into a new paradigm prior to the paradigm shift to germ theory. A  paradigm isn’t just a scientifically or medically accepted belief, like the humoral theory used to be; it is “the entire worldview in which it exists, and all of the implications which come with it. This is based on features of landscape of knowledge that scientists can identify around them. There are anomalies for all paradigms … that are brushed away as acceptable levels of error, or simply ignored and not dealt with.” Yes, scientists and doctors are just as capable of putting their fingers in their ears and singing ‘la-la-la I can’t hear you’ when faced with information they don’t want as any other set of humans. When enough evidence accumulates, like in the case of germ theory or the theory of evolution, it can cause a paradigm shift – a de facto scientific revolution. However, woe betide the scientist or doctor who breaches the paradigm walls prior to a paradigm shift, or the one who doesn’t do it ‘respectfully’. The new ideas are accepted by a few but usually crushed by majority the powers-that-be, just like the Catholic church did when dealing with Copernicus and Galileo. People, no matter how logical or rational or educated they think themselves to be, have a paradigm. Scientists and doctors are people. Push their paradigm and they will push back from anger and fear and they will claim that the outliers who are challenging the paradigm are the ones who are ignorant, fearful, and wrong. Sometimes the challengers ARE wrong. But (and this is a significant “but”) sometimes they are right. Nonetheless, being right doesn’t really help in the short term. The ones in the right often have to wait until they are dead to get the respect they deserve.

Medical anthropologists study the paradigms, and watch how the biomedical and scientific community builds, maintains, and defends the paradigm per culture. This makes us cheeky monkeys because we scoff at the certitude in which people quote ‘science’ as definitive, inerrant truth. We are, in a way, biomedical and scientific heretics because we do not axiomatically accept the authoritarian interpretations of data. However, that’s in our job description as it were. Doctors and scientists who commit paradigm heresy usually have it a lot harder because they are rebelling from within.

The sad thing about being a heretic is that it often comes with a side order of martyrdom … which is exactly what happened to Ignaz Semmelweis.

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