Ignaz Semmelweis and the lessons of fear and medical innovation

The man who saved more lives than any other physician (in the history of humanity combined) died in a mental institution — unrecognized and shunned by the medical community. He was beaten by guards and died a miserable death. Dr. Ignaz Semmelweis was a Hungarian obstetrician practicing in the mid-1800s, years before Louis Pasteur came up with his germ theory and Joseph Lister popularized hand washing.

While working as an assistant professor at the Vienna General Hospital in Austria, Semmelweis noticed that women were dying at an alarmingly high rate at his clinic: up to 35% of women giving birth died of puerperal fever, an infectious pelvic disease, mostly caused by endometritis, leading to bacteremia, septicemia, and death. Yet, women giving birth at an adjacent clinic, being treated by midwives — and even those not reaching the clinics and giving birth on the street — had a much lower rate of infection and death (less than a tenth of the frequency) than those in his clinic. This fact made Semmelweis “so miserable that life seemed worthless.” He sought to find a logical reason for this discrepancy.

After months of doing research, pouring over every minute detail that separated his clinic from that of the midwives’, the answer finally revealed itself during the autopsy of his friend, Jakob Kolletschka, who had been accidentally stabbed with a scalpel by a medical student during a procedure and whose autopsy revealed that he’d died from a disease that was similar to puerperal fever.

During the 1800s in this Vienna hospital, autopsies were done in the same clinic as Semmelweis practiced. It was common for medical students and their preceptors to do an autopsy and then head to a delivery, without using gloves or washing their hands between procedures. Semmelweis came to believe that there were particles in the cadavers that contributed to the infection and death of the women being delivered in his clinic. Although the prevailing theory at the time was that each case of puerperal fever was caused by different and unrelated illness, Semmelweis believed that there was only one cause and that by practicing proper hygiene many of these deaths could be prevented.

To test his theory, he forced his students to wash their hands with chlorinated lime before delivering. The rate of death during childbirth immediately dropped from up to 35% to 1-2% in the ensuing months. Still, Semmelweis was ridiculed by the entire medical community. His colleagues were appalled and insulted to hear that they were being blamed for the death of these women, and they went after Semmelweis, questioning his knowledge and convincing the medical community that the man who thought that invisible, theoretical “cadaverous material” from autopsies caused the death of women, was nothing short of insane.

Eventually, Semmelweis was fired from his clinic in Vienna and forced to move back to Budapest, Hungary. His ideas continued to be mocked, rejected, and ignored by his colleagues. In a last attempt at convincing his fellow obstetricians of his theory, Semmelweis began writing emphatic letters imploring his fellow doctors to practice proper hygiene and stop killing women. He was eventually committed to an asylum, where he was beaten by guards and, in a tragic dose of irony, died of septicemia, the same bacterial spread that led women with puerperal fever to die of their disease.

Of course, Semmelweis was right about the importance of hand washing. His theory has led to millions and millions of lives being saved. Despite being shunned, ignored, and ridiculed, he continued to believe in his ideas, and he fought to promote them until his very dying day.

Despite his sad fate, Semmelweis’s struggle for truth should be an inspiration to physicians who continue to question the status quo. Medical innovation cannot move forward without strong people pushing it forward, fearlessly voicing their theories and making sure that they are not hampered by the fear of being dismissed, shunned, or ignored by their colleagues. It’s the only way to foster progress. In the spirit of Semmelweis, we need to remain innovative. Share your ideas, your intuitions, your questions. Realize that human innovation cannot happen if you don’t think for yourself and speak your mind. If you get shut down by someone, don’t be discouraged. Be proud. Be happy, even. Be anything but ashamed.

As Albert Einstein said, “Great spirits have always encountered violent opposition from mediocre minds.”

Alberto Hazan is an emergency physician and author of Dr. Vigilante and The League of Freaks.  This article was originally published in Academic Life in Emergency Medicine.

Comments are moderated before they are published. Please read the comment policy.

  • John C. Key MD

    Well Neil, I guess you haven’t been around very much or very long, are perhaps you have had your head in noncontroversial work for so long you don’t notice the “disruptive doctors”. The history of medicine (and other great ideas) are littered with the bodies of Semmelweis and his brethren. They are around today…just look for the innovators.

    • rbthe4th2

      Not just doctors but patients who fight for doctors AND other patients.

  • Andrea Borondy Kitts

    Unfortunately things haven’t changed much since the 1800′s. The “instrument” of choice today is the sham peer review. Consider this recent egregious targeting of a top robotic cardiac surgeon at the University of Arizona, finally exonerated after a lot of advocacy by his patients, a lot of financial and emotional heartbreak to him and his family, and a loss of his live saving skills to his patients and the citizens of Tucson and Arizona. Dr. Poston was summarily suspended at the end of January. Two of the cases used to claim he is incompetent are not even his cases. In one case he wasn’t even in the operating room when another surgeon did a procedure on the wrong side. In the other he was the assisting surgeon and stepped in and saved the patient’s life when the lead surgeon doing the robotic procedure made a mistake. To my knowledge neither of the surgeons operating in these 2 cases were peer reviewed A third case resulted from falsified data in a complaint that a patient was mistakenly set up for a robotic procedure. Two other cases being used against him claim he “almost” performed surgery that wasn’t needed.
    Just cut and paste the link below in your web browser to read the story. Also read the comments to the story giving additional information. I have copied my comment to the story here just after the web link address.

    http://azstarnet.com/news/science/health-med-fit/prominent-ua-doctor-taunted-as-robo-rob-says-settlement-clears/article_028b3388-b753-57f5-acf8-cc0a1c266b2e.html

    I live in Connecticut. I am a lung cancer advocate, a patient advocate, and a Masters of Public Health student. I have never met Dr. Rob Poston. However, I was so outraged by the obvious malicious politically motivated attack on this exceptional surgeon by the University of Arizona that I had to do something. So on March 10th, 2014 I started a petition asking Anne Hart, President of the University of Arizona to reverse Dr. Poston’s suspension. Signing the petition are 544 people, many of them patients of Dr. Poston. There are over 100 comments, all of them glowing testimonials to Dr. Poston’s skill as a surgeon, compassion and empathy for his patients, and excellent leadership and support for his staff and peers. Read them for yourself. Just copy and paste the link into your web browser. http://www.change.org/petitions/ann-weav…er-hart-reverse-dr-robert-poston-s-suspension

    Now that Dr. Poston has been completely exonerated, he will be able to go on with his personal life and his life as a surgeon transforming cardiac surgery and saving lives. Unfortunately, it won’t be for the benefit of the citizens of Tucson and of the state of Arizona. This whole episode is a lose-lose situation; for patients, the University, the general public and for Dr. Poston and his family. The only winners are the lawyers. Although Dr. Poston’s case has been settled and his name cleared it is imperative to make sure this doesn’t ever happen again.

    It is beyond comprehension how a University allowed personal vendettas to take precedence over the financial interests and reputation of the University and, most of all, over the best interests of the patients and the general public. Dr. Poston’s outstanding surgical outcomes (as evidenced by his 67% lower mortality rates as compared to the 5 other U of A cardiac surgeons) and his superb “bedside manner” (as evidenced by the many glowing comments and support from his patients) should only garner praise and support from the University. In fact, it did. In June 2013 he received a performance review stating he was “truly exceptional”. In September 2013 his contract was renewed for 2 years.

    Under Dr. Poston’s leadership the University of Arizona Medical Center went from a having backwater mediocre cardiac program to receiving a 3 star rating from United Healthcare. Dr. Poston has an outstanding national reputation. He is one of literally a handful of cardiac surgeons who has earned a research grant from the NIH, and is the author of hundreds of peer reviewed publications. He has garnered accolades and excellent publicity for the University of Arizona for his ground breaking work in robotic cardiac surgery. It would seem to be in the best interests of the University to help and support Dr. Poston in his work. But instead, the University of Arizona let a small group of dissatisfied, at best mediocre, doctors afraid of not being able to keep up with Dr. Poston, hijack the entire peer review process. After a peer review that was not only a sham but also did not follow due process, Dr. Poston was summarily suspended in January 2014 depriving the citizens of Arizona of life saving minimally invasive cardiac surgery

    It is totally obvious to even the most naïve among us that the peer review targeting Dr. Poston, shortly after Dr. Greussner’s departure, was politically motivated. Consider that two of the cases being used to claim he is incompetent are not even his cases. In one case he wasn’t even in the operating room when another surgeon did a procedure on the wrong side. In the other he was the assisting surgeon and stepped in and saved the patient’s life when the lead surgeon doing the robotic procedure made a mistake. To my knowledge neither of the surgeons operating in these 2 cases were peer reviewed A third case resulted from falsified data in a complaint that a patient was mistakenly set up for a robotic procedure. Two other cases being used against him claim he “almost” performed surgery that wasn’t needed. This sham peer review of Dr. Poston is a threat to every patient and to the public health of the nation. If we allow these actions to stand, shame on us. We deserve what we get.

    I filed a complaint in April on behalf of Dr. Poston with the Joint Commission asking them to investigate the peer review process used in his case. Skip Garcia, Senior Vice President for Health Sciences and Interim Dean College of Medicine for University of Arizona Medical Center, stated in a letter that the University follows Joint Commission guidelines in their peer review process. These guidelines were not followed. In fact, the University did not adhere to their own internal processes for Dr. Poston’s peer review. The Joint Commission is an independent, not-for-profit organization that accredits and certifies more than 20,500 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

    I was made aware that the joint commission has agreed to thoroughly investigate my allegations. It is a self-evident conclusion from Ms Innes’ story that they are likely to agree that the University of Arizona Medical Center peer review is in violation of Joint Commission standards. Medicare funding depends on maintaining Joint Commission accreditation and there are rumors that Medicare is planning their own investigation of unnecessary and/or improper procedures that were not addressed by faulty peer review oversight at that institution. Hopefully a thorough investigation will result in changes at the University that will restore the original intent of peer review to protect patients

    Peer reviews that are hijacked for political purposes cannot do their proper job of reviewing doctors whose practices and outcomes truly are a threat to patients.

    For more information on the sham peer review process cut and paste the links below in your web browser.
    http://old.post-gazette.com/pg/03299/234499.stm
    https://sites.google.com/a/legalknol.com/www/medical-malpractice/twelve-signs-of-sham-peer-review
    http://www.semmelweissociety.org/semmelweis%20pdf/home/left%20side%
    http://www.semmelweissociety.org/semmelweis%20pdf/home/left%20side%20links/articles/1article_waite_napoleonic.pdf

  • T H

    There will always be people who will continue to believe as they wish despite massive evidence to the contrary (Holocaust deniers, for example).

    And research is often as much about the funding as it is about the research itself, because if Dr. G is getting $200k, then Dr. H isn’t… and if Dr. H can make Dr. G’s line of inquiry look silly/foolish/wrong/etc, she might lose her grant… leaving Dr. H with another chance at the $200k.

    And Semmelweis saves lives every day, just in the same way everyone who does modern mathematics with a calculus basis should give thanks to Newton.

  • querywoman

    So-called modern medicine like better pills and shots have prolonged a lot of lives, but hygiene gets a lot of credit, also.
    There’s nothing quite like sanitation that keeps cities cleaner of waste.
    Life is about balance, though. Regrettably, certain standards of modern hygiene may have intensified allergies and asthma.
    It’s a good thing I am a lousy housekeeper!

  • buzzkillerjsmith

    You need to do better research, Dr. H.

    Dr. Ignaz Semmelweis was NOT imprisoned and beaten because of quackery. He suffered these misfortunes because of his absolutely ridiculous name.

    And rightly so.