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.

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