An adapted excerpt from Decisions: Practical Advice from 23 Men and Women Who Shaped the World. Reprinted with permission from Kensington Books. Copyright © 2020 Robert L. Dilenschneider.

Count me among those who apparently didn’t get the “science gene.” In my case, the Bunsen burner in my high school lab did me in. I know many people who, faced with dissecting a rubbery dead frog, gave the scalpel back to the biology teacher and decided to major in English Lit.

But fortunately for all of us, there are many people who, genetically endowed or not, live and work in the land of science.

A pioneer in the brave new world of germ theory—Ignaz Semmelweis, bucked the mid-nineteenth century medical power structure. Though I’ll bet you’ve never heard of him, he is probably responsible for the fact that we wash our hands so often.

Semmelweis was born in 1818 and died in 1865. Educated in Hungary and Austria, he was practicing medicine at the Vienna General Hospital in 1847, the time of his great discovery/decision. Spontaneous generation was beginning to be supplanted by germ theory.

Semmelweis decided to pay attention to “childbed (puerperal) fever,” which, of course, struck only women after childbirth and was almost invariably and horribly fatal. (I’ll get to the hand-washing.) Mothers, in fact, had identified the crux of the “childbed fever” problem long before doctors (generally men) did.

Before the mid-nineteenth century, most babies were born at home with midwives (generally women) attending mother and child. Infection and risks of all kinds were constant threats, but doctors were normally called in only for emergencies. As “health care” institutions began to develop, birthing moved out of the home and, more and more, doctors supplanted midwives. And that’s when Semmelweis noticed, as did new and prospective mothers, that there was a connection between childbed fever (and mothers dying) and babies born with a doctor’s help versus a midwife’s.

I’ve given you a red herring here. What’s relevant is not the gender of the doctor or the midwife, but the fact that doctors almost always came to the maternity ward directly from … the morgue, where they performed autopsies and … did not wash their hands. Our modern minds reel at the implications of this unsanitary practice, but in the mid-nineteenth century when “germs” was a new concept, that’s the way it was. Midwives were in the maternity ward solely to attend to their patients, and did not have the “opportunity” to carry so many germs so easily.

In 1847, when Semmelweis decided to pursue the connection that was so clear to him, he encountered what we would now call “pushback.” His solution—that doctors wash up between studying the dead and attending to the living—was so simple and elegant, yet it criticized those who held the power in the practice of medicine. Doctors (male) were superior, while midwives and mothers (women) were inferior.

The fact is that some of Semmelweis’s personal characteristics may have also hindered the adoption of his discovery. He was not an especially collegial or engaging fellow. He didn’t seem to care how others perceived him and he didn’t like to spend time communicating with peers in the medical community. He did not broadcast his discovery. Did he decide not to override these not-exactly-helpful foibles, or was he incapable of change?

The incidence of childbed fever dropped markedly once hand-washing became more and more routine. As it was eventually obvious that the practice had many other benefits in the hospital and every other setting (think: restaurant kitchens!), hand-washing is now second nature to all of us. And it’s evolving! Recently, I read a news story reporting that it doesn’t matter if you use hot or cold water—just use lots of soap and don’t stop lathering until you count to ten.

There is much to learn from Semmelweis and his decision:

1. If you want to make a difference, identify a problem and decide to solve it.
2. Know what you’re talking about. Semmelweis brought years of rigorous education and experiments, both successful and not.
3. Don’t be enslaved to what conventional wisdom tells you is acceptable. If Semmelweis had, he would never have decided to face up to the medical power structure in which he was steeped.
4. Deciding not to decide is also a decision. Because of his personality, Semmelweis was indifferent to taking certain actions that might have helped spread his discovery.
5. Be sure to publicize—tell others—of the progress you have made. It may spur them to do still better for society.

Robert L. Dilenschneider is the author of Decisions: Practical Advice from 23 Men and Women Who Shaped the World.

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