Human Folly & the Paradox of Human Intelligence

The Semmelweiss Tragedy

Doubt is a painful experience; to face the fact that ones basic assumptions may be in error is a difficult enough matter for the individual (as we saw with Bertrand Russell) - if this occurs at a group level the problem is far greater. When beliefs are internalised they become bound up with the psyche of the individual, or of the group, and because of this are highly resistant to change. The failure to realise just how much less certain is our knowledge of the world than we believe it to be, is one of the most common of human failings. So a challenge to any set of beliefs that are widely subscribed to are likely to be interpreted as a challenge to the believing group itself. Criticising conventional beliefs or practices, of any kind, can indeed be a perilous business, as this next sad story affirms.

It seems extraordinary these days, when the principle of bacteriological infection is universally accepted, that even as late as the last quarter of the I9th century the idea was not understood and not generally accepted. Hospitals were dreadful places before the introduction of antiseptic procedures and their mortality rates were appallingly high. Patients undergoing a surgical operation of any kind were likely to be infected by the so-called Hospital Disease, and if they were, were lucky to survive. Some hospitals had worse reputations than others, but in some the death rate for operations was 50% Hospitals were understandably feared, but many women still chose to have their children delivered there; unfortunately there was a terrible risk of infectious disease. Naturally the deaths by Peuperal, or Childbirth fever were of great concern to obstetricians, but the causes were a complete mystery

In the middle of the last century Ignaz Semmelweis, a young Hungarian obstetrician working in a hospital in Vienna, noticed that one of his wards had three times as many cases of Peuperal fever than another. The only difference between the two wards was that the women in the 'bad' ward were delivered by medical students, while those in the 'good' ward by midwives. Initially Semmelweis attributed this disparity to the greater experience of the midwives. But a fatal incident in the hospital led him to reconsider. A colleague cut himself whilst performing a post-mortum on women who had died of Peupural fever, his wound became terribly septic and within a few days he had died. It occurred to Semmelweis that there might be similar linkage between the high death rates in the 'bad' maternity ward and his students, many of who came to the ward directly from the dissecting tables, where they had been cutting up bodies to learn anatomy. Was it possible that they were transferring the 'putrefaction', by way of their hands, from these corpses to the living mothers?

At the time there was no knowledge of microscopic bacteriological pathogens, so there was no explanation for such a transfer. But Semmelweis decided to interfere with this possible line of transmission and insisted that his students wash their hands in a solution of lime chlorate before they entered the labour wards. The results of this simple exercise were dramatic. Almost immediately the mortality rate in the 'bad' ward dropped from being far higher to being well below that of the 'good' ward. Semmelweis had invented the principle of antisepsis.

This important discovery did not, however, get the recognition it deserved. In fact it was scarcely recognised at all. Although the death rates in his wards continued to be far lower than those of any other hospitals his success inspired professional jealously and opposition rather than emulation. Semmelweis had never been on particularly good terms with his superiors. He had pronounced liberal views, and it was known that in 1848 he had taken part in revolutionary activities. He was seen by his superiors as a difficult personality (he had a somewhat emotional and volatile personality), and his latest obsession simply fuelled the deteriorating relationship between them. Eventually he was dismissed from the clinic in Vienna and returned to Hungary. He continued to practice obstetrics however, and continued to develop his antiseptic techniques. In the hospital in which he worked childbirth mortality was reduced to less than 1%, an incredibly low figure for the time.

Over the next ten years Semmelweiss accumulated a mass of evidence supporting his methods. He published the results and sent copies to medical institutions throughout Europe. But the book was completely ignored, despite the fact that Peuperal fever continued to rage. The statistics were horrifying indeed. In the Viennese hospital from which he was sacked (and which had abandoned his antiseptic methods) 35 women out of 101 died in the labour wards during the autumn of 1860. We can only surmise the effect that this must have had upon Semmelweis when he got to hear about it.

Why was his message ignored? From a historical perspective it seems almost incredible that such clear evidence for the prevention of mortality, at such a small cost and involving only the most elementary precautions, should not have been immediately and widely adopted. Instead, these ideas met with a determined resistance from the medical profession. Louis Pasteur, Semmelweiss's contemporary, encountered a similar reaction in France when advancing his 'germ' theory of disease. There is little doubt that this hostility stemmed in great part from an unwillingness on the part of surgeons to face the fact that they themselves had been responsible for spreading disease, albeit unknowingly. That they may have caused untold, and unnecessary, suffering and death was an almost unbearable supposition, and was bound to induce an unconscious reaction.

It was also the case that, understandably, Semmelweis was losing patience with his colleagues in the profession, and getting more strident in his arguments. It was perfectly clear to him that the adoption of simple methods of hygiene could save countless lives and he had the evidence to support his claims. But try as he might he could not get his ideas across to the medical establishment. He became increasingly desperate and began to threaten various Professors of Obstetrics that if they would not at least try out his ideas he would go over their heads and appeal directly to their patients, informing them that they were 'placing their womenfolk in danger for the price of a few pennies worth of Chloride of Lime'. His challenge was ignored.

The continued resistance to these ideas was utterly irrational, but in the end it was Semmelweis himself that snapped. He became prone to bouts of serious depression, and at other times would fly off into rages against his co-workers. His mental condition steadily deteriorated. In the summer of 1865 he was taken by his colleagues for a coach ride, in the course of which they visited a local mental sanatorium. Once there his friends slipped away and Semmelweis was forcibly restrained, confined by a straitjacket and placed in a darkened cell. A medical examination undertaken soon after his admittance revealed that he had an injury to his right hand that appeared gangrenous. It had been accidentally self-inflicted during his last obstetric operation. He died two weeks later of a pueperal-type infection. An autopsy revealed some organic brain damage. Semmelweis had been insane - but was nevertheless a martyr of rational thought.

In one of the most poignant coincidences in medical history Joseph Lister performed the first ever surgical operation using antiseptic dressings on the day before Semmelweis died. Despite his success of his experiments Lister was also ridiculed, but the tide of opinion was changing. The theory of the bacteriological transmission of disease, and of the necessity of antiseptic methods was slowly but steadily accepted by the medical profession. Lister's pioneering achievements eventually brought him great honours (he was knighted and made a Baron), but Semmelweis who had anticipated his ideas by at least fifteen years has been almost completely forgotten.