The so-called “Semmelweis reflex” is a metaphor for a certain type of human behavior characterized by reflex-like rejection of new knowledge because it contradicts entrenched norms, beliefs or paradigms. It’s named after Dr. Ignaz Semmelweis (1818-1865) whose ideas were ridiculed and rejected by his contemporaries. Another term for it is “cognitive dissonance” and “the march of the pajama people.” Anything that can’t be “proven” according to the standards and methodology and authority of their ontological belief system is automatically dismissed.
This case also illustrates in spades “Winter’s Razor,” which holds that large, elite, powerful organizations are infested with unprincipled hacks, overrated empty suits and far worse, malevolents.
In the first half of the 19th century, about five European women in a thousand died from childbirth. Death rates in maternity hospitals were often 10 times that figure. Dr. Semmelweis and the poet Oliver Wendell Holmes led the campaign to stop the spread of the disease by urging doctors to wash their hands. Pompous obstetricians felt offended.
“Doctors are gentlemen,” said primadonna Charles Meigs of the Jefferson Medical College in Philadelphia. He argued that no such care was needed, “and gentlemen’s hands are clean.”
The vast majority of childbirth and surgical mortality cases were due to just one bacteria: Streptococcus pyogenes. Readers may recall our article on the assassination of James Garfield that described how as late as 1881, surgeons probed the wounded president’s gut with dirty fingers. S. pyogenes causes a range of other diseases, including strep throat, scarlet fever, rheumatic fever and skin infections
Puerperal Fever, or child-birth infection, became an epidemic after male midwives — later to be called “obstetricians” — ran midwives out of town and took over birthing as a “profession.” These men, new to this natural function of life, didn’t have the sense to know about something called hygiene and hand washing, which ironically, midwives diligently practiced. The empty suits also insisted that all women have their babies at rat-infested filthy hospitals to make things easier for themselves. They went from bed to bed without washing hands, in filthy clothing and sometimes after dealing with people who had died from infections.
Enter Dr. Semmelweis who was puzzled that Puerperal Fever was rare among women giving “street births.”
“To me, it appeared logical that patients who experienced street births would become ill at least as frequently as those who delivered in the clinic,” Dr. Semmelweis said.
He was determined to test for what protected those who delivered outside the clinic from these destructive unknown endemic influences.
Dr. Semmelweis introduced hand washing with chlorinated lime solutions for interns who had performed autopsies. He then tested the concept in his Vienna maternity hospital. Conditions were identical in the two samples tested. The only major difference was the individuals who worked there. The first clinic was the teaching service for medical students, while the second clinic had been selected in 1841 for the instruction of midwives only. By 1846 mortality rates from childbirth-Puerperal Fever were far below the doctor’s clinic.
The germ theory of disease had not yet been accepted in Vienna. Thus, Dr. Semmelweis concluded some unknown “cadaverous material” caused child-bed fever. The cause was not correct, but the idea of some type of infection caused by poor hygiene most certainly was. But this wasn’t enough for the slighted medical profession. Dr. Semmelweis in 1847 instituted a policy of using a solution of chlorinated lime (calcium hypochlorite) for washing hands in his wards. Mortality rates plummeted.
These findings were presented by Dr. Semmelweis’ assistants throughout Europe. The doctor, once he saw his ideas were being summarily rejected by the medical community, reacted by publishing nothing.
The rejection of Semmelweis’s empirical observations is often traced to “belief perseverance,” the psychological tendency of clinging to discredited beliefs. Also, some historians of science argue that resistance to path-breaking contributions of obscure scientists is common and “constitutes the single-most formidable block to scientific advances.” It seemed Dr. Semmelweis was not part of “The Club.”
Further, Dr. Semmelweis was a Hungarian nationalist and was caught up and distracted in the 1848 Revolution. He was obliged to leave the obstetrical clinic when his term expired on March 20, 1849. According to his own account, he left Vienna in 1850 because he was “unable to endure further frustrations in dealing with the Viennese medical establishment.”
This angel of the birthing mother then spread his wonders to a hospital in Budapest in 1851. Semmelweis replicated his Vienna success and eliminated the fever because of his sanitation upgrades and policy. During 1851–1855, only eight patients died from child-bed fever out of 933 births (0.85%).
Despite the impressive results, Dr. Semmelweis’ ideas were not accepted by the other obstetricians in Budapest. The professor of obstetrics at the University of Pest, Ede Flórián Birly, never adopted Dr. Semmelweis’ methods and continued to promote blood purging. Birly was openly derisive of the good doctor.
In 1855, Dr. Semmelweis was made professor of obstetrics at the University of Pest maternity clinic. Once again he instituted chlorine washings and the results were impressive.
Finally, and perhaps too late, in 1858-1861, Dr. Semmelweis wrote several essays and a book about his successful methods. In his 1861 book, the clearly frustrated doctor lamented the slow adoption of his ideas:
“Most medical lecture halls continue to resound with lectures on epidemic childbed fever and with discourses against my theories. … The medical literature for the last 12 years continues to swell with reports of puerperal epidemics, and in 1854 in Vienna, the birthplace of my theory, 400 maternity patients died from childbed fever. In published medical works my teachings are either ignored or attacked. The medical faculty at Würzburg awarded a prize to a monograph written in 1859 in which my teachings were rejected.”
At a conference of German physicians and natural scientists, most of the speakers rejected his doctrine, including the celebrated Rudolf Virchow, who was a scientist of the highest authority of his time. Virchow’s great authority in medical circles contributed potently to Dr. Semmelweis’ lack of recognition.
Ede Flórián Birly, Dr. Semmelweis’ predecessor as Professor of Obstetrics at the University of Pest, never accepted his teachings. He continued to believe that Puerperal Fever was due to uncleanliness of the bowel.
August Breisky, another quack obstetrician in Prague, rejected Dr. Semmelweis’ book as “naive” and referred to it as “the Koran of puerperal theology.”
Carl Edvard Marius Levy, head of the Copenhagen maternity hospital, was an outspoken critic of Dr. Semmelweis’s ideas.
After a number of unfavorable foreign reviews of his 1861 book, Dr. Semmelweis lashed out against his critics in a series of open letters. They were addressed to various prominent European obstetricians, including Späth, Scanzoni, Siebold, and to “all obstetricians.” They were full of bitterness, desperation and fury and were “highly polemical and superlatively offensive,” at times denouncing his critics as irresponsible murderers or ignoramuses.
In mid-1865, his public and mental behavior became irritating and embarrassing to his associates. According to K. Codell Carter, in his biography of Semmelweis, the exact nature of his affliction cannot be determined. The likely suspect is ironic. It was probably third-stage syphilis, a then-common disease among obstetricians who examined thousands of women at free clinics.
In 1865, a decision was made by the quack medical industry to put this troublemaker away.
János Balassa, Hungary’s leading medical “authority,” wrote a document referring Dr. Semmelweis to a mental institution. The doctor was lured under false pretenses to a Viennese insane asylum located in Lazarettgasse and involuntarily committed. When he 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 isolation, dousing with cold water and the administration of castor oil, a laxative.
Rather than being showered with prestige and awards, this much-maligned great champion of medical advancement and sound principles died a broken and lonely man after two weeks of confinement, on Aug. 13, 1865, at the age of 47, from a gangrenous wound, the result of poor medical hygiene and an infection on his right hand that may have been caused by his assault. The autopsy gave the cause of death as pyemia — blood poisoning or sepsis.
Dr. Semmelweis was buried in Vienna on Aug. 15, 1865. Only a few people attended the service, and he was totally ignored. The contrast between the forces of righteous and good versus the dark forces of evil couldn’t be more stark than this fate.
One of Dr. Semmelweis’ detractors, János Diescher, was moved in as Semmelweis’ successor at the Pest University maternity clinic. Immediately, mortality rates jumped sixfold to 6%, but the physicians of Budapest said nothing. There were no inquiries and no protests. None of the empty suits either in Vienna or in Budapest seemed to have been willing to acknowledge the good doctor’s superior record. For all practical purposes, the real cause of Ignaz Semmelweis’s lonely death in an insane asylum was realizing a deep sense of the invincible social power of false truths.
Dr. Semmelweis’ remains were transferred to Budapest in 1891. On Oct. 11, 1964, they were transferred once more to the house in which he was born. It took many decades before he was given his due. The house is now a historical museum and library. Today, fittingly, Ignaz Semmelweis is honored. Better late than never.