Ignaz Semmelweiss: Cleanliness

Ignaz Semmelweiss (1818-1865) initially went to university to become a lawyer. However, a friend invited him to a lecture and medicine. Becoming fascinated with medicine Semmelweiss switch his studies to become a physician.

Death in the Maternity Ward

In 1844, Semmelweiss graduated from the University of Vienna as a medical doctor. After graduation, Semmelweiss accepted a position as a doctor at a charity hospital for poor women. The hospital had two wards. One ward was for training doctors, while the second ward was for training midwives. For some strange reason, pregnant women would beg to be sent to the midwife ward to have their baby.

Semmelweiss was curious about this but could not get a straight answer from the women about why they preferred midwives to medical doctors. Eventually, he heard rumors that people believed that more women died from the doctors than the midwives. Semmelweiss began to investigate this. He found that about 1% of the women who went to the midwives died while about 25% of the women who went to the doctors died. In other words, it was safer to go to a midwife than a highly trained medical doctor for childbirth.

Many of the women who died among the doctors died from childbed fever, a type of infection. Semmelweiss was trying to figure out what was causing this infection. During this time, one of Semmelweiss’ best friends died. His friend died from childbed fever. What made this strange was that Semmelweiss’ friend was a man and had not had a baby.

The Problem Found

It turns out that his friend had been performing an autopsy one week before his death on one of the many women who had died from childbed fever. During the procedure, the careless student accidentally nicked Semmelweiss’ friend’s finger. The injury caused some minor bleeding, which eventually led to the infection that caused his death.

Semmelweiss figure that childbed fever was contagious and that doctors were spreading this infection around through uncleanliness. It was common for a doctor to go from the morgue to the operating room to visiting patients while wearing the same blood-soaked clothes. On the other hand, the midwives never performed autopsies (they weren’t qualified) and always made sure everything was clean.

Semmelweiss concluded that doctors needed to wash their hands and keep their clothes clean. When he shared this with his colleagues and students, they thought it was embarrassing because being clean was for midwives. After all, they were doctors. Others thought this was a joke. The hospital administrator called Semmelweiss’ idea foolish and claimed there was no budget for the soap and water Semmelweiss was wasting.

Success and Failure

With time, and through Semmelweiss’s stubbornness, the death rate fell from 25% to 1%. In line with the midwives’ results. The administrator called the decline a coincidence, students claimed that Semmelweiss was calling them murderers, and they disagreed with him. This all was happening in the mid 1840’s at the beginning of Semmelwiess’s career.

Despite the 1840ss benefit of handwashing, the students and the leadership continued to resist Semmelweiss’ innovation. This eventually led to Semmelweiss leaving the hospital. Once he was gone, the handwashing stopped, and the death rate soared again. However, the doctors did not care as long as they did not have to wash their hands like midwives.

Handwashing was not accepted as standard practice until the late 1860s. This means that this basic idea of cleanliness was ignored for about 20 years by the medical establishment. Semmelweiss was never able to see this happen as he died in the mid-1860s from an infection he received from cutting his finger during a surgical procedure.

Conclusion

A central lesson drawn from this story is how slow people are, despite their intelligence, training, and experience, to change. The doctors thought they knew what was best based on social conventions rather than evidence. They were more worried about looking like doctors (bloodstained clothes and dirty hands) than working to save lives. This is not unique to doctors as people often will fall victim to their pride. Fortunately, most of us do not deal with life and death daily, so our shortcomings do not have the same impact on people.

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