The Price of Telling the Truth: Ignaz Philipp Semmelweis

Table of Content

1.Intro: The consequence of telling the Truth
2.Semmelweis
2.1.Background
2.2.Discovery
2.3.Fighting the Orthodoxies
2.4.Price of Telling the Truth
3.Closing

1.Intro: The consequence of telling the Truth

Telling the truth may not always be a good thing. In fact, if a newly discovered truth conflicts the status quo or a dominant belief of a time that legitimises a powerful institution, not only is the truth repudiated, often vehemently, but also the one that expresses the truth tends to be ostracised and silenced by the authority, like Galileo Galilei. The following story shows another example, which involved even human lives.

2.Semmelweis

2.1.Background

Often dubbed as the ‘saviour of mothers,’ Ignaz Philipp Semmelweis was a Hungarian physician that pioneered antiseptic procedures. Semmelweis initially studied law at the University of Vienna, and it was shortly after the autumn of 1983 that he switched to medicine, and in 1844, he was awarded his doctorate degree in medicine. In 1846, at the age of twenty-eight, the young doctor was filled with passion and determination to save more lives and found himself working as an assistant in the obstetrics department of Vienna General Hospital, the largest hospital in Vienna then.

At that time, maternity wards across Europe were plagued with puerperal fever, commonly known as ‘childbed fever.’ While young Semmelweis was working as an assistant, he witnessed the high mortality rate of mothers at childbirth, staggering 1 in 6 on a daily basis. At the Viennese hospital, two maternity clinics were set up. In the “First Clinic”, doctors were teaching medical students, and in the “Second Clinic”, midwives were trained. Curiously, the doctor’s ward had 3 times more mortality rates than the midwives’ ward in the 6-year period of 1841-1846, and in 1846, the “First Clinic” had five times higher mortality rate than the “Second Clinic” (Semmelweis, 1861, p.46). When their bodies were dissected during an autopsy, whitish pus and putrid flesh were frequently found with a stench so strong that some students even threw up on the spot.

2.2.Discovery

The most common belief as to the cause of the disease at that time was an untested notion that poisonous particles in the air were inhaled through the lungs and brought on the fever, although such aetiology did not quite explain the disproportionate difference in mortality rates between the two wards in the same hospital. Moreover, some women were so afraid to be admitted to the “First Clinic” that they gave birth in the streets, and much to Semmelweis’ surprise, childbed fever was rare amongst women that gave street births.

Witnessing the horrific incidents day after day, Semmelweis was determined to find the cause of the endemic at once. He closely analysed the difference between the two clinics, even taking into account religious practices people were engaged, and finally narrowed down to the only noticeable difference. It was people working there; midwives on one hand, and well-respected doctors on the other, who were teaching medical students anatomical orientation through dissecting corpses. Semmelweis hypothesised that the cause of the disease was the direct hand-to-hand contact between patients and doctors, who often went straight from cadaver dissection to the maternity ward. Such a line of thought, a nascent form of germ theory, was somewhat a revolutionary concept at that time.

One day, an incident occurred, which seemed to enforce his hypothesis. A leading doctor in the forensic department, a close friend of Semmelweis, was accidentally pricked in the finger by a student’s scalpel during yet another post-mortem examination on a woman that suffered from puerperal fever, and within a few days, the doctor died of a severe infection (Semmelweis, 1861, p.52). When his body was examined, the same whitish pus and putrid flesh were found.

Subsequent to the event, Semmelweis grew convinced that physicians, who were performing autopsies on women that died of puerperal fever, became infected of the childbed fever themselves, and without sanitising their hands, they went to deliver babies, and the disease was passed into the women’s blood through various open cuts and wounds (Semmelweis, 1861, pp.52-53). Semmelweis (1861, p.52) recalled that ordinary washing soap did not suffice to remove adhering cadaveric particles, as the doctors’ hands always retained cadaveric reek afterwards. This explained the lower mortality rates in the “Second Clinic” where midwives were not engaged in autopsies with no contact with corpses.

If this was the definitive cause, the solution was simple. Doctors who were delivering babies must wash and disinfect their hands properly beforehand. Whilst few doctors followed such a rigorous antiseptic procedure in any hospitals at that time, some were even offended at the suggestion of such a painstaking procedure, as it meant that their failures to disinfect their hands had previously contributed to the soaring mortality rates. Instead, they sneered at Semmelweis’ hand washing practice, labelling it as ridiculous and nonsensical.

Nonetheless, Semmelweis, as being absolutely convinced, implemented the antiseptic procedure of washing hands with chlorinated lime solutions, and the mortality rate quickly dropped by half. He instituted this as he empirically discovered that this chlorinated solution effectively removed the putrid smell of infected autopsy tissue. Thanks to his initiative, within a year, the death rate of childbed fever in the “First Clinic” dropped to 1%.

2.3.Fighting the Orthodoxies

The problem, though, was that the head of the department Johann Klein was a conservative and narrow-minded doctor with enormous influence and authority in the medical field, who forced his doctors to strictly adhere to medical orthodoxies previously established, namely the status quo. After furiously arguing over possible causes of childbed fever, Klein was rather sceptical of Semmelweis’ motive, suspecting that the self-righteous young physician was seeking credit for himself to raise his profile in the field. “A sanctimonious self-promoter with youthful zeal”, thought Klein.

Klein attributed the decline in the mortality rate in Semmelweis’ ward to a new ventilation system that Klein recently installed. Klein held on to his belief, also for the reason that admitting Semmelweis’ theory implied that doctors in his hospital including himself had technically been murdering their pregnant patients and their babies, albeit inadvertently. The thought of it must have been intolerable.

2.4.Price of Telling the Truth

In 1849 when the previously agreed upon duration of Semmelweis’ assistantship was nearing an end, Klein declined to renew the young physician’s contract, which, in effect, left the young Hungarian out of a job. The whistleblower was shunned and ostracised by the establishment.

Although he subsequently built his career as a physician back in his hometown Budapest, due to his authoritarian management style whereby he attempted to ruthlessly enforce his antiseptic practice in his hospital, he eventually became abandoned by all his colleagues and the medical community as a whole, even though his hygiene practice saved hundreds of lives. Virtually penniless, he lost his mind, so people thought, including his own wife, thus he was admitted to a mental hospital. It may have been third-stage syphilis, which was a very common disease those days amongst obstetricians who had to examine thousands of women. Within 14 days of his admittance, he attempted to escape from the institution but stopped by guards and severely beaten up. Shortly after then, he died, in 1865, at the age of forty-seven.

Years after his death, particularly after the French bacteriologist Louis Pasteur confirmed the germ theory and the British surgeon Joseph Lister successfully operated with hygienic methods, Semmelweis’ antiseptic practice finally earned measurable acceptance, which was long overdue. Had it happened earlier, countless lives would have been saved.

3.Closing

Today, fake news circulates and blatant lies are told by public figures without being adequately held accountable. The masses are misled, and their gullibility is exploited by politicians and the media, while the wheeler-dealers are extending their own cause. In the midst of the madness, however, changing people’s belief is still extremely difficult, and the price for telling the truth seems to remain pricy.

Reference & Bibliography

Greene, Robert. (2012). Mastery. Viking Press.
Summelweis, I. (1983)[1861]. Etiology, Concept and Prophylaxis of Childbed Fever. (trans.). K. Codell Carter. Madison, The University of Wisconsin Press
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