How medical arrogance kills

After becoming disillusioned with the study of law, Ignatz Semmelweis, a young Hungarian, moved to the study of medicine, graduating with a medical degree from the prestigious University of Vienna in 1844. He applied for positions in pathology and then medicine, but received rejections in both, probably because he was both Hungarian and Jewish.

Obstetrics, a relatively new area for physicians, previously dominated by midwifery was looked down upon by doctors. This is where he was accepted[1]Ignaz Semmelweis.

At the time, the leading cause of maternal mortality in Europe at that time was puerperal fever – an infection, now known to be caused by the streptococcus bacterium, that killed postpartum women.

Prior to 1823, less than 1% of women died in childbirth at the Vienna Hospital. But after a policy change mandated that medical students and obstetricians perform autopsies, in addition to their other duties, the mortality rate for new mothers suddenly jumped to 7.5%.

The Vienna Hospital opened a second obstetrics division, to be staffed entirely by midwives. The older, First Division, to which Semmelweis was assigned, was staffed only by physicians and medical students. It quickly became apparent that the mortality rate in the first division was much higher than the second.

At this time, the general belief was that bad odors – miasma – transmitted disease.

Semmelweiss determined to establish the reason for the higher mortality rate and came to the conclusion that the only difference was that the midwives did not perform autopsies. 

His final clue came after the death of his friend and colleague, pathologist Jakob Kolletschka. Kolletschka died after receiving a scalpel wound while performing an autopsy on a woman who’d died of puerperal fever. His autopsy revealed massive infection from puerperal fever.

Semmelweiss concluded:

general sepsis arose from the inoculation of cadaver particles, then puerperal fever must originate from the same source. … The fact of the matter is that the transmitting source of those cadaver particles was to be found in the hands of students and attending physicians.

Semmelweis mandated hand-washing across his department. Starting in May 1847, anyone entering the First Division had to wash their hands in a bowl of chloride solution. The incidence of puerperal fever and death rapidly dropped to below 1% as it was when midwives performed deliveries. 

Unfortunately, as in the case of his contemporary John Snow, who discovered that cholera was transmitted by water and not miasma, Semmelweis’ work was not accepted, and the obstetrical chief, refused to reappoint Semmelweis to the obstetrics clinic.

Instead of being celebrated for his discovery, Semmelweis was committed to an insane asylum where he died of an infection at the age of 47[2]In 1850, Ignaz Semmelweis saved lives with three words: wash your hands.

In 1867, the Scottish surgeon Joseph Lister, who apparently had never heard of Semmelweis, elaborated the theory and practice of antiseptic surgery, which included washing the hands with carbolic acid to prevent infection. With Lister’s reputation the practice gained acceptance, although millions of women died in the interim.

It is the same professional arrogance that Jenner experienced with his discovery of the smallpox inoculation[3]Smallpox