Semmelweiss (Saviour of Mothers) Battle With Science Dogma

Semmelweiss (Saviour of Mothers) Battle With Science Dogma

In Science Dogma aka Theory Has Always Fought Against New Observed Evidence

A friend reminded me of the fact that pioneers in science are often subjected to outrageous criticism and in particular pointed me to the life of Ignaz Philipp Semmelweiss (July 1, 1818 – August 13, 1865) who was a Hungarian physician of German extraction now recognized for his genius as an early pioneer of antiseptic procedures. Described as the “savior of mothers”, Semmelweiss discovered that the incidence of infection and death of women following childbirth could be drastically cut by the use of hand disinfection in obstetrical clinics.

Debilitating and deadly puerperal fever was common in mid-19th-century hospitals and often fatal, with mortality at 10%–35%. Semmelweiss proposed the remarkable practice of having doctors wash their hands with water containing a small amount of bleach before tending to mothers in childbirth, he did this in 1847 while working in Vienna General Hospital’s First Obstetrical Clinic.

Semmelweiss was appointed assistant to Professor Johann Klein in the First Obstetrical Clinic of the Vienna General Hospital a comparable position today in a US hospital would be “chief resident”. His duties were to examine patients each morning in preparation for the doctors rounds, supervise difficult deliveries, teach students of obstetrics and be ‘clerk’ of records.

Two maternity clinics were at the Viennese hospital. The First Clinic had an average maternal mortality rate due to puerperal fever of about 10% (actual rates fluctuated wildly). The Second Clinic’s rate was considerably lower, averaging less than 4%. This fact was known outside the hospital. The two clinics admitted patients on alternate days, but women begged to be admitted to the Second Clinic, due to the bad reputation of the First Clinic.

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Semmelweiss paper advocating doctors wash their hands, saving countless mothers from infection following childbirth, leading to ridicule of Semmelweiss

Semmelweiss described desperate pregnant women begging on their knees not to be admitted to the First Clinic. Some women even preferred to give birth in the streets, pretending to have given sudden birth en route to the hospital (a practice known as street births), which meant they would still qualify for the child care benefits without having been admitted to the clinic.

Before Pasteur and the knowledge of germs!

Semmelweiss 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.  What protected those who delivered outside the clinic from these destructive unknown endemic influences?”

Semmelweiss was severely troubled that his First Clinic had a much higher mortality rate due to puerperal fever than the Second Clinic. He wrote, ” It made me so miserable that life seemed worthless”.

The two clinics used almost the same techniques, and Semmelweiss started a meticulous process of eliminating all possible differences, including even religious practices. 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.

He had observed that the doctors’ wards which did not follow his hand washing and disinfection methods had three times the mortality of midwives’ wards where the attending women practiced a much higher level of personal hygiene. Could that be the way to save new mothers from dying?

semmelweis_graphHe implemented his hand-washing requirements and the result was the mortality rate in the First Clinic dropped 90% which was comparable to that in the Second Clinic. The mortality rate in April 1847 was 18.3%. After hand washing was instituted in mid-May, the rates in June were 2.2%, July 1.2%, August 1.9% and, for the first time since the introduction of anatomical orientation, the death rate was zero in two months in the year following this discovery.

Despite several publications of results where hand-washing reduced mortality to below 1%, Semmelweis’s observations conflicted with the established scientific and medical opinions of the time and he and his ideas were condemned and rejected by the medical community and he was subjected to rage and ridicule. Some doctors were offended at the suggestion that they should wash their hands and that Semmelweis could offer no acceptable scientific explanation for his findings save the observed life giving results. Keep in mind this was decades before Pasteur and Lister showed the world the existence and threat of germs!

Semmelweiss persecuted to death for claiming facts were more important than theory

The ire, outrage, and ridicule of his colleagues was so great that in 1865, Semmelweiss was committed to an asylum, where he died at age 47 after being beaten by the guards, only 14 days after he was committed.

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Semmelweiss, driven to the madhouse and an early death by critics of his hand washing study, is today honored on this 50 Euro-cent coin

Only belatedly did his observational evidence gain wide acceptance. More than twenty years later, Louis Pasteur’s work offered a theoretical explanation for Semmelweis’s observations—the germ theory of disease. As such, the Semmelweiss story is often used in philosophy of science courses—demonstrating the virtues of empiricism or positivism over skepticism and providing a historical account of how knowledge based on observation counts as scientific (and thus accepted) knowledge, and how pontificating dogma by do nothing observers does not.

It has been seen as an irony that Semmelweis’s critics considered themselves positivists and not skeptics, but even positivism suffers problems in the face of theories which seem magical. Such as the idea that mysterious invisible particles might create infection, with no causal mechanism being stipulated, after a simple contact.

Semmelwies’ critics could not accept his ideas of minuscule and largely invisible amounts of decaying organic matter as a cause of every case of childbed fever— ideas which in the absence of a replicative biological mechanism, must have seemed to them as no more chemically likely than homeopathy. To his contemporaries, Semmelweis seemed to be reverting to the speculative theories of earlier decades that were so repugnant to his positivist contemporaries. Indeed he was not, but his presentation of what has now become truth did not protect him from the outrageous attacks of his peers.

Little has changed today

Today’s ethics of science seems to have changed very little since the time of Semmelweiss as the self appointed defenders of scientific dogma still rule with iron fists and acid tongues. There are countless examples in every field of medicine where newly observed evidence is rejected unless it conforms to accepted theory aka dogma. Punishment by the self appointed defenders of the ‘faith’ is swift and ruthless, especially in this age of anonymous internet trolls.