Surviving Medicine Part 2: Lessons from Semmelweis

The advent of the scientific method has produced great human triumphs over the vagaries of nature, especially when it comes to healing sick bodies. Modern ‘healthcare’ is a miracle of human ingenuity and business innovation. However, many of the medical treatments on offer today and in the past are not based on any an ethical framework. Much of what the health industry and health authorities both advise and mandate does more harm than good. Money is a factor in the healthcare industry even if it’s offered by the government. In this series, I’ll tell the stories of treatments that are miracle cures, incredible advances, and spectacular disasters. Negotiating the world of doctors, medicines, treatments, and bureaucracies is necessary if one wants to reap the benefits and avoid the disasters.

True medicine is hard. Understanding the human body is difficult for several reasons, not the least of which is the incredible complexity at the edge of where the human body meets the rest of the physical world. Biology is hard, and I’ve long found it fascinating that we humans have been to the moon, and we have rovers on Mars right now, but we can’t agree on what we’re supposed to eat. Physics is easier than biology.

We humans have powerful methods of observation, and many medical breakthroughs, things that have added countless millions of years of life to hundreds of millions of humans, have often come from lower-level medical technicians or nurses who made observations and followed a hunch all the way to a significant breakthrough. Once such person who did exactly that was Ignac Semmelweis. His theory that doctors could delivery ‘death agents’ from one patient to another led doctors to start washing their hands between patients, and that simple step saved hundreds of lives around Semmelweis and millions down the line. His insight led to the broader field of germ theory, and his story is worth noting not just because of the breakthroughs he initiated, but because his career and ending are illustrative of problems in medicine and society that plague us still.

I first became aware of Semmelweis years ago when I heard about him on the Freakonomics Radio series about the perils of medicine. In the series, called Bad Medicine, Steven Dubner recounted the story of Semmelweis and his experience at a hospital in Vienna.

Semmelweis was born in 1818 in Hungary when it was a part of the Austrian Empire. In 1846, he began working at a hospital in Vienna that had a free maternity ward. Women had been giving birth in tents, caves, out in the open, or just at home, for thousands of years, but this hospital was set up in part to address the incidence of infanticide which is what awaited illegitimate kids in that society.

There were two maternity wards at the hospital, called the First Clinic and the Second Clinic, and Semmelweis quickly became aware that there was a much high mortality rate in the First Clinic. Pregnant women would enter, give birth, and then come down with ‘puerperal fever,’ what we now call postpartum infections. These are infections in the female reproductive tract. The women in First Clinic would get these fevers and die. They died at a much higher rate than in the Second Clinic and even higher than women who gave birth on the street outside the clinic. Semmelweis wanted to know why.

Semmelweis observed that First Clinic was operated by medical students who would, as a regular practice, touch corpses in the morgue as part of their training, and also address the pregnant women. The Second Clinic was run by midwives only, and they had no contact with corpses. Semmelweis suspected that somehow, the medical students that touched the corpses were transferring ‘cadaverous particles’ to the pregnant women and this led to them acquiring the fever. The solution was as simple as it was elegant; the doctors needed to wash their hands with a chorine solution before they touched the women. As soon as this policy was instituted, the instance of puerperal fever dropped to nearly zero. There was no difference between First and Second Clinic any longer.

From this observation and practice, germ theory was further developed and the practice of hand washing stations for doctors and medical practitioners began to spread. “Scrubbing in’ is a practice that goes back to Semmelweis. Hand washing after using the bathroom has stopped the spread of germs that encounter the hands and get transferred to the mouth through food. Again, those signs seen in every restaurant bathroom telling employees to wash their hands can be traced to Ignac Semmelweis.

Breakthroughs in medicine often begin with such casual observations, and simple changes to policy.

I thought of Semmelweis again after Peter Attia mentioned him on his podcast, and Attia also said something about how Semmelweis came to a bad end. I recalled that on the Freakonomics Radio series that mentioned Semmelweis, the story wasn’t about Semmelweis or germs; it was about how doctors still don’t wash their hands every time they’re supposed to, even when they know they are putting others at risk. They often fail to follow the very reasonable and well justified rules.

So, I looked up the wiki entry for Semmelweis and found out about his sad ending. In a story far too common in the field of science, Semmelweis was mocked for his theories, doctors did not attribute fevers to touching corpses, and Semmelweis lost his job. He moved around a bit but never really got over the rejection associated with what he knew to be a simple truth. He went public with his concerns and criticized the leading authorities of the day in no uncertain terms. As he got older, his behavior deteriorated, and he was referred to a mental hospital. To get him there, he was tricked by another doctor, and when he realized what was happening, he resisted mightily. A fight ensued, and an injury he received to the hand became gangrenous, and he died of an infection two weeks after being committed.

Semmelweis left a legacy of learning and lives saved. Even at the end of his life, he offered another profound lesson, which is the resistance in the medical establishment to the status quo. They can save your life, or take it, and often the differences comes down to the doctor, the prevailing medical theory, and luck, good or bad. Even in medicine and science, there is an orthodoxy and a heterodoxy, and the two fight to the death. Don’t let anyone tell you that science and religion are completely separate, because they aren’t. There is still much ‘belief’ in science and real science is never ‘settled’ science.

In every interaction with the medical authorities anywhere, the rule is Caveat Emptor: Let the buyer beware.

SURVIVAL PLAN: Observe the behavior of the medical professionals around you. They make a lot of mistakes and are careless. And don’t take the status quo answer to questions as gospel. They are wrong about things all the time.

The Freakonomics episode is here:

The full take of Semmelweis is here:

A tribute to the man lives in in Hungary where there is a university/institute named after him

Semmelweis died in an asylum, but now there is an institute named after him.
The data

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