Needless Death at the Hospital — This Rejected Truth Resulted in 5X More New Mothers and Babies Dying

One Doctor’s Crusade to Change the Medical Establishment

Ignaz Philipp Semmelweis was an obstetrics physician at the Vienna General Hospital during the late 1840s. At the time, the hospital operated two free obstetrics clinics which admitted patients on alternate days. The First Clinic was also a training facility for new physicians, while the Second Clinic was used to train midwives. It was thought that by training midwives as well as doctors, women would be more likely to have the proper care. But the two clinics had vastly different reputations, with women clamouring to be admitted to the second and not the first. The reason was the difference in maternal mortality rates due to puerperal fever, also known as postpartum fever, a bacterial infection that occurs in women after childbirth or a miscarriage. The mortality rate of the First Clinic averaged almost twenty percent, while the Second Clinic’s mortality rate was substantially lower, averaging less than four percent.

Even more surprisingly, many women chose to have a “street birth” (i.e., outside the clinic, but supposedly while en route) and then be admitted for free after-care. These “street births” had the lowest incidence of puerperal fever of them all. Semmelweis contemplated, “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?”

Semmelweis was miserable that the First Clinic’s mortality rate for puerperal fever was several times higher than the Second Clinic’s. He said, “Life seemed worthless.” The two clinics were identical except for one thing: the staff were different. The First Clinic was the university clinic, where students were taught medicine, while the Second Clinic was only open to trained midwives.

Semmelweis’s epiphany occurred in 1847, following the demise of his good friend and mentor Jakob Kolletschka, who died of an infection caused by an accidental stab by a student’s scalpel while performing an autopsy. Kolletschka’s autopsy revealed puerperal fever-like pathology in women similar to those infected with the disease. Immediately after Kolletschka’s death, Semmelweis proposed a link between cadaverous contamination and puerperal fever. He concluded that medical students carried autopsy particles to obstetrics patients in the First Clinic because they had touched cadavers before entering the maternity ward. In the Second Clinic, where midwives did not perform autopsies, mortality rates were much lower.

Semmelweis proposed that doctors should routinely wash their hands (and instruments), especially before delivering babies, would reduce puerperal fever and other infectious diseases. In April 1847, the mortality rate in the first clinic was 18.3%. The hospital introduced hand washing in mid-May, and the mortality rate fell to 2.2% in June. It was 1.2% in July, 1.9% in August, and within 14 months, the mortality rate was zero.

At the time, treatments such as bloodletting were still seen as a mainstream therapy for many diseases, including puerperal fever. Semmelweis’s idea that cleanliness was the key to preventing hospital-borne illness and death was seen as extreme, leading to ridicule, rejection, and even imprisonment. Consequently, he was forced to move to Budapest, where he could practise as safely as a physician.

Semmelweis was angered by the disinterest of the medical establishment and began writing anguished letters to influential obstetricians, frequently branding them irresponsible murderers. His contemporaries, including his spouse, thought he was losing his mind, and in 1865 he was committed to a mental asylum. He died there 14 days later, possibly due to being severely beaten by guards.

Semmelweis’s discovery was widely accepted only years after his death when Louis Pasteur further developed the germ theory of disease, offering a theoretical explanation for his findings. Semmelweis is now considered a pioneer in the field of antiseptic procedures.

Insight and Application

The leadership lesson from the story of Ignaz Philipp Semmelweis is the importance of open-mindedness and the willingness to challenge the status quo. Semmelweis observed and analyzed the difference in maternal mortality rates between the two clinics and identified a problem that had gone unnoticed for a long time. He did not accept the traditional view that puerperal fever was an inevitable outcome of childbirth. Instead, he used his analytical skills to propose a new theory that linked cadaverous contamination and puerperal fever.

In the late nineteenth century, no one knew that microorganisms caused infections and surmised that illnesses were caused by other means. With puerperal fever, the medical establishment thought that at least 30 different things might cause this and routinely used bloodletting and purging as standard therapies.

Despite the publication of numerous experiments demonstrating that handwashing saved lives, Semmelweis’s observations clashed with the established scientific and medical standards of the time and his ideas were rejected. It was difficult for him to provide a hypothetical explanation for his findings of reduced mortality due to handwashing. Some doctors were also irritated by the suggestion that they wash their hands and mocked Semmelweis for it.

Semmelweis’ lack of tolerance for criticism may have contributed to his downfall. He lashed out at those who disagreed with him, making enemies out of hospital employees who would then sometimes sabotage his antiseptic initiatives. As a result, in 1851, when he had been deprived of numerous perks, he left the Viennese General Hospital.

Three brilliant young doctors supported Semmelweis, and slowly but steadily, these physicians overthrew rigid and outdated methods of the establishment. Despite their encouragement, Semmelweis was resistant to publishing the results of his practice and conducting the experiments that would help corroborate it. Years later, when Semmelweis finally published his findings, it was done so in a ramshackle fashion, unpolished, and subsequently unaccepted by the medical and scientific community. The world had to wait another 15 years until researchers, such as Louis Pasteur, developed the theoretical framework for microbes causing diseases before there was the widespread adoption of sterilization and antiseptic procedures in hospitals.

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