Something Completely Different

Medicine bites man: Take a number please...

well anyway as I was saying… last Saturday night (that would be July 12th, 2009), I happened to read the wiki biographical entry about a great, but little known man of science Ignaz Semmelweis. Semmelwies discovered that having his clinic staff wash their hands with a chlorinated lime solution after performing autopsies dramatically reduced the mortality rate in the Vienna General Hospital maternity clinic where he was the director. He was of course, rediscovering the principle of contagion, which had been lost in the western world since the fall of the Roman Empire. He even supported his conclusion with carefully collected statistical evidence, based on his review of the mortality rates of all the major hospitals in Europe for the previous 100 years.

Surprisingly enough, the reaction of the medical community ranged from complete indifference to outright scorn. He not only lost his position, he struggled continue his work for the next 14 years. Employment was so hard for him to find, that he often worked as a volunteer, saving lives in every clinic in which he practiced using the same hygenic methodolgy.

In 1861 he started having “mental problems” of some sort. These are listed in Wikipedia as “severe depression, excessive absent mindedness” and turning “every conversation to the topic of childbed fever” Evidently he was still cognitively intact for he also published Etiology, Concept and Prophylaxis of Childbed Fever that same year. His book was received negatively. In response, he wrote a series of open letters refuting his critics, calling them “irresponsible murderers” and “ignoramuses” among other things.

Theories about the cause of his mental state include senile dementia, emotional exhaustion or even syphilis which was apparently a “common” illness in obstetricians who worked in free clinics (!).

Wiki bios can be prefunctory, so I don’t know what justified pathologizing the poor guy’s mental breakdown. Personally, I think that simple human frustration and disappointment would have been enough for most people. Semmelweis’s professional conduct suggests that he cared very deeply about his patients’ safety and clearly understood that failing to heed his findings was causing countless unnecessary deaths. Why else would he have KEPT TRYING to sell his technique with an increasingly hostile medical profession and an oblivious public, even as it cost him his livelihood, his reputation and ultimately his life?

While describing his critics in the medical profession as “irresponsible murderers,” isn’t exactly concilatory, it does has a certain ring of truth. The death toll from bad medical practice prior to the 20th century surely rivals that of warfare, famine or pestilence. He wasn’t the only person to make such an assertion about the state of medicine in the 1800’s.

During the yellow fever outbreak in 1793, in which thousands of people died, an English pamphleteer, William Cobbett, published tables that documented the increase in mortality district by district after Benjamin Rush “treated” the populace by bloodletting and purges. Other critics backed up the accusations with similar tables. Cobbett claimed that Rush was bleeding people not because of any scientific findings that supported the practice, but because Rush wanted to be at the helm of something great. Rush sued Cobbett for what he said in a courtroom presided over by one of his old friends. A jury awarded $85,000 in damages to Rush - a huge sum at the time. It so ruined Cobbett that he had to flee to England, thus silencing a vocal critic of Rush’s preposterous medical practices.

By 1865, Semmelweis was drinking immoderately. The resulting deterioration in his behavior led to a plot to institutionalize him that resulted in his demise. He was “lured” to an insane asylum. When he realized what was happening, he tried to escape and was severely beaten by one of the attendants. He died two weeks later of internal bleeding, presumably from the beating and was then buried unmourned and unremarked on August 15th at a funeral attended by almost no one.

Now, I’ve admired Semmelwies since the early 1980’s when I first encountered his story while reading a history of Western medicine. I don’t recall that the account merited more than a paragraph. Interestingly, in 1843, Oliver Wendell Holmes, Sr. had published a very similar hypothesis in America in The New England Quarterly Journal of Medicine. He was even more clearly aware of the real causes of contagion and advocated burning the clothing of anyone who came into contact with the fever and keeping any medical person exposed isolated from patients for a period of six months. I don’t know if Dr. Semmelwies was aware of Holmes’ data, but his progressively worsening situation suggests that if he did it wasn’t helpful.

I’m not really sure what prompted me to summon up a more in-depth version Saturday night. Prior to this, I had always recalled his story as another one of those ironic little historical bon mots, which handily illustrated my sophomoric contention that much of history is really just very, very black humor. But now that I’m older, sadder and wiser, requainting myself with the tragic arc of his life in more detail seriously disturbed me. At 54, I have much more experience with the awful, hopeless finality of human suffering and death.

His story interested me in the first place because I thought I saw parallels in my own experience. In my fearless youth, I too was abused for both advocating ideas and doing things that have all become rather commonplace nowadays. In 1975, I spent a week or so in an old-style mental hospital after boldly telling a policeman I didn’t think there was anything wrong with being gay. My misadventure was thankfully much less traumatic. I wasn’t beaten up, let alone mortally injured, and thus lived to tell it. The extent of the brutality was that I was forcibly medicated when I refused to take a tranquilizer. This only happened once, thereafter I merely cheeked most of the medication and declined to confront the unfolding injustice. I got out after a week because my parents found out where I was and came to Lexington raising holy hell and retrieved me. Looking back 35 years later, I realize that I didn’t then appreciate just how terrifying this experience and it’s implications were. Instead of fleeing the scene, I quietly resumed my miserably bohemian collegate life in exactly the same vein as before in exactly the same mean old town.

Semmelweis’s story is a sobering reminder of one of the more common dangers that people ahead of their time too easily encounter. Innovators from Socrates to Benazir Bhutto have demonstrated that seeking to improving the world makes it quite a dangerous room.
It’s not hard to see why some reform could be considered dangerous to the powers that be, but it’s hard to imagine why something as innocuous as handwashing could result in such a personal catastrophy. What Semmelweis exemplifies, I suppose, is that if you love mankind, you must love him at your own risk.