THE SEMMELWEIS REFLEX

Ignaz Semmelweis was a Hungarian physician, and a professor of Obstetrics and Gynaecology, who formulated the cause of childbed (puerperal) fever, which claimed many lives in the late 19th century and introduced the concept of antisepsis into medical practice, he is the first one to suggest that a simple act of handwashing can save lives. What a visionary right?? But his story didn’t seem to have a happy ending, so what happened in the time and life of Semmelweis? His story goes like this.

In the year 1846, Semmelweis was appointed as an assistant to a professor of Obstetric clinic in Vienna hospital, the Viennese hospital had two obstetric clinics, the first one was dealt mostly by doctors and medical students, and the second one was dealt with mainly by midwives. The mysterious thing that happened was, the first clinic had a higher maternal mortality rate of up to 10% compared to the second one which had a significantly lower mortality rate of less than 4%. Semmelweis was too much troubled by this bizarre difference in numbers and looked into the issue seriously. He is known to have stated once “It made me so miserable that life seemed worthless" that’s when an unfortunate incident happened to his colleague and a good friend, Jakob Kolletschka who was a professor of Forensic medicine in the Vienna hospital, whose death turned to be a breakthrough for Semmelweis, he found that Prof. Jakob who was poked accidentally with a student’s scalpel which was used for cadaveric post-mortem examination, and his autopsy revealed a pathology similar to the ones found on the women who succumbed to puerperal fever, that was Semmelweis's Eureka moment when he considered if the pathology of the professors autopsy can be attributed to the “cadaveric particles” , then the similar pathology that was found in the autopsy of the puerperal death could also be attributed to the “cadaveric particles” but now the question was how did these women contract those particles, clearly they didn’t have a scalpel cut from the one used for post-mortem examination, when he was analysing these facts that’s when he realised, the visitors of the first Obstetric clinic with significantly high mortality rates were medical students, who used to attend post-mortem cadaveric examination before they would come to the obstetric clinic and he formulated that they could bring these “cadaveric particles” to the obstetric clinic which eventually could cause childbed fever spiking the maternal mortality rates. This is indeed a groundbreaking discovery and this theory was formulated by Semmelweis at a time in which the Germ theory of diseases hasn’t been widely accepted yet. He didn’t just suggest it, but also went on to believe that these “cadaveric particles” were predominantly carried by our hands and a simple act of cleansing our hands before handling a patient would prevent its transmission. So he suggested washing hands with Sodium hypochlorite solution, before performing the obstetric procedure, he believed that could eliminate the cadaveric particles and would reduce the transmission. Once this practice was established to everyone’s astonishment the mortality rate in the first clinic dropped drastically from a whopping 18% to 2%, isn’t that a marvelous thing?? Shouldn’t Semmelweis be celebrated and honored for this remarkable achievement? But that’s not what happened what follows is even more tragic than the deaths that occurred in the obstetric clinics.

Soon after this discovery by Semmelweis, he encouraged all his colleagues to practice handwashing and he even suggested cleaning the surgical instruments which have already proven to reduce the mortality rates. But not just his theory was rejected; Semmelweis was ridiculed, ignored, and humiliated. But, did they not see the obvious evidence sitting right in front of their eyes? The evidence of a drop in mortality rates, after adapting the practice of handwashing and cleanliness at the workplace. In spite of that, why was he treated barbarically, the answer for this is what we will be analyzing now.

The majority of people who rejected Semmelweis’ theory didn’t do it for scientific reasons, most of them did it for Political and cultural reasons, the concept of washing hands suggested that their hands were dirty and they simply couldn’t accept the fact that a Gentleman’s hand is dirty. As ridiculous as it sounds, they were not able to accept or digest the fact they were the ones indeed causing the deaths, by the means of transmitting those particles as suggested by Semmelweis. And they had the advantage of Semmelweis’ theory lacking materialistic evidence; it was just considered as speculation, even though it seemed to be true, they didn’t want to accept it as it would affect their reputation. You can question, whether their reputation is more important than the potential lives that could possibly be lost due to the transmission of those deadly particles, but the sad answer was, their reputation mattered more to them. But the hospital authorities can't be blamed completely, Semmelweis hadn’t published any scientific articles at that time nor did he bring his work to the notice of significant scientific minds of Vienna.

This story of Semmelweis is just an example of the resistance faced by many of the scientific minds in human history, most of the inventions haven’t received nods right away from the first instance they were put forward, most of them were denied due to cultural indifferences and already adapted traditions which is hard to change, and also the so-called herd mentality, which is almost immune to change of any kind. This prevails even now, people and societies in general, find it hard to adapt to change or deviate from their long-held beliefs. Sometimes they fear the innovation put forward might threaten the position of people in power, and also certain societies like to uphold their supremacy or dominancy over the rest of the population. In many cases, the new innovation or technologies should have been denied not because of scientific reason, rather due to such cultural, political, and traditional beliefs. This can even be put forth as an explanation for the developmental differences among different nations with varied geographic distribution, some nations are technologically advanced than its counterpart, which has equal manpower and resources which in turn might be inferior in such development, the reason for such variances can be cited are not due to lack of indigenous ideas or innovative nature or due to lack of genius minds in the later society, but rather due to stark differences in the reception of any new technologies and innovation when put forward to concerned authorities or to the particular person in power. This can be cited even to our Nation, there is no place for doubt with regard to the innovations and technological advancements we have made in the past few decades, but what has to be questioned is whether the resources available here are being fully utilized, it is about the ratio of manpower and resources available to the innovations in different sectors we achieve every year if you see from that point of view you can clearly see the discrepancy there. Again if you look into the reason for it, it will bring us to the same point we started, It’s not about the availability of talent or indigenous minds but rather what matters is the platform we provide for them to get recognition. Here, I would like to quote one of the greatest minds of our Nation and a dearest teacher for millions of students, Dr.A.P.J Abdul Kalam, “What makes life difficult in Indian Organisation is the widespread prevalence of contemptuous pride. It stops us from listening to our juniors, subordinates, and people down the line; You cannot expect a person to deliver results if you humiliate him. The line between firmness and harshness, between strong leadership and bullying, between discipline and vindictiveness, is very fine but it has to be drawn” these words can’t be more true. These words don’t just reflect how our Indian society functions but would be applicable to many other societies with a similar problem.

This is the whole concept of the Semmelweis reflex, which is a metaphor for the reflex-like tendency to reject new evidence or new knowledge because it contradicts established norms, beliefs, or paradigms. Especially in a country like India this is very much applicable because ours is a culturally intertwined society, we take pride in our culture and the values it teaches us, and most of it in fact is true. But from what history has taught us, like the life of Semmelweis, we should always learn from these lessons, improve and try not to repeat the same mistakes in the future. Yes, of course, tradition and values are important, but the same clouding our analytical thinking and hindering the advancements of mankind is not acceptable, most of the traditions we follow today have an explanation behind it, it was justifiable in the time period when it was adapted and followed, but when we move on with time it is ideal to bend the norms of society for the benefits and for the betterment of mankind. After all, the ultimate truth of life is that “Change is the only thing that never changes”.

This concept of Semmelweis Reflex will keep repeating itself in history. Now considering that, what happened to Semmelweis was one such miniature version. The practice of handwashing is one of the major lifelines of antiseptic precautions we follow today, now centuries after his death, we have realized that a theory proposed by a man in a time period when none of the scientific evidence we have today existed, is undeniably one of the groundbreaking discovery; a simple, yet a powerful act. Today he is celebrated and his name will go on to last in history forever.

But what happened in his real life is more than tragic. Semmelweis’ theory was not only rejected, he was humiliated, ridiculed and even he was proposed to have a mental illness. Semmelweis was not just bothered by the fact of his theory being rejected, what affected him more is that, hundreds of people are dying due to a cause that could very well be prevented. Semmelweis still never gave up he wrote open letters criticizing the people in power, and he also wrote to the higher officials, but nothing was of any use. This ultimately led to a change in his behavior, he began to lash out openly at the critics through letters that were full of bitterness, desperation, and fury and were highly polemical and superlatively offensive. He couldn’t tolerate the fact that, many lives are lost due to pure ignorance of a few people and he even went on to call them openly as murderers. Over the course of time he started to behave in an inappropriate manner and spent more time away from family. The cause of his behavioral change couldn’t be attributed to any particular disorder. It was so tragic when his wife who stood with him throughout, at one point in the time believed he was suffering from a mental illness, this turn of events ultimately led to a nervous breakdown, which led him to end up in an Asylum. Days after his admission to the asylum he died, he was believed to have developed gangrene in his right hand, and in his autopsy, his cause of death was mentioned to be blood poisoning as a result of pyemia, in the end, he succumbed to the cause he struggled to fight his whole life. Semmelweis was lucky enough to gain posthumous recognition. This world has witnessed many Semmelweises, whose stories we will never know of. So what we have to learn from his life is not just the practice and the theories he taught us, but also how to treat the Semmelweises of our generation and those of the generations to come.