| Semmelweis
reflex |
Date Written |
2008 |
| Author |
Joe Holmes |
Date Revised |
|
The “Semmelweis reflex” is from the real life
experience of Dr Ignaz Philipp Semmelweis (his brief life story
is included below) who is now recognized as a pioneer of antiseptic
policy in medical procedures. From 1847 to 1865 he proved beyond
any doubt that basic chlorine washings of hands and medical instruments
in hospitals could save thousands of lives. Because germs had not
yet been discovered he could prove that medical sanitation worked
but not why it worked therefore even some Drs that saw it work rejected
it.
The “Semmelweis reflex” refers to a problem common in the medical
world. It is the automatic rejection of something different even
if it’s obvious, without giving it serious thought, inspection,
or experiment. It is an outright dismissal of any information that
is radically out of sync with the status quo even if there is strong
empirical evidence to back it up. (Some modern examples)
The “Semmelweis reflex” is often associated with "Eminence
Based Medicine” where Drs gain confidence over an impressive number
of years by repeating the same mistakes of other Drs. Medical professionals
often do this by using medical jargon and offering obtuse opinions
to perpetuate a belief system where authority has more power than
valid science.
Both “Semmelweis reflex” and "Eminence Based Medicine” are
involved in “Medical Myopia” where the medical world is so sure
of something that they even reject overwhelming proof to the contrary
from their own medical research world.
The following life story is a very condensed version of what
Wiki has but matches what I’ve seen in other sources. I have
added a few comments See Wikipedia
Dr Semmelweis
Ignaz Philipp Semmelweis (July 1, 1818 - August 13, 1865)
was a Hungarian physician called the "savior of mothers"
who discovered, by 1847, that the incidence of puerperal fever,
also known as childbed fever could be drastically cut by use
of hand washing standards in obstetrical clinics. (Mothers
and babies were dying from serious infections picked up because
the Drs that delivered them didn’t wash their hands or instruments
after doing autopsies on mothers or babies that had just dyed
from serious infections picked up the same way)
While working at the Vienna General Hospital in Austria, Semmelweis
discovered in 1847 that hand washing with chlorinated lime solutions
reduced the incidence of fatal puerperal fever from about 10 percent
to about 1-2 percent. During 1848 Ignaz Semmelweis widened the scope
of his washing protocol to include all instruments coming in contact
with patients in labor and used mortality rate time series to document
his success in virtually eliminating puerperal fever from the hospital
ward.
The breakthrough for Ignaz Semmelweis occurred in 1847 with
the death of his friend Jakob Kolletschka from an infection
contracted after his finger was accidentally punctured with
a knife while performing a postmortem examination. Kolletschka's
own autopsy showed a pathological situation similar to that
of the women who were dying from puerperal fever. Semmelweis
immediately proposed a connection between cadaveric contamination
and puerperal fever. (At the time many thought that
puerperal fever was a weakness in women and babies and it
didn’t happen in men because they were stronger. Semmelweis
realized that the pus on the knife that cut his friend had
contained the disease and that puerperal fever was not a weakness
in women)
Toward the end of 1847, accounts of Semmelweis's work began to
spread around Europe. Semmelweis and his students wrote letters
to the directors of several prominent maternity clinics; in these
letters they described their recent observations. Ferdinand von
Hebra, Vienna's celebrated dermatologist and the editor of a leading
Austrian medical journal, announced Semmelweis's discovery in the
December 1847 and April 1848 issues of his periodical. Hebra and
claimed that Semmelweis's work had a practical significance comparable
to that of Edward Jenner's introduction of cowpox inoculations to
prevent smallpox.
In late 1848 - a British physician named Routh, who had been Semmelweis's
student when the chlorine washings were initiated, wrote a lecture
explaining Semmelweis's work. The lecture was presented before the
Royal Medical and Surgical Society in London and was published in
a prominent medical journal. A few months later, another of Semmelweis's
former students, M. F. Wieger, published a similar essay in a French
periodical.
Accounts of his discovery were being circulated throughout Europe.
He had reason to expect that the chlorine washings would be widely
adopted and that tens of thousands of lives would be saved.
At the time, diseases were attributed to many different and unrelated
causes. Semmelweis' hypothesis, that there was only one cause, that
all that mattered was cleanliness, was extreme at the time, and
was largely ignored, rejected or ridiculed. He was dismissed from
the hospital and had difficulty finding employment as a medical
doctor.
His observations went against all established scientific medical
opinion of the time. The theory of diseases were highly influenced
by ideas of an imbalance of the basic "four humours" in
the body, a theory known as dyscrasia for which the main treatment
was bloodlettings.
Other more subtle factors may also have played a role. Some surgeons,
for instance, were offended at the suggestion that they should wash
their hands; they felt that their social status as gentlemen was
inconsistent with the idea that their hands could be unclean.
Specifically, Semmelweis' claims were thought to lack scientific
basis, since he could offer no acceptable explanation for his findings.
Such a scientific explanation was only made possible some decades
later when the germ theory of disease was developed by Louis Pasteur,
Joseph Lister, and others.
On 20 May 1851 Semmelweis assumed the relatively insignificant
position of unpaid, honorary head-physician of the obstetrical ward
of Pest's small St. Rochus Hospital. Childbed fever was rampant
at the clinic. After taking over in 1851, Semmelweis virtually eliminated
the disease. During 1851-1855 only 8 patients died from childbed
fever out of 933 births (0.85 percent).
He assumed that position for six years until June 1857.
Despite the results, Semmelweis's ideas were not accepted by the
other obstetricians in Budapest.
Semmelweis next instituted chlorine washings at the University
of Pest maternity clinic. Once again he attained impressive results.
Semmelweis had now achieved dramatic successes at three obstetrical
facilities. Even so, his ideas continued to be ridiculed and rejected
both in Vienna and in Budapest.
Semmelweis's views were much more favorably received in England
than on the continent, but he was more often cited than understood.
In 1856, Semmelweis' assistant József Fleishcer reported the successful
results of handwashings at St. Rochus and Pest maternity institutions
in the Viennese Medical Weekly. The editor remarked sarcastically
that it was time people stopped being misled about the theory of
chlorine washings. A popular translation into English is "it
was time to stop the nonsense of hand washing with chlorine"
In his 1861 book, Semmelweis lamented the slow adoption of his
ideas: "Most medical lecture halls continue to resound with
lectures on epidemic childbed fever and with discourses against
my theories. […] The medical literature for the last twelve years
continues to swell with reports of puerperal epidemics, and in 1854
in Vienna, the birthplace of my theory, 400 maternity patients died
from childbed fever. In published medical works my teachings are
either ignored or attacked. The medical faculty at Würzburg awarded
a prize to a monograph written in 1859 in which my teachings were
rejected".
In a textbook, Carl Braun, Semmelweis's successor as assistant
in the first clinic, never accepted Semmelweis' teachings.
The impact of Braun’s views is clearly visible in the rising mortality
rates in the 1850s.
Beginning from 1861 Semmelweis suffered from nervous complaints.
He turned every conversation to the topic of childbed fever.
A number of unfavorable foreign reviews of his 1861 book prompted
Semmelweis to lash out against his critics in series of open letters
written in 1861-1862. He bitterly attacked various prominent European
obstetricians. The open letters were highly offensive, at times
denouncing his critics as irresponsible murderers or ignoramus.
The attacks undermined his professional credibility.
In mid-1865, his public behavior became irritating and embarrassing
to his associates.
On 30 July 1865 Ferdinand von Hebra lured him to a Viennese insane
asylum located in Lazarettgasse. Semmelweis surmised what was happening
and tried to escape. He was severely beaten by several guards, secured
in a straitjacket and confined to a darkened cell He died after
two weeks, on 13 August 1865, aged 47, from a gangrenous wound,
possibly inflicted by the beating. The autopsy revealed extensive
internal injuries, the cause of death pyemia - blood poisoning.
In maternity clinics this would have been called childbed fever
(In documentary I watched they indicated that when
Semmelweis realized he would be locked up and never released
he broke free and would not let any one or any force stop
him from making it to a part of the hospital where he knew
he could find pus covered medical instruments which he used
to cut himself. The beating occurred as they tried to stop
him. Then as they dragged him away he told them that puerperal
fever was not a weakness in women but was in the pus and he
told them accurately how he would die from it. He hoped that
if the Drs watched him die from childbed fever after cutting
himself that they would get the connection, they didn’t but
he had described accurately in advance how he would die)
A few medical periodicals in Vienna and Budapest included brief
announcements of Semmelweis's death. The rules of the Hungarian
Association of Physicians and Natural Scientists specified that
a commemorative address be delivered in honor of each member who
had died in the preceding year. For Semmelweis there was no address;
his death was never even mentioned
Janos Diescher was appointed Semmelweis' successor at the Pest
University maternity clinic. Immediately mortality rates jumped
sixfold to to six percent. But there were no inquiries and no protests;
the physicians of Budapest said nothing. Almost no one - either
in Vienna or in Budapest - seems to have been willing to acknowledge
Semmelweis's life and work
Semmelweis' advise on chlorine washings was probably more influential
than he realized himself. Many doctors, particularly in Germany,
appeared quite willing to experiment with the practical handwashing
measures that he proposed, but virtually everyone rejected his basic
and ground-breaking theoretical innovation - that the disease had
only one cause, lack of cleanliness.
On a broader scale, to a contemporary reader, Semmelweis would
appear to have demonstrated glaringly evident experimental evidence,
that chlorine washings reduced childbed fever. Today, it may seem
absurd that his claims were rejected, precisely on the grounds of
purported lack of scientific reasoning, or what today would be called
a scientific proof. It is equally absurd that his unpalatable observational
evidence only became palatable when quite unrelated work by Louis
Pasteur in Paris some 20+ years later suddenly offered a theoretical
explanation for Semmelweis' observations - the germ theory of disease.
Semmelweis is now recognized as a pioneer of antiseptic policy
Yet a legacy is the so-called Semmelweis reflex. It is not a "real"
physiological reflex but a metaphor for a certain type of human
behavior characterized by reflex-like rejection of new knowledge
because it contradicts entrenched norms, beliefs or paradigms -
named after Semmelweis whose perfectly reasonable hand-washing suggestions
were ridiculed and rejected by his contemporaries.
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