Ignaz Semmelweis and the Cure No One Used

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Ignaz Semmelweis“On March 20, 1849 Ignaz Semmelweis was removed from his position in the lying-in department.”

This sentence appears at the bottom of page 355 of a book named Medicine: Volume 5 by Harold Nicolas Moyer, published by G.S. Davis on January 1, 1899. The book is written in the type of century-old English that made use of big words and long sentences. It appears so quickly and so indistinctly that it offers a sense of unimportance. It is almost a footnote in the life of Semmelweis.

But, the reason for the “removal” of Ignaz Semmelweis had repercussions that sounded around the world.

Modern Medicine

Dr. Semmelweis came into his own at a time when medicine was undergoing a massive shift in thinking. Ideas of evil spirits and spells cast by sorcerers as a reason for illness was giving sway to the scientific process, examination, evaluation and training. It was a virtual ground zero for the medical profession as we know it today. The complete inexperience and misunderstanding of the medical community then seems ridiculous to us now. But they did not benefit from the equation of trial and error for over a century and a half as we do. Medicine then did not have the second, most important part of the equation to look at; error.

For instance, Mrs. Winslow’s Soothing Syrup was a concoction manufactured by Jeremiah Curtis and Benjamin Perkins of Maine. The two are told to have gotten the recipe from Charlotte Winslow, who was Jeremiah’s mother-in-law. She “developed” the wonder drug while she was a nurse herself. This mixture was an absolute blessing (she thought) to the infants for whom she cared. It would instantly soothe and treat even the most unconsolable child, regardless of the ailment. The medicine was a huge hit and in 1868 the company reported to have sold around 1.5 million bottles annually. It seemed the drug worked wonders for relieving pain in infants and stress in parents. Maybe because of it’s primary ingredient,

65mg per fluid ounce of morphine in every bottle!

Consider this comment by NurseLoey on drugs.com about doses of morphine. “I am a hospice nurse and the standard dose of liquid morphine to keep a pt comfortable is 5mg every 2 hours as needed for pain or shortness of breath.”

This from a nurse who treats fully grown patients in the most excruciating time of most of their lives. But Mrs. Winslow was pumping babies full of it on a regular basis.

In 1911 the American Medical Association wrote a book called Nostrums And Quackery, Articles on the Nostrum Evil and Quackery. It is basically an outing of all scams and cons that the AMA could research from sorcery to mail fraud. One sickening section called “Baby Killers” is exactly what it says. In it  Mrs. Winslow’s “remedy” was ripped to shreds. But it wasn’t pulled from the shelves for 19 years after the publication.

Laudanum

Another remedy, indicative of our medical knowledge during the 1800’s was Laudanum. It was initially given as a cough suppressant, but because of it’s incredibly addictive qualities was actually used to treat almost every conceivable ailment except death.

In Dr. Chase’s Recipes, written by Dr. A.W. Chase in 1874, he offers a recipe for making laudanum. This was handy in case the lay person wanted to make their own.

Laudanum- Best Turkey opium, 1oz.; slice, and pour upon it boiling water, 1 gill (1/4 pint), and work it in a bowl or mortar until it is dissolved. Then pour it into the bottle, and with alcohol of 76 per cent 1/2 pt. (side note, the alcohol recommended in this recipe of 76 per cent apparently pairs perfectly with your opium. This is a higher percentage of alcohol than almost every liquor available in your neighborhood grocery store, including the famed Bacardi 151.)  Rinse the dish, adding the alcohol to the preparation, shaking well and in 24 hours it will be ready for use.

Famous Faces

Vin Mariani was a “stomach stimulant, pain reliever and appetite suppressant” sold around the same time. It was made from 6mg of cocaine and 17% alcohol per ounce. Angela Mariani, the Corsican scientist who made the concoction had testimonials from HG Wells, Jules Vern, Thomas Edison, the King of Spain and President William McKinley.

Coca-Cola, which included more cocaine was a knock-off of Vin Mariana created by John Pemberton.

Puerperal Fever

Dr. Ignaz Semmelweis entered this environment to save lives and advance the fledgling profession of medicine. Puerperal Fever, better know as childbed fever, was killing patients then at a rate close to that of some lung cancers today. These were not patients with terminal illness. They were pregnant mothers and the babies they were delivering. In some cases hospitals faced a 50% mortality rate during the childbed (puerperal) fever epidemic. Mothers and babies were dying at alarmingly high rates even by century and a half old standards.

On March 13, 1847 professor Jakob Kolletschka died after an infection in his finger. To drive the point home let me write that again.

He died from an infection in his finger.

Dr. How Creatives Get Paid 11 Days FasterSemmelweis noticed some amazing similarities between the infections in the professor and the infections of the victims of childbed fever. The similarities convinced him that the infections were coming from passing “poisons from the dead bodies.”

A Cure

Two months later in May, Semmelweis instituted a rule that before any examinations, doctors or nurses must wash their hands with a chloride of calcium solution. Childbed fever deaths dropped by nearly 70% after this one change. In October Semmelweis realized that the tools were also spreading death. Again he instituted a rule mandating tool cleaning in between examinations. This caused the death rate to spiral downwards towards zero.

As a result the numbers get astounding, so much that by March of 1848, 276 women were admitted to a Vienna hospital without a single death for the first time in years.

The hand and tool washing was a complete success, and Semmelweis was it’s champion. Semmelweis was literally a lifesaver to the 276 women who lived through March of 1848.

Semmelweis Removed

So why is it that one year later Semmelweis was, “removed from his position in the lying-in department?”  Was it that his life-saving technique didn’t include the standard doses of opium, heroin or cocaine for the time? Perhaps there a sinister plot to control the population of the world. Or is the answer even simpler than that?

One likely answer to why Semmelweis was fired has been beautifully demonstrated in a psychological experiment done 120 years later, with toy robots and seven to nine year old boys.

Jonathan Freedman is a very popular name in the anti-child-spanking community of parents. If you dig into the research behind the movement, even briefly, you will find his name and this study cited repeatedly. Because Freedman didn’t study how to change a child’s behavior in the moment. He studied how to influence lasting change, which was the goal of Semmelweis.

Freedman knew that in 1965 most boys of seven to nine years obeyed their parents as a result of the threat of spanking. Spanking was the gold standard of parenting then. There was not an anti-child-spanking community, in fact it was just the opposite.

Who Does the Spanking?

Sunday Dec. 12 1965 article in the Chicago Tribune titled Princess Grace Does the Spanking in Monaco.

In a rare interview with this reporter, Princes Grace discussed how she raised her family.

“Children need much love and affection,” she said, “but also some discipline. I’m rather severe with mine.”

Did Rainier ever apply a hairbrush to his offspring like ordinary fathers?

“Well, sometimes I use my hand on them,” she replied.

Prince Albert, his mother said, already is being taught that it will be his duty one day to govern the principality, and she added: “It is fairly easy to teach him. He is quiet, and thinks a lot.”

He is quiet, and thinks a lot.

Any parent of a toddler knows what a relief those moments of silence can be. The article is not asking about the validity of spanking or if the family used spanking, but how did the family use spanning and who did it.

In the fractured era of LBJ’s Great Society, the start of the Vietnam War, and the racial tensions in the American South the validity of spanking was not on the forefront of societal happenings. The quick peace and quiet it brought, much like Mrs. Winslow’s Soothing Syrup must have been a huge relief.

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The Experiment

But a small experiment happening in the backdrop of this pivotal moment in history would go on to influence the parenting style of the nation. It would also explain why Dr. Semmelweis was fired a century earlier.

This excerpt from Readings in Managerial Psychology by M. Boje explains it best.

“An experiment by Jonathan Freedman gives us some hints about what to do and what not to do in this regard.

Freedman wanted to see if he could prevent second to fourth grade boys form playing with a fascinating toy. But, just because he had said that it was wrong to do so some six weeks earlier. Anyone familiar with seven to none year old boys must realize the enormity of the task. However, Freedman had a plan. If he could first get the boys to convince themselves that it was wrong to play with the forbidden toy, perhaps that belief would keep them from playing with it thereafter. The difficult thing was making the boys believe that it was wrong to amuse themselves with the toy-an extremely expensive, battery controlled robot. (This was in 1965)

Threats or Real Change

Freedman knew it would be easy enough to have a boy obey temporarily. All he had to do was threaten the boy with severe consequences should he be caught playing with the toy. As long as he was nearby to deal out stiff punishment, Freedman figured that few boys would risk operating the robot. He was right. Freedman would say, “It is wrong to play with the robot. If you play with the robot I’ll be very angry and will have to do something about it.” He then left the room for a few minutes. The boy was then observed secretly through a one-way mirror. Freedman tried this threat procedure on twenty-two different boys. Twenty-one of them never touched the robot while he was gone.

So a strong threat was successful while the boys thought they might be caught and punished. But Freeedman had already guessed that. He was really interested in the effectiveness of the threat in guiding the boys’ behavior later on, when he was no longer around.

Six Weeks Later

Freedman sent a young woman back to the boys’ school about six weeks after he had been there. She took the boys out of the class one at a time to participate in an experiment. Then each boy went back to the room with the five toys.The assistant gave him a drawing test without ever mentioning any connection with Freedman.

She told the boy that he was free to play with any toy in the room while she was scoring the test. Of course, almost all the boys played with a toy. The interesting result was that, of the boys playing with a toy, 77 percent chose to play with the robot that had been forbidden to them earlier. Freedman’s severe threat, which had been so successful six weeks before, was almost totally unsuccessful when he was no longer able to back it up with punishment.

Round Two

But Freedman wasn’t finished yet. He changed his procedure slightly with a second sample of boys. These boys were also initially shown the array of five toys. Freedman warned them not to play with the robot while he was briefly out of the room. His reason again was, “it is wrong to play with the robot.” This time, Freedman provided no strong threat to frighten a boy into obedience. He simply left the room and observed through the one-way mirror. Now he wanted to see if his instruction against placing with the forbidden toy was enough. It was. Just as with the other sample, only one of the twenty-two boys touched the robot during the short time Freedman was gone.

A Difference

The real difference between the two samples of boys came six weeks later, when they had a chance to play with the toys while Freedman was no longer around. An astonishing thing happened with the boys who had earlier been given no strong threat against playing with the robot. When given the freedom to play with any toy they wished, most avoided the robot, even though it was by far the most attractive of the five toys available. (The others were a cheap plastic submarine, a child’s baseball glove without a ball, an unloaded toy rifle, and a toy tractor.) While these boys played with one of the five toys, only 33 percent chose the robot.

Something dramatic had happened to both groups of boys. For the first group, it was the severe threat they heard from Freedman to back up his statement that playing with the robot was “wrong.” It had been quite effective at first, while Freedman could catch them. Should they violate his rule later, though, when he was no longer present to observe the boys’ behavior, his threat was impotent. His rule was, consequently, ignored. It seems clear that the threat had not taught the boys that operating the robot was wrong. Only that it was unwise to do so when the possibility of punishment existed.

Group Two

For the other boys, the dramatic event had come from the inside, not the outside. Freeman had instructed them, too, that playing with the robot was wrong, but he had added no threat of punishment should they disobey him.

There were two important results.

First, Freedman’s instruction alone was enough to prevent the boys from operating the robot while he was briefly out of the room. Second, the boys took personal responsibility for their choice to stay away from the robot during that time. They decided that they hadn’t played with it because they didn’t want to. After all, there were no strong punishments associated with the toy to explain their behavior otherwise. Thus, weeks later, when Freedman was nowhere around, they still ignored the robot because they had been changed inside to believe the they did not want to play with it.”

Real Change

Freedman proved that, at least in young boys playing with robots, forcing them to act a certain way did not change their minds about acting that way. Threats only created the desirable situation in the moment, but it did not create lasting change. Although this experiment was done on children, it demonstrates exactly what happened to Dr. Semmelweis.

Not much is written about the firing of Dr. Semmelweis, but a few scattered sentences like the one at the beginning of this post. But his angry and abusive personality is well documented and has been surmised as the reason for his termination.

It is widely accepted that he forced and threatened his sanitation practices into existence. Sherwin B. Nunland captured the personality of Semmelweis using the doctors own words in his book Doctors: The Biography of Medicine.

In His Own Words

Here is an excerpt.

“To Josef Spaeth, Professor of Obstetric at the Josefs-Akademie of the University of Vienna, he wrote:

Herr Professor, you have convinced me that the Puerperal Sun which arose in Vienna in the year 1847 has not enlightened your mind even though it shone so near to you. This arrogant ignoring of my doctrine, this arrogant boasting about errors, demands that I make the following declaration. Within myself, I bear the knowledge that since the year 1847 thousands and thousands of puerperal women and infants who have died would not have died had I not kept silent. Instead of providing the necessary correction to every error that has been spread about puerperal fever. And you, Herr Professor, have been a partner in this massacre.

More Damage

Friedrich Scanzoni, Professor of Obstetrics at Wurzburg was admittedly was wrong about hand washing. But he advanced the medical practice by leaps in his life. To him Semmelweis wrote:

“Should you, Herr Professor, without having disproved my doctrine, continue to train your pupils with the doctrine of epidemic childbed fever, I declare before God and the world that you are a murderer and the “History of Childbed Fever” would not be unjust to you  if it memorialized you as a medical Nero.”

The book goes on to explain that Semmelweis never saw himself as anything but an outsider. He came from a humble background, did not read or write nearly as well as his counterparts and did not have the confidence to stand up to any criticism. His lack of charisma and confidence coupled with his anger and arrogance would steal his opportunity to influence the world.

Enter Joseph Lister

It wan’t until 1867 when a man named Joseph Lister of Listerine fame showed up and actually began influencing doctors to wash their tools. If you are keeping track that is 18 years of uneccessary childbed fever deaths.

Between 1849, when Semmelweis was fired, but had proved his hand washing technique and 1867 when Joseph Lister began influencing doctors to wash roughly 584,500 babies died, just in England and Wales.

How many Mother Teresa, Gahndis, scientific breakthroughs and bestseller did we lose in those 18 years? Not because we didn’t want to, or didn’t know how, but because one man didn’t have the influence. It wouldn’t be until 1867 that someone with influence would use the information Semmelweis had worked so hard to get to actually save lives.

The End

But, by then Semmelweis was dead.

Reportedly he died in 1865 mentally incapacitated. He was possibly beaten to death by his “caretakers” in the mental facility in which he spent his final days.

We are not usually subjects of the conspiracy, or fate. More often we are the recipients of the rewards offered by the life we have chosen to live. But more importantly, by the person we have chosen to become.

The chapter on Semmelweis in Doctors: The Biography of Medicine ends this way.

“And so Sophocles might have written it, with a Greek chorus of dying mothers a great hero, a great truth, a great mission, and finally a mad flight of passionate arrogance resulting in destruction. The gods who were the professors of obstetrics did not bring it about; the hero brought it upon himself.”

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