Semmelweis Reflex: Rejecting New Information Without Knowledge
Prof. Dr. Kadircan KESKİNBORA
Bahçeşehir University Faculty of Medicine
HBT Magazine Issue 102 – 9 March 2018
“Semmelweis reflex” is the name given to the situation where people automatically (reflexively) reject information without subjecting it to any experience or observation. The term was first coined by author Robert Anton Wilson, who was famous for his studies on puerperal fever. It was inspired by what happened to Ignaz Semmelweis.
Ignaz Philipp Semmelweis (1818 – 1865) was an obstetrician and gynecologist working in Vienna. He was a German of Hungarian origin. Semmelweis noticed that the death rates due to puerperal sepsis (puerperal fever) were very high in women giving birth in the clinic where he worked. There was a certain order of patient visits in the hospital, and specialist doctors would lecture medical students on the cadaver before going to the delivery room. Doctors were aware of hand cleaning, but the importance of hand washing was not discovered as much as it is today. Gloves had not been invented and the age of antibiotics had not yet begun. At that time, the healthcare community knew how to wash hands, but they were unaware of the importance of hand washing. Nobody knew about such a thing as surgical gloves. In fact, it is said that in France, blood stains on surgeons' aprons showed their seniority, so surgeons did not wash their aprons. So, the dirtier the gown, the more experienced the surgeon. There is no hand washing either. Therefore, deaths from infections were quite high. Since surgeons did not wash their hands and operated in dirty aprons, surgical infections were not taken into consideration at that time, saying "it is in the nature of this job".
There were two delivery rooms in the hospital where Semmelweis worked: one was the 1st hall, where trainee doctors entered for medical education, and the other was the 2nd hall, where trainee midwives entered for midwifery training. Semmelweis saw that while the sepsis rate was over 30% in the births that took place in the hall where the doctors entered, it was within normal limits in the other hall. When he investigated the reason for this, he realized that the doctors came to this hall after dealing with cadavers in the anatomy class. In those days, a colleague of his who performed an autopsy on a patient who died due to puerperal sepsis and accidentally cut his own finger during the autopsy, died with the same symptoms, which opened Semmelweis' horizons: He began to think that the cause of the deaths of women and children was "the contamination of healthy people by small cadaver particles".
French chemist and pharmacist Antoine-Germain Labarraque found that a chlorinated solution (the ancestor of today's bleach) used to bleach textile materials had antiseptic properties and recommended doctors to use this solution for the disinfection of open wounds. It was also heard that during the plague epidemic, every part of Paris, the capital of France, was washed with "chlorine".
Semmelweis asked all doctors to wash their hands with “Labarraque solution” after examining cadavers and before each patient. And the surprise he expected happened: The death rate dropped from 30% to 2%. He observed that, similar to puerperal fever, patients with open and watery wounds and those who were hospitalized in the same ward for different reasons also contracted the infection. He began to think that "tiny microbes in open wounds are airborne." Naturally, he compiled all these observations and findings and published information about the signs, symptoms and preventive measures of infectious diseases. He advised all surgeons to wash their hands before starting surgeries. The dates showed the year 1847.
What Happened to Semmelweiss
However, his colleagues very harshly rejected the possibility that these deaths could have occurred due to "doctor error". They put forward opinions such as that doctors' hand washing is sufficient, that what they say is meaningless, especially considering the cleanliness of "Viennese" doctors, that diseases cannot be transmitted from cadavers, that if what they say is true, the death rate should be much higher, and so on. Semmelweis's claims were considered exaggerated, unrealistic, without sufficient evidence, and excessive. His colleagues complained about Semmelweis to important media outlets and medical academies. Due to his Hungarian origin, the attacks gradually reached the level of racism. He was accused of quackery and expelled from the university. The information he put forward was forgotten, and Semmelweis, who could not explain his problem to anyone, left the profession after a while. He fell into depression, so much so that; It is said that he stopped young couples he saw while walking on the streets of Vienna and warned them, "Tell your doctor when you are going to have a baby, and make sure he washes his hands before giving birth." He was eventually committed to a mental hospital and died there in 1865.
As we have seen, the theses he put forward were rejected by his colleagues without any counter-theses, research or detailed examination. This behavior was called the Semmelweis reflex.
Antisepsis
These discussions in 1847 reached their final conclusion 20 years later, after Louis Pasteur's antisepsis studies. Semmelweis was right, the soap did not kill all the germs on the hands and the cause of the disease was due to unknowingly incorrect application by the “doctors”.
Were all of Semmelweis's claims true? Puerperal fever was not transmitted from cadaver particles, as was thought. This disease is caused by a bacterium called "Streptococcus pyogenes", which resides in the pharynx and normal skin of healthy people. This disease occurs easily when hygienic conditions are not met adequately at birth. Semmelweis was wrong about the cause of puerperal fever, but thanks to his important observations and the rational sanction he applied, he enabled doctors to intervene with "germ-free" hands while passing from patient to patient, thus preventing the emergence of the disease. Thanks to all this work, Dr. Ignaz Semmelweis took his rightful place as the "savior of mothers" in those days and the "father of antisepsis" in surgery today.
Another Antisepsis Advocate: Dr. Joseph Lister
Another name is also mentioned as the father of antisepsis in medicine: Joseph Lister (1827-1912). The germ theory, put forward by Pasteur in 1864 by proving that it was found everywhere, even in the human body, gave a new direction to Lister's work.
It is not known whether Lister was unaware of what Semmelweis had done or whether he was aware of it, he drew attention to the same issue, said the same things, but unlike him, he managed to convince his colleagues. Lister is one of those who initiated the golden age of surgery in medicine with the discovery of anesthesia.
Lister notices that the waters are clear and clear on one side of the Thames River, which was full of dirt and flowing turbidly at that time. When he investigated the cause, he found that the "carbolic acid" used to process leather in a tannery operating in that region was the cause. Lister, who had an epiphany at that moment, concentrated his work in this field and introduced the concept of antisepsis by proving that carbolic acid kills microbes. The results are excellent when all surgical instruments and the hands of the surgical team performing the surgery are washed with carbolic acid. This invention of Lister (actually the invention of which Semmeweis could not convince anyone) and the discovery of anesthesia ushered in a new era in surgery: the golden age of surgery.
It is a sad fact that many medical books do not mention Semmelweis, and long after that, Joseph Lister, who advocated the use of antiseptic solution in surgical interventions, was mentioned more often and even was mentioned as the father of the idea.
Resources:
1) Van de Laar. Under the Knife (Trans. Gürer E.). Istanbul, Koç Univ. Publications. 2016, pp.116-7
2) http://chronotopeblog.com/2015/06/06/the-semmelweis-reflex-why-does-education-ignore-important-research/ Access:22.4.2017
3)http://www.filozof.net/Turkce/tarih/tarihi-kisilikte-sahsiyetler/19285-joseph-lister-kimdir-hayati-eserleri-hakkinda-bilgi.html?showall=&start=1 Access: 20.2.2018
Access: 20.2.2018