It's true, I'm not always known to be a conformist. I can be difficult and occasionally disagree
in matters of opinion (the definition of a dissenter). The next time someone comments about my lack
of conformity, I'll quote Professor Cass Sunstein from the University of
Chicago "Dissenters benefit others while conformists benefit
themselves."
Semmelweiss was the quintessential dissenter. He challenged the conformists' accepted
wisdom and sought answers to problems that, in his mind, had not be suitably
explained. But for challenging the norm,
he was ostracized, condemned, and driven to a state of near insanity that led
to an early death. July 1st marked what
would have been Ignaz Semmelweiss' 195th birthday. His legacy of positive dissent, benefited
patients not just in his lifetime, but has been essential to patient safety
ever since. It seems fitting to pay
homage to the man who, through his "difficult" manner and positive
dissent from accepted wisdom in the introduction of antiseptic hand hygiene,
has saved the lives of millions of patients.
wisdom and sought answers to problems that, in his mind, had not be suitably
explained. But for challenging the norm,
he was ostracized, condemned, and driven to a state of near insanity that led
to an early death. July 1st marked what
would have been Ignaz Semmelweiss' 195th birthday. His legacy of positive dissent, benefited
patients not just in his lifetime, but has been essential to patient safety
ever since. It seems fitting to pay
homage to the man who, through his "difficult" manner and positive
dissent from accepted wisdom in the introduction of antiseptic hand hygiene,
has saved the lives of millions of patients.
The General Hospital of Vienna boasted quite favorable
conditions for its time. Unlike its
contemporaries of the early part of the 19th century who often had 3 or 4
patients/bed, the General Hospital of Vienna's policy was 1 patient/bed. They further segregated patient care by
class: a section for the wealthy, a section for patients who were able to pay a
small sum for care and a third section and certainly the largest for those who
were unable to pay. The indigent
patients were permitted free care with the understanding that some of that care
would be seen to by medical students and midwives in training.
conditions for its time. Unlike its
contemporaries of the early part of the 19th century who often had 3 or 4
patients/bed, the General Hospital of Vienna's policy was 1 patient/bed. They further segregated patient care by
class: a section for the wealthy, a section for patients who were able to pay a
small sum for care and a third section and certainly the largest for those who
were unable to pay. The indigent
patients were permitted free care with the understanding that some of that care
would be seen to by medical students and midwives in training.
In the indigent section of the hospital there were two
maternity clinics that admitted patients to one or the other on alternate
days. One clinic was largely for
training of midwives while the second was for training of doctors. When Semmelweiss was appointed assistant to
the Professor of the First Obstetrical Clinic some of his first observations
were of women desperately weeping and begging to be admitted to the Second
Obstetrical Clinic rather than the First and for a very good reason, the First
clinic had a deadly reputation.
maternity clinics that admitted patients to one or the other on alternate
days. One clinic was largely for
training of midwives while the second was for training of doctors. When Semmelweiss was appointed assistant to
the Professor of the First Obstetrical Clinic some of his first observations
were of women desperately weeping and begging to be admitted to the Second
Obstetrical Clinic rather than the First and for a very good reason, the First
clinic had a deadly reputation.
In the First Clinic, maternal mortality rates due to
Childbed Fever (a form of septicemia) rarely dipped below 10% of admissions and
in some months climbed as high as 30%.
Conversely, in the Second Clinic where the midwives were in training,
the mortality rate rarely climbed above 2%.
Physicians and governmental authorities were more than aware of the
ravages of Childbed Fever to the point that they were often referred to as
"houses of death", but causes were most often attributed to miasmas
(foul air), improper diet, strong liquors or violent mental emotions.
Childbed Fever (a form of septicemia) rarely dipped below 10% of admissions and
in some months climbed as high as 30%.
Conversely, in the Second Clinic where the midwives were in training,
the mortality rate rarely climbed above 2%.
Physicians and governmental authorities were more than aware of the
ravages of Childbed Fever to the point that they were often referred to as
"houses of death", but causes were most often attributed to miasmas
(foul air), improper diet, strong liquors or violent mental emotions.
Haunted by the higher rates of Childbed Fever in the
First Clinic, Semmelweiss was unwilling to accept the conformist view. The only difference between the two clinics
were the people working there. After
eliminating all factor that were consistent between the two clinics he
eventually concluded that the medical students were carrying "cadaverous
particles" (e.g. microbes) on their person to the First Clinic after performing
autopsies of patients who had died from Childbed Fever. When his best friend and fellow physician
died after being cut by a student during an autopsy he was compelled to
act. He was convinced the cause of
transmission was from contaminated hands of physicians and students.
First Clinic, Semmelweiss was unwilling to accept the conformist view. The only difference between the two clinics
were the people working there. After
eliminating all factor that were consistent between the two clinics he
eventually concluded that the medical students were carrying "cadaverous
particles" (e.g. microbes) on their person to the First Clinic after performing
autopsies of patients who had died from Childbed Fever. When his best friend and fellow physician
died after being cut by a student during an autopsy he was compelled to
act. He was convinced the cause of
transmission was from contaminated hands of physicians and students.
Semmelweiss demanded that all students and physicians
clean their hands with a chlorinated lye solution before attending patients in
the First Clinic in order to remove or destroy the invisible cadaverous
particles. The strategy worked and
deaths attributable to Childbed Fever rapidly dropped to below that of the
Second Clinic where the midwives had always kept their hands clean and did not
attend autopsies. Unfortunately, rather
than celebrations and change in practice the culture of conformity triumphed
and Semmelweiss was forced to resign his position and subsequently the
mortality rates in the First Clinic returned to pre-intervention levels.
clean their hands with a chlorinated lye solution before attending patients in
the First Clinic in order to remove or destroy the invisible cadaverous
particles. The strategy worked and
deaths attributable to Childbed Fever rapidly dropped to below that of the
Second Clinic where the midwives had always kept their hands clean and did not
attend autopsies. Unfortunately, rather
than celebrations and change in practice the culture of conformity triumphed
and Semmelweiss was forced to resign his position and subsequently the
mortality rates in the First Clinic returned to pre-intervention levels.
As we know, Semmelweiss' ideas were eventually accepted
and he has become widely recognized as the "Father of Hand
Hygiene". In celebration of his
195th birthday, I hope the next time you sing "Happy Birthday" while
washing your hands, you'll remember Ignaz Semmelweiss!
and he has become widely recognized as the "Father of Hand
Hygiene". In celebration of his
195th birthday, I hope the next time you sing "Happy Birthday" while
washing your hands, you'll remember Ignaz Semmelweiss!
Bugging Off!
Nicole
