What Semmelweis Taught Me

Ignaz Phillip Semmelweis, 1860 engraving by Jenő Doby.

What does a book report on the life of a nineteenth-century Hungarian obstetrician named Ignaz Semmelweis (1818-1865) have to do with art and art education, the subjects I’m now immersed in? Quite a lot, as it happens.

Never heard of Semmelweis? Neither had I until I read a historical fiction about him entitled The Cry and the Covenant, by Morton Thompson. It was in my senior year at Hunter College High School in New York City, in fulfillment of a biology assignment to read and report on a book about someone who had made a major contribution to the life sciences. I have no idea how or why I chose that book about Semmelweis. What I do know is that it left an indelible impression on me, with ripples extending far beyond medicine and biology.

Semmelweis’s transformative work should have made his name a household word the world over. As a young doctor serving as the chief resident in the First Obstetrical Clinic of Vienna’s most prestigious hospital, he discovered an astonishingly simple measure for virtually eradicating puerperal (“childbed”) fever, which had been killing new mothers and infants at an appalling rate. Remarkably, prior to his work, women who gave birth in the street were far more likely to survive than those who entered the hospital.

Observing that the mortality rates in the First Clinic were more than double those in the hospital’s Second Clinic, Semmelweis deduced the cause. Whereas the Second Clinic was attended only by midwives, the First Clinic was under the care of doctors in training, who often went directly from studying cadavers in the autopsy room to examining women in labor. Though the germ theory of infection had not yet been established as a fundamental principle of medicine, Semmelweis reasoned that the medical students were unwittingly transmitting some unknown contaminant through cadaverous material left on their hands.

In response, he instituted a policy requiring students to wash their hands in a solution of chlorated lime before examining patients. (Since that solution was most effective in eliminating the putrid smell of infected cadaverous tissue, Semmelweis surmised that it eradicated the infectious material itself.) As of April 1847, the mortality rate in the First Clinic had been 18.3%. After hand washing was begun in May, the rate in successive months dropped to 2.2%, 1.2%, 1.9%, and even zero—rates comparable to those in the Second Clinic.

In the following year, Semmelweis stipulated that all instruments used to examine women in labor should also be cleaned beforehand in the chlorine solution—which resulted in the virtual elimination of childbed fever in the First Clinic. Numerous further confirmations of his policy’s salutary effect were forthcoming and were disseminated to the medical community through published papers, professional presentations, and word of mouth.

A Terrible Truth

The transcendent lesson to be learned from the life of Semmelweis lay not in his remarkable discovery, however. It lay in the medical establishment’s stubborn resistance to adopting his simple preventive measure. Despite the overwhelming evidence of its effectiveness, Semmelweis’s policy was almost universally ridiculed and rejected. Eminent German physicians derided him as der Pesther Narr (the Fool from Pest). The vast majority of doctors clung to their prior notions regarding the cause of childbed fever—ranging from miasmas to imbalance in the mothers’ bodily humors. Long-established physicians and hospital administrators in the more “advanced” European countries were not about to be shown up by a young upstart from Hungary. Still less were they disposed to acknowledge that their practices were responsible for countless deaths.

Semmelweis eventually lost his position at the hospital and was impelled to return to Hungary. From there he tried in further desperation to enlighten fellow physicians regarding his urgent findings. Not until nearly two decades later was he posthumously vindicated in the eyes of the medical establishment, however, when Louis Pasteur demonstrated the underlying microbiology of infection. In the interim, thousands of women and babies needlessly died. So, too, Semmelweis himself tragically and prematurely died, possibly driven to insanity by his inability to save those helpless victims of other doctors’ blind stupidity.

Ironically, the Viennese hospital that had once driven Semmelweis out in ignominy is now named after him. But his story was so notorious a blot on the medical profession that its students are now taught to beware the “Semmelweis effect”—the reflex-like tendency to reject new evidence or knowledge because it contradicts established beliefs. As I wrote in my book report (thanks to pack-rat tendencies, I still have the original!), his experience “shows the necessity of a completely open, un-prejudiced mind in science.”

Though I did not comment on it at the time, the wider lesson to be learned from Semmelweis’s case lodged itself in the recesses of my memory. The tendency to reject anything that challenges established views is a universal psychological phenomenon. As one of Semmelweis’s friends observes in Thompson’s novel, it is “the oldest disease of humanity.” It applies not just to science but to every sphere of human life. I see it clearly in my encounters with the art establishment. The striking difference is that the present groupthink operates against tradition in favor of anything radically new in the guise of art. Art historians, critics, cultural trustees and administrators alike are now wedded to the “institutional theory,” under which virtually anything can qualify as art—from a urinal purchased in a plumbing-supply store to a piece of purported music consisting of nothing more than the ambient noise of the concert hall. What they are not prepared to accept is a theory that challenges that view.

With the example of Semmelweis to inspire me, however, I persist undaunted in arguing that the “institutional” definition of art—and all the nonsense that flows from it—is absurd. For a telling example of the nonsense, see “Fake Art—the Rauschenberg Phenomenon.”