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Before the discovery of antibiotics and before even the germ theory of contagion, the work of Ignaz (first named Ignác) Semmelweis in the mid-nineteenth century in Vienna seems almost universally understood to be unique in terms of his discoveries about how puerperal sepsis - puerperal fever - (childbed fever) was spread by doctors to patients. He is likewise hailed for uniquely implementing hand washing practices in hospitals and so cutting the death rate from childbed fever of mothers giving birth to around some one per cent (Varga 2009). According to the story, Semmelweis was ostracized at the time for his radical thinking, which eventually drove him insane to the point where his last years were spent in an asylum. The story is used to demonstrate the dangers of 'experts' ignoring, without properly thinking about, new findings that do not fit orthodox 'knowledge', or else responding with automatic denials. Hence the term Semmelweis Reflex is routinely relied upon to make the point.
Until recently I believed in it myself. But then, following a little research, I discovered that the famous Semmelweis story was first comprehensively busted as a myth 91 years ago (Adaiwi 1921); more concisely 33 years ago (Nuland 1978) more concisely still a decade ago (Wainwright 2001) and in the greatest of detail 9 years ago (Nuland 2003).
There are a number of hypothesis for why known fallacies, myths and other false 'facts' continue to be circulated by credulous experts in the academic press (see Arbesman 2012). In this article I make the claim that the long-busted Semmelweis myth is also a supermyth, for the simple reason that it continues to be believed by expert scientist and other skeptics who continue to credulously disseminate it, albeit with excruciatingly unintended irony, as an example of the need for all of us all to be careful to update knowledge in order to avoid spreading myths and fallacies.
With most exquisite irony
In a long line of scientific writing, the Semmelweis story has most lately been credulously disseminated by Samuel Arbesman (2012) in his book ‘The Half-Life of Facts: Why Everything We Know Has An Expiration Date’. Arbesman re-tells the story in an excruciatingly un-intentional ironic attempt to explain why experts fail to appreciate new evidence that contradicts orthodox ‘knowledge’. Arbesman (who incidentally also credulously spread the Spinach, Popeye, Decimal Error Iron Myth after it had been busted here on Best Thinking) is in esteemed company in his acceptance and promoton of the Semmelweis story. Because it is unquestioningly repeated by, for example, the inventors of cognitive dissonance – Tavris and Aronson (2008 – pp. 8, 102), prolific debunker of Bad Science, Ben Goldacre (2009 – p. 293), Research Fellow of the James Randi Foundation, Tim Farley, (no date) and the BBC (2003)
A suitable place to begin is with the Semmelweis story is to examine the essential content of the tale, particularly the versions that are so often told and credulously believed by those who promote themselves as skeptics and scientific experts.
The Semmelweis Story: A credulously believed apocryphal tale
Arbesman’s (2012 pp. 176-177) account of the Semmelweis story is typical of countless renditions that can be read in peer reviewed papers and elsewhere in the academic press and popular science genre:
‘In the 1840’s Ignaz Semmelweis was a noted physician with a keen eye. While he was a young obstetrician working in the hospitals of Vienna, he noticed a curious difference between mothers who delivered in his division of the hospital and those who delivered at home, or using midwives in the other part of the hospital. Those whose babies were delivered by the physicians at the hospital had a much higher incidence of a disease known as childbed fever, which often causes a woman to die shortly after childbirth, than the women delivering with midwives. Specifically, Semmelweis realized that those parts of the hospital that did not have their obstetricians also perform autopsies had similarly low amounts of childbed fever as home deliveries.
Ignaz Semmelweis argued that the doctors – who weren’t just performing autopsies in addition to deliveries but were actually going directly form the morgue to the delivery room – were somehow spreading something from the cadavers to the women giving birth, leading to their deaths.
Semmelweis made a simple suggestion: Doctors performing deliveries should wash their hands with a solution of chlorinated lime beforehand. And this worked. It lowered the cases of childbed fever to one tenth the original amount.
However, rather than being lauded for an idea that saved lives for essentially no cost, Semmelweis was ostracized. In the mid-nineteenth century, there was no germ theory. Instead, the dominant paradigm was a certain theory of biology that blamed disease upon imbalances of “humors”. If you’ve ever noticed that someone is in “good humor,” this is a vestige of this bygone medical idea. So the medical establishment for the most part ignored Semmelweis. This quite likely drove him mad, and he spent his final years in an asylum.’
A Semmelweis Horror Story
Accounts vary with regard to who had Semmelweis admitted to the asylum and why. Moreover there are different accounts of how he actually died. One particularly severe claim has it that members of the medical establishment ordered his murder to silence him. Consider this one from the pen of Donald (2012 p.112-113), which reads like an old Alfred Hitchcock movie plot:
‘When Semmelweis left the clinic, the death rate returned to its original position. In every subsequent post he took up, Semmelweis instituted the same hand-washing regime and the death rate plummeted, but his old enemies had him manoeuvred out of every position he assumed – and the death rate rose in his wake. And still nobody listened. Unbelievably, the Viennese Medical Council saw Semmelweis as a troublemaker, intent on blaming patient and infant death on some of its more influential members, who felt it their right to poke around inside patients with hands still dripping with germs.
Roundly ridiculed as a crank, Semmelweis was cut out of the medical fraternity and marginalized. But he remained unrepentant. Continuing his campaign in exile, Semmelweis published an open letter to the obstetrics fraternity at large, which was, unfortunately for its sender, a little on the antagonistic side. Feeling that decisive action was needed, Semmelweis’ enemies decided to have him declared insane and locked away where he could create no more waves.
In 1865 a small group of physicians, led by Vienna’s leading dermatologist Ferdinand Ritter von Hebra (1816-80), lured Semmelweis to an asylum under the pretense that his opinion was sought on certain matters. No sooner was Semmelweis through the door, he became suspicious and tried to leave, but von Hebra’s henchmen were prepared and they beat Semmelweis so badly that he died shortly after in one of the asylums dungeons.’
The Septic Cut Fallacy
Some propagators of the Semmelweis myth (e.g. Krismnamurthy 2002 p. 227) have it that he died of septicemia from a cut he already had on his finger on entering the asylum. This neatly ironic symmetry providing ingredient of the myth undoubtedly stems from a confabulation of the facts from an earlier key event in the story. Namely, it was the death on March 20 1847 of Jakob Kolletschka from an accidental cut from a medical students knife that led to Kolletschka's death by septicemia and it was this connection that led to Semmelweis' eureka moment of the causal link between infected tissue from cadavers and child-bed fever (see Nuland 2004 p.98). Subsequent investigation of the asylum records in Vienna, an x-ray examination of Semmelweis' remains and an expert pathologist's opinion all suggest that Semmelweis died from internal injuries received during a severe beating, including being 'stomped' on, by several asylum staff (Nuland 2004).
The core components of the Semmelweis Story
The Semmelweis Story then essentially goes like this: In the 1840’s while working as a young doctor in Vienna, Semmelweis noticed a statistical correlation between mothers dying shortly after childbirth due to fever and doctors performing autopsies and using cadavers to demonstrate midwifery techniques prior to attending new born deliveries. Although germ theory was not then known, Semmelweis made the simple but radical suggestion that doctors performing deliveries should thoroughly wash their hands. At his own hospital his idea worked and lowered childbed fever mortality to one tenth of what it had been. However, the orthodox medical establishment ostracized him and ignored his findings because they ran contrary to existing ‘knowledge’. He was less than diplomatic in how he went about disseminating his ‘discovery’ and criticizing those who ignored him, which never helped his cause. The failure of the weirdly stubborn medical establishment to accept his unique yet simple life-saving discovery drove poor Semmelweis literally insane and he died from septicemia of a wound he received in an asylum.
The essential components of the story are as follows:
(1) That Semmelweis made a significant and unique contribution to knowledge about the spread of contagions by doctors and how to prevent such spreading.
(2) That Semmelweis had no theoretical notion regarding what exactly it was that doctors were spreading to their patients because germ theory had not at the time been discovered
(3) That the medical and scientific establishment railed against him simply because his claims went against orthodox ‘knowledge’ about the four humours of medicine and because he was rude in condemning his detractors.
(4) That the failure of others to understand and accept his unique and significant discoveries drove him totally insane.
Mythbusted: Why the Semmelweis story is both myth and supermyth
Contrast the above renditions of the simple and compellingly believable Semmelweis story with Milton Wainwright’s superbly concise busting of it as a myth (Wainwright 2001 p. 173):
‘Semmelweis concluded that childhood fever was spread by a poison found in dead flesh (the so called ‘cadaveric principle’), although the germ theory is mentioned in his book published in 1861 which treated the topic in detail. He boldly stated that, “Puerperal fever is not a contagious disease, but it is conveyable from a sick to a sound puerperal by means of decomposed organic matter.”
By insisting that the cadaveric principle alone caused childbed fever, Semmelweis invoked the wrath of critics. The Dublin-based physician John Denham, for example, pointed out (in 1862) that Semmelweis overlooked the fact that childbed fever frequently appeared in towns there were no lying-in hospitals or dissecting rooms, and in rural districts where medical practitioners were seldom called upon. Many of Semmelweis’ forebears and contemporary critics were also aware of the link between puerperal fever and both erysipelas and scarlet fever. Such observations can now readily explained by the fact that puerperal fever is caused by the haemolytic streptococci which are spread on unwashed hands and on the breath of anyone carrying Streptococcus pyogenis.'
Wainwright (2001) goes further in his myth busting (p.174) as to the true reasons for Semmelweis' treatment by the medical establishment to reveal that an article published in the New England Journal of Medicine and Surgery (Holmes 1843) - five years before 1848 when Semmelweis was credited with the practice - explains that an unnamed doctor had as early as 1835 (thirteen years before Semmelweis began his own work on puerperal fever) demonstrated the good sense to change his clothes after each maternity-related visit and to wash his hands in chlorinated lime. Moreover, since the 1700s the Vienna hospitals had been implementing the recommendations of Charles White that the occurrence of childbed fever could be dramatically reduced by cleanliness and isolating victims.
Wainwright (2001) concludes (p. 174):
‘…we are told that he alone realized that puerperal fever was spread by doctors and could be prevented by antiseptic hand washing. As we have seen this is simply not the case. It is noteworthy that when Semmelweis’ work first became known the famous Edinburgh surgeon James Young Simpson fired off vitriolic letters to the medical journals refuting the idea that the Hungarian doctor should receive any priority on his ideas. Despite this intervention the Semmelweis myth grew, and continues to be uncritically propagated – essentially because it is too good a story to miss. It satisfies our need to elevate the underdog to near mythical status. In so doing, we ignore the many pioneers who went before Semmelweis and miss out on a more complex and more fascinating story.’
Sherwin Nuland (2003) provides a much more detailed myth busting than does Wainwright. Dissapointingly, Nuland does not reference Wainwright's myth busting, even though it went into print three years before his own (Nuland 2003) book. But even more oddly than that, Wainwright failed to cite Nuland's (1979) journal article on the subject. This is a pity because, not having read Nuland's account, Wainwrights’ otherwise important myth busting propagates what we might name The Cadaveric Only Fallacy.
The Cadaveric Only Fallacy
Neat, simplistic, compelling, yet false accounts of the Semmelweis story have it that he believed that childbed fever was spread solely from dead tissue from cadavers. While this provides an easy to recall explanation for why he had his detractors in the medical community, the truth is more complex (see Nuland 1979 p. 261 and p. 266; Nuland 2003 p.19). In fact, as Nuland points out, Semmelweis knew perfectly well that what he described as invisible decomposing organic matter was pus from either living or dead patients. And he explained - while some of his supporters failed to do so clearly - that this pus, which would today be described as bacteria laden ( but not in Semmelweis' lifetime since bacteria had not then been discovered), could be from any source. It could come from a putrid cadaver (as everyone understood his explanation) or a live sick mother, a lanced boil on a live patient or pus soaked sheet from another patient - dead or alive.
If we take the strict difference between the meaning of infectious and contagious to be that described by the Oxford Disctionaries then:
Strictly, a contagious disease is one transmitted by physical contact, whereas an infectious one is transmitted via microorganisms in the air or water.
This means that where the cause of childbed fever was concerned, Semmelweis adhered to the contagious hypothesis, but not the infectious one.
The issue is not only complex, it is also confusing because, as explained above, some writers claim that Semmelweis thought only that the contagion had to come from dead bodies. In this regard, Nuland (2003) is at pains to explain that others in the mid ninteenth century failed to understand that Semmelweis' knew that the childbed fever contagion did not necessarily have to come from pus from dead bodies alone. To repeat the point made above, Semmelweis had also explained that chidbed fever could be caused by contact with the pus from any putrid bodily infection of live patients as well as from those of infected corpses.
The Hand Washing Discovery Fallacy
Again, simple myth mongers will have it that Semmelweis discovered the importance of hygiene and - specifically - hand washing. The truth is once again, as always in this story, more complex. For example, the Vice Chancellor of Liverpool University, J. George Adaiwi's vitriolic destruction of the Semmelweis Myth (Adaiwi 1921) must have been something to behold because even the written text of it still crackles with his electrified determination to set the record straight that Semmelweis was not the unique hygiene pioneer that the myth of Semmelweis claims. Moreover, Adaiwi produces figures to show that Charles White had a better record of hygienic success at reducing childbed fever than the more hallowed Hungarian hand washer.
Semmelweis’ claimed importance of hand washing discovery was not his own at all. This fact then pulls the rug out from under the story that he was driven mad by the failure of others to realize that he alone had made a unique, important and life-saving discovery about the importance of hygiene.
Most importantly, the fact is that Semmelweis was incurring criticism not simply because he was insisting that "arrogant" doctors should wash their hands but because he refused – or at least failed - to recognise evidence that puerperal fever is an infectious (e.g. airborne) as well as a contagious (direct contact) disease
On the question of the cause of his 'madness', given his profession as a young doctor in Venice in 19th century, when 30 per cent of its population was infected with syphilis, it is highly likely that the manifestation of Semmelweis' mental illness was a consequence of him having contracted an earlier syphilitic infection or else as Nuland (1979; 2003) believes he may have had Alzheimer’s Disease.
From Varga (2009), we learn that an in-depth examination of the records of what really happened reveals the extent of Semmelweis’ mental illness, its manifestations, the most likely cause of it being syphilis rather than frustration and rage at his failed attempts to gain credit for the ideas of others. Others have claimed that he had Alzheimer's Disease (Nuland 2003). Whatever disease he had it was that which manifested as mental illness not frustration from being ignored and ridiculed by the medical establishment because since the time of his dismissal from the hospital in Vienna he had lived a happy and prosperous life in Budapest, Hungary from the early 1850's. There he became Chief Obstetrician and was able to implement his hand washing regime with the same excellent resulting decline in mortality rates from childbed fever. He married a woman many years his junior, had many children and earned a lot of money.
Most importantly, Benedek Varga explains the reasons why Semmelweis was committed to an asylum in Vienna and the reasons for the previously unreported role played by the Hungarian political-medical establishment in creating the myth of Semmelweis as a misunderstood and mistreated genius. Varga, who is Director General of the Semmelweis Museum, Library and Archives of the History of Medicine in Budapest, explains why in the late 19th Century Hungary needed to create a scientific hero in order to cement its identity as a modern state, He goes on to explain why, in retrospect, Semmelweis was a perfect choice following the discoveries of Pasteur and Koch. He explains how, in the late 19th Century, the entire scientific community was subjected to a massive nationally funded Hungarian public relations machine, which included the commissioning of monuments and other art to celebrate Semmelweis and, in particular, the insertion of cunningly biased articles in Western medical journals.You can hear the full story here on this video of a paper given on the subject at Oxford Brookes University in Varga (2009) .
Varga (2009) explains that Semmelweis was taken to the asylum in Venice by his own family, following a number of occasions where he had acted inappropriately – such as arriving for dinner totally naked.
Semmelweis was badly beaten by staff at the asylum soon after his arrival and he consequently died, rather ironically, of septicemia two of weeks later. Exactly why he was beaten remains the kind mystery that the complete debunking of the Semmelweis Myth reveals is oddly yet ironically beloved of both dot-joining conspiracy theorists and their arch enemies in the skeptical scientific community alike. I suspect that he may have been beaten because, as Varga reveals, he he was tricked into entering the asylum on the pretext that he was inspecting it and then suddenly committed to it by his family against his will. We must remember that in those days many mental health institutions were frightening places. It seems likely that Semmelweis would have received his injuries whilst fiercely resisting staff who were not only imprisoning him against his will but had done so in what must have been a shocking and frightening nightmare scenario. Whatever the case, he died within two weeks of being committed. He most certainly did not, as Arbesman (2012, p177) writes, spend his final years in an asylum.
In sum, every single one of the four essential components of the Semmelweis Story that are listed above are proven to be completely false.
By omitting crucial facts in order to simply re-tell a compelling uncomplicated story of Semmelweis’ rejection by influential members of the medical establishment, all of the authors who uncritically re-tell it in order to support their own explanations for why inconvenient facts are often ignored are inadvertently hiding the real facts that explain why Semmelweis was treated with indifference by the medical establishment. Quite how these accidental myth spreading ‘skeptics’, including the inventors of the notion of cognitive dissonance (Tavris and Aronson 2008), will deal with this mythbusting remains to be seen. We can only hope that at the very least they will cease their credulous and embarrassing spreading of the Semmelweis Supermyth.
A much more subtle and less specific debunking of the Semmelweis Myth has been provided by Allchin (2001; 2004), who explains how the myth is misused by educators to seek to explain how science derives its authority.
The starting point of the phenomenon that I have identified and named the supermyth is when an orthodox expert in their subject area publishes a statement of purported fact that is based upon an error in reasoning (fallacy) or else upon a factual error. That published claim then takes on a life of its own as it is credulously reinforced as veracious by numerous orthodox respected skeptics who each cite it unquestioningly in their own scholarly publications, in news paper articles, on television and websites. The great irony is that, unlike ordinary myths, supermyths are created by respected orthodox scholars and then credulously disseminated by other experts distinctively in the spirit of promoting the need for skeptical thinking in order to understand how myths are spread and to help us overcome our tendency towards credulous bias. You can read about three Supermyths that I discovered on my Supermyths website and at Dysology.org. Alternatively, clicking on each of them here will take you directly to the Best Thinking article that busts each myth: (a) The Popeye Spinach Supermyth, (b) The Zombie Cop Myth, and (c) The Crime Opportunity Myth.
Not knowing it is actually a myth that was busted over a decade ago (Wainwright 2001) and so believing the apocryphal Semmelweis’ story to be a veracious account, Arbesman (2012 p177) arguably the most recent expert to fall for the myth explains what he believes to be the importance of this famous story. Ironically, his explanations for the errors of others appear now to explain his own:
‘The tendency to ignore information simply because it does not fit within one’s worldview is now known as the Semmelweis reflex, or the Semmelweis effect. It is related to its converse, confirmation bias, where you only learn information that adheres to your worldview.
The Semmelweis reflex and confirmation bias are important aspects of our factual inertia. Even if we are confronted with facts that should cause us to update our understanding of the way the world works, we often neglect to do so.’
At page 179 Arbesman again with great unintended irony underlines why he credulously believes the Semmelweis story is important in helping us to understand expert bias:
'…more often we have to go out of our way to learn something new. Our blindness is not a failure to see the new fact; it’s a failure to see that the facts in our minds have the potential to be out-of-date at all. It’s a lot easier to keep on quoting a fact you learned a few years ago, after having read it in a magazine, than to decide its time to take a closer look…'
Had Arbesman actually heeded his own advice and taken a closer look he would have realised that research has revealed that this apocryphal tale of the poor downtrodden hero Semmelweis is in fact a myth. Why he, like so many other skeptical scientists, are suckers for supermyths is the big question that I am on a quest to try to answer.
It is, of course, remotely possible that Arbesman is some kind of skeptically mischievous experimenting genius who has deliberately peppered his book on the half-life of facts with myths in order to see whether they are spotted by others and pointed out by them as I have done so here and in my Amazon review of his book. But, unless he has written down or made a pre-publication dated video recording of such an aim – along with a list of the myths he has deliberately re-told as though they are veracious knowledge – and left that information in a sealed container with his lawyer, notary public or publisher we should remain highly skeptical of such a possibility. In reality, Arbesman’s Errata and Updates page for The Half-Life of Facts is already pointing the way to a much needed second edition if he is to avoid prolonging the half-life of myths beyond what they would have been had he not written the book in the first place. Most surely that was not his aim.
Here is most certainly an area where more research is needed if we are to ever to get beyond creating and reciting dark and spangly rhetorical explanations for why expert skeptics are suckered by such supermyths. I am rather interested right now in going back as far as I can to seek to discover who first published the Semmelweis Myth. Following Varga's (2009) account I suspect that late 19th century papers, penned by Hungarian scientists and published in English language and German medical journals are a good place to look.
What Nuland, and their more vitriolic skeptical kind (e.g. Adaiwi 1921) have shown us from their careful and comprehensive research is that the claimed Semmelweis Reflex - that favourite lesson that scientists and sceptical scholars rely upon in order to teach the lesson that ‘experts’ relying upon embedded orthodox knowledge can fiercely and without 'thinking' contest new ideas and irrationally reject them, like a knee-jerk reflex, without due regard to the veracity of the new findings - is wrongfully evidenced.
In truth, the particularly negative treatment Semmelweis received in Vienna and from the wider medical community in the mid-nineteenth century was not at all because he had made an unique and well evidenced discovery that flew in the face of orthodox knowledge. The truth is far more complex. Far from being rejected by some kind of collective protective orthodox knowledge reflex mechanism, Semmelweis's problems stemmed from a number of complex and intersecting political, social, scientific, unclear explanations on his part and from his followers, personal failings and personality factors - along with a dose of correspondingly rationally sceptical uncertainties among his peers - that were all at play. That is the true story of Ignác (Ignaz) Semmelweis. These combined factors all came to bear on his life and work over the course of many years. This reality is hardly evidence of a reflex rejection.Moreover, the final ironic symmetry providing twist to the tragic myth of Semmelweis, namely that he died of sepsis from a finger wound received during his final gynecological examination is completely fabricated.
As Kappler and Potter (2005; p. 2) explain:
'Although myths are regarded as fictional representations, they often reveal underlying ideals. Myths often tell us more about our social and cultural values than they do about any particular circumstance. While myths seem to explain events, they more often instruct us on how to integrate an event into our belief systems and worldviews,'
Events transformed into myths take on persuasive motivating power from such memorable larger than life qualities (Bromley, Shupe and Ventimiglia 1979). Ironically, if there is any kind of reflex at all it is to be found in this story it is in the knee-jerk willingness of self-proclaimed skeptical scientists to believe in the Semmelweis Reflex Myth simply because it conforms to their world view. And that most ironic twist does provide veracious ironic symmetry to the busting of a myth that was unintentionally created and organically grown to help us appreciate the importance of veracity.
The Semmelweis myth, in its telling and re-telling has incorporated new fallacies that have allowed it to gain more persuasive appeal to the point where it has become a great 'truth' believed by the scientific community. This Myth, though busted over 90 years ago, is still credulously believed by many in the scientific community. Most ironically, it is based upon the understanding that their telling of the Semmelweis story confirms their doctrine that dis-confirmed knowledge has no place in a scientific world view.
The lesson that we can now take from the strangely ignored busting of the Semmelweis Myth is that we need to understand what it is about such supermyths that makes them so compellingly believable that even skeptical scientists, writing about the problem of myths and fallacies in science, credulously use them, with toe-curling excruciating unintended irony, as veracious examples of the need to avoid relying upon myths. Furthermore, research in the field of supermyths might even throw new light on what it is that is so compellingly attractive about all myths.
Perhaps such research will reveal how long it takes, and why, for busted supermyths to cease being so widely relied upon as though they are veracious knowledge. If it does, I would like to propose that we name that delay the Semmelweis lag.
Adaiwi, J. G. (1921) Charles White of Manchester (1728 1813) and the Arrest of Puerperal Fever. Lyod Roberts Lecture. Manchester Royal Infirmary. http://archive.org/stream/charleswhiteofma00adamuoft/charleswhiteofma00adamuoft_djvu.txt
Allchin, D. (2001) Scientific Myth-Conceptions. Issues and Trends: http://www1.umn.edu/ships/library/myth.pdf
Allchin, D. (2004) Pseudohistory and Pseudoscience. Science & Education 13: 179–195. http://depa.fquim.unam.mx/amyd/archivero/AllchinsobrePseudo_20824.pdf
Arbesman, S. (2012) The Half Life of Facts: Why Everything We Know Has an Expiration Date. New York. Current. Penguin Books.
BBC (2003) H2g2 Ignaz Semmelweis The Guide to Life the Universe and Everything: http://www.bbc.co.uk/dna/hub/A1067663
Bromley, D. Shupe, A, and Ventimiglia, J. (1979) Atrocity tales, the Unification Church, and the social construction of evil. Journal of communication, 29 (3) pp. 42-53.
Donald, G. (2012) When the Earth was Flat: All the Bits of Science we got Wrong. London. Michael O’Mara Books Ltd.
Farley, T. (no date) Skeptic History: A Tale of Two Scientists, Redux. James Randi Educational Foundation.. http://www.randi.org/site/index.php/swift-blog/1757-skeptic-history-a-tale-of-two-scientists-redux.html
Goldacre, B, (2009) Bad Science. London. Fourth Estate.
Holmes, O. W. (1843) The contagiousness of puerperal fever. Reprinted in Medical Classics (1936) pp. 195-268. Taken here from Wainwright, M. (2001) Childbed fever- the Semmelweis myth. Microbiology Today. Vol 28. p. 173.
Kappeler, V. E. and Potter, G. W. (2005) The Mythology of Crime and Criminal Justice. (Fourth Edition) . Long Grove, Illinois, Waveland Press Inc.
Krishnamurthy, K. (2002) Pioneers in Scientific Discovery.New Delhi. Mittal Publications.
Nuland, S. (2003) The Enigma of Semmelweis - an interpretation. Journal of the History of Medicine and Allied Sciences. http://jhmas.oxfordjournals.org/content/XXXIV/3/255.full.pdf
Nuland, S. (2003). The Doctor's Plague: Germs, Childbed Fever and the Strange Story of Ignác Semmelweis . New York. W.W. Norton.
Tavris, C. and Aronson, E. (2008) Mistakes were made (but not by me), why we justify foolish beliefs, bad decisions and hurtful acts. London. Pinter and Martin
Varga, B (2009) The Myth and Cult of Ignaz Semmelweis: Constructing History of Science during the 20th Century. Paper presented at Oxford Brookes University, History of Medicine Seminar Series. 20 Oct. http://www.pulse-project.org/node/177
Wainwright, M. (2001) Childbed fever- the Semmelweis myth. Microbiology Today. Vol 28. pp. 173-174. http://www.sgm.ac.uk/pubs/micro_today/pdf/110102.pdf
Further Reading on this theme:
In 1865 János Balassa wrote a document referring Semmelweis to a mental institution. On July 30 Ferdinand Ritter von Hebra lured him, under the pretense of visiting one of Hebra's "new Institutes", to a Viennese insane asylum located in Lazarettgasse (Landes-Irren-Anstalt in der Lazarettgasse).:293 Semmelweis surmised what was happening and tried to leave. He was severely beaten by several guards, secured in a straitjacket and confined to a darkened cell. Apart from the straitjacket, treatments at the mental institution included dousing with cold water and administering castor oil, a laxative. He died after two weeks, on August 13, 1865, aged 47, from a gangrenous wound, possibly caused by the beating. The autopsy revealed extensive internal injuries, the cause of death pyemia—blood poisoning.:
At the St. Rochus Hospital in Budapest, Semmelweis was allowed to introduce disinfection in the obstetrical division. In 1855 he became professor of theoretical and practical midwifery at the University of Pest. In 1857 he married. But the deaths of two children during the next few years added personal grief to professional suffering, a suffering that intensified as opposition to his ideas spread throughout Europe.
With much reluctance Semmelweis organized his observations and published his great work on puerperal fever, The Etiology, Concept, and Prophylaxis of Childbed Fever (1861). Even this did not silence his opponents, and Semmelweis, unable to accept this resistance, was committed to an insane asylum in 1865, where he died of blood poisoning. Not until 1883 did the Boston Lying-In Hospital introduce methods of antisepsis, methods similar to those used several decades earlier by Semmelweis.
At last, although acceptance of his principles was gaining ground, the long years of controversy and intense preoccupation with defense of his doctrine affected Semmelweis's mind. Because of increasingly eccentric behaviour, he was admitted to a sanatorium for mental disorders. There an infected wound on his finger, received during a gynecological operation, was discovered. Defying all efforts at control, the infection progressed to gangrene followed by extensive sepsis, leading to his death in 1865 at the age of 47. By a tragic irony Semmelweis died from the same manifestations of pyemia as his friend, Kolletschka, whose death provided the clue to the prevention of puerperal fever.
Sadly, Semmelweiss was committed to an insane asylum when he started to exhibit what was possibly the early onset of Alzheimer’s disease. While there he was beaten by the staff and died from his injuries
In 1865 he suffers a mental breakdown. Friends commit him to a mental institution. There -- as though to close the circle on his brief 47-year life -- he cuts his finger. In days, he dies of the very infection that killed his friend Kolletschka and from which he's saved thousands of mothers.
Semmelweis was outraged by the indifference of the medical profession and began writing open and increasingly angry letters to prominent European obstetricians, at times denouncing them as irresponsible murderers. His contemporaries, including his wife, believed he was losing his mind and he was in 1865 committed to an asylum (mental institution). Semmelweis died there only 14 days later, possibly after being severely beaten by guards.
Semmelweis was slow and reluctant as an author, or no doubt his opinions would have obtained an earlier vogue; moreover, he was not only tender-hearted, but also irascible, impatient and tactless. Thus it cannot be said that the stupidity or malignity of his opponents was wholly to blame for the tragical issue of the conflict which brought this man of genius within the gates of an asylum on 20 July 1865. For over a century it was said that he brought with him into this retreat a dissection wound of the right hand, eventually causing his death, a victim of the very disease for the relief of which he had already sacrificed health and fortune. However, it is much more likely that he died of a beating administered by the asylum's staff.
Was it merely the new age of bacteriology that shed fresh light on his theory that renewed his esteem? Benedek Varga adds a new perspective to the otherwise huge, albeit often romanticised, discussion of Semmelweis. Namely the view of how his achievements were used by the Hungarian medical community to strengthen their international reputation. Varga does not question the originality and importance of Semmelweis’s discovery, but locates his changing reputation within the context of late 19th century Hungarian medical society and medical politics.
The Myth and Cult of Ignaz Semmelweis: Constructing History of Science during the 20th Century Benedek Varga
20 Oct 2009, Oxford Brookes University, History of Medicine Seminar Series
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About the Author
Dr Mike Sutton is the originator of the Market Reduction Approach to theft. He is the General Editor of the Internet Journal of Criminology
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