The sketch and the photograph

The sketch and photograph above are of the same man, Dr Ignaz Semmelweis, a Hungarian doctor who lived between (1818 – 1865). The photograph on the right was taken when Dr Semmelweis was 47 years-old. Within just a few months of it being taken, he was dead. The sketch on the left was made just three-years previously.

The story of Dr Semmelweis is one that I recall whenever I am asked for advice on how to deal with ‘difficult people’, or people who are resisting change. Both terms usually really mean either, “how do I make them do what I want to do’ or “tell me how to make them think how I do”. His story is also one that suggests we make the greatest changes and have the most insight when we see how we are part of the problem.

If you do not know the story of Dr Semmelweis, please just take a few moments to read this.

Dr Semmelweis like all young, enthusiastic professionals arrived at his new job in the maternity clinic at the General Hospital in Vienna and very quickly started collecting some data to understand why so many women in maternity wards were dying from puerperal fever — commonly known as childbed fever. He studied two maternity wards in the hospital. One was staffed by all male doctors and medical students, and the other was staffed by female midwives. And he counted the number of deaths on each ward.

When Semmelweis crunched the numbers, he discovered that women in the clinic staffed by doctors and medical students died at a rate nearly five times higher than women in the midwives' clinic.

Semmelweis went through the differences between the two wards and started ruling out ideas.

Right away he discovered a big difference between the two clinics. In the midwives' clinic, women gave birth on their sides. In the doctors' clinic, women gave birth on their backs. In response, he had women in the doctors' clinic give birth on their sides.

Then Semmelweis noticed that whenever someone on the ward died of childbed fever, a priest would walk slowly through the doctors' clinic, past the women's beds with an attendant ringing a bell. This time Semmelweis theorised that the priest and the bell ringing so terrified the women after birth that they developed a fever, got sick and died.

So Semmelweis had the priest change his route and ditch the bell. As you can guess, it had no effect.

By now, Semmelweis was frustrated. He took a leave from his hospital duties and travelled to Venice. He hoped the break would clear his head.

When Semmelweis got back to the hospital, some sad but important news was waiting for him. One of his colleagues, a pathologist, had fallen ill and died. Semmelweis studied the pathologist's symptoms and realized the pathologist died from the same thing as the women he had autopsied. This was a revelation: Childbed fever wasn't something only women in childbirth got sick from. It was something other people in the hospital could get sick from as well. None of this, of course, answered Semmelweis' original question: "Why were more women dying from childbed fever in the doctors' clinic than in the midwives' clinic?" So Semmelweis hypothesised that there were cadaverous particles, little pieces of corpse, that students were getting on their hands from the cadavers they dissected. And when they delivered the babies, these particles would get inside the women who would develop the disease and die. If Semmelweis' hypothesis was correct, getting rid of those cadaverous particles should cut down on the death rate from childbed fever.

His next step was to order his medical staff to start cleaning their hands and instruments not just with soap but with a chlorine solution. And when he imposed this, the rate of childbed fever fell dramatically. Semmelweis didn't know anything about germs. He chose the chlorine because he thought it would be the best way to get rid of any smell left behind by those little bits of corpse.

You'd think everyone would be thrilled. Semmelweis had solved the problem. But they were not thrilled. For one thing, doctors were upset because Semmelweis' hypothesis made it look like they were the ones giving childbed fever to the women.

For another, his ideas and approach (that were the genesis for modern germ theory) went against all existing medical theory and accepted practice. And Dr Semmelweis, dedicated and committed as he was a ‘bloody difficult person’. He was not very tactful, infact he could be downright rude. He publicly berated people who disagreed with him and he made some influential enemies. Just three months before his death, the journal of his own hospital published a paper denouncing his ideas.

Semmelweis tried to convince doctors in other parts of Europe to wash with chlorine, but no one would listen to him. Eventually, even the doctors in his own hospital gave up the chlorine hand-washing, and Semmelweis lost his job. Depressed, rejected and publicly criticised – even his wife said he was wrong, he died prematurely in an asylum.

Question: Do we need to let go of being ‘right’ and knowing the answers?