The Ward in Vienna That Medicine Refused to See - An RC Inspired by IIM Indore

The Vienna General Hospital of the 1840s ran two maternity clinics side by side. One was staffed by physicians and medical students, the other by midwives. Women admitted to the first clinic died of childbed fever at several times the rate of women in the second, and accounts of the period say that some pleaded to be sent to the midwives instead. Ignaz Semmelweis, a young assistant physician in the first clinic, refused to treat the gap as a fact of life.

He ruled out explanation after explanation. Overcrowding was worse in the midwives' ward. The position of mothers during labour made no difference. Then, in 1847, his colleague Jakob Kolletschka died after a student's scalpel cut him during an autopsy, and the course of his illness resembled that of the dying mothers. Semmelweis reasoned that something carried on the hands of doctors, who went straight from the dissecting room to the delivery room, was killing patients. Midwives did not perform autopsies.

He ordered every examiner to wash with a chlorinated lime solution before touching a patient. Reported figures put mortality in the first clinic at close to eighteen percent in the spring of 1847 and at about two percent by the summer. The result should have ended the argument. A fact without a mechanism is easy to dismiss. Semmelweis had no theory of germs to offer, only a pattern, and the work of Pasteur and Koch that would supply one lay years ahead.

A fact without a mechanism is easy to dismiss.

Many colleagues took offence at the suggestion that the hands of gentlemen could carry death. Semmelweis was not kept on at his post in Vienna and wrote furious open letters to critics. He died in 1865 in an asylum, reportedly from an infection that began with a wound.

His manner added to the difficulty. He had trained as an obstetrician, not as a student of infection, and he lectured like a man who believed that evidence spoke for itself. When it did not, he turned to accusation, and he reportedly called physicians who ignored his rule murderers in print. Persuasion requires an audience that feels respected, and he made that nearly impossible.

Defenders of the sceptics make a respectable case. Medicine in that era had seen many confident cures that failed, and a community that accepted every striking correlation would soon drown in error. A physician who asks colleagues to change their habits on the strength of one hospital's figures, and who answers doubt with insult, makes the filter harder to pass.

The episode has nonetheless given a name to a habit. The Semmelweis reflex, a label usually credited to later writers rather than to anyone of his own time, describes the tendency to reject new evidence because it contradicts established norms. The trouble with the label is that it can be applied only in hindsight. Those who rejected his claim believed that they were defending standards, and from the inside, defending standards and defending habits feel exactly alike.

Every institution that has dismissed a true idea has done so in the language of rigour. Every institution that has welcomed a false one has done so in the language of openness. Nothing in the procedures themselves separates the two cases ahead of time. Somewhere among the settled doubts of the present sits a ward in Vienna, and no one can yet say which one.