Chapter 3: The Semmelweis Reflex

"The security provided by a long-held belief system, even when poorly founded, is a strong impediment to progress. General acceptance of a practice becomes the proof of its validity, though it lacks all other merit."

Dr. Bernard Lown, inventor of the defibrillator and Nobel Peace Prize winner, (1921- )

“...I send this message so that our past will always be remembered.”

Optimus Prime

August 13, 1865. Semmelweis is dead. It was a homicide. Two weeks ago he was beaten by the staff of the asylum after a colleague lured him there under false pretenses. When Dr. Semmelweis found out what was happening, he tried to leave, was detained, became aggressive, and was viciously beaten by security. Two weeks later he lies dead of his injuries.

It was not murder, merely a homicide. There was no intent; his death was accidental. A frequent hazard of the “mentally ill.”

Who was he?

Ignaz Semmelweis, M.D., was an Austrian-Hungarian physician, born in 1818. At 47, he died in an insane asylum, which was, ironically, part of the hospital where he had been the head of obstetrics.

Was he mentally ill?

In the 1840’s Semmelweis was appointed the head of obstetrics at Vienna General Hospital. There he practiced medicine. He also practiced critical thinking and science, which cost him his life.

Dr. Semmelweis was unusual in that he made observations prior to drawing conclusions. Unlike his colleagues, his observations were not constrained by what “everybody knows.” Semmelweis made three observations over time and figured out what was happening to young mothers on his watch.

In the obstetrics department at Vienna General there were two clinics. The First Obstetrical Clinic and the Second Obstetrical Clinic. In the First Clinic the mortality rate of young mothers was several times higher than in the Second Clinic. But, it was just accepted and every good doctor “knew” that disease is caused by an imbalance of the basic four humors of the body.

Semmelweis was sickened by the fact that mortality was so much higher in his First Clinic, an issue well known outside the hospital. These clinics served the indigent, alternating days. Expectant mothers desperately tried to avoid the First Clinic; preferring a street birth to being treated in the deadly First Clinic. The first observation: women who delivered before arriving at the hospital rarely died of childbed fever.

Dr. Semmelweis ruled out all differences between the two clinics except one: the people who worked there. In the First Clinic medical students trained; in the Second Clinic midwifery students trained. The second observation: Doctors and medical students (First Clinic) performed autopsies every morning on the dead women; midwifery students (Second Clinic) did not participate in autopsies.

March 13, 1847. 44-year-old Vienna General Hospital Professor of Forensic Medicine, Dr. Jakob Kolletschka lies motionless and naked on an autopsy table. Relevant history: Professor Kolletschka had contracted lymphangitis and phlebitis in an upper extremity and subsequently died febrile with bilateral pleurisy, pericarditis, peritonitis, and meningitis. These pathological findings are those found in the multitudes of women dying of childbed fever. The third observation: One of Dr. Kolletschka’s fingers had been pricked by a medical student with a scalpel that had been used in an autopsy of a dead obstetrical patient. Dr. Semmelweis later wrote, “Day and night I was haunted by the image of Kolletschka's disease and was forced to recognize, ever more decisively, that the disease from which Kolletschka died was identical to that from which so many maternity patients died.”1

Semmelweis theorized unseen “cadaverous particles” were being carried from the dead to the living. He began experimenting with various cleansing agents. Soap and water failed to remove the invisible particles (as it failed to remove the stench from the hands of those who participated in autopsies of women who died of childbed fever.) When chlorinated lime solution (which contains calcium hypochlorite found in today's household chlorine bleach) was tried the death rate fell dramatically. For the first time in years since the initiation of pathological anatomy (the performance of autopsies) the mortality in the First Clinic some months was zero.

Dr. Semmelweis’ theory of cadaverous particles was rejected; as was the lifesaving procedure of hand washing with chlorinated lime solution after autopsies. Why? Dr. Charles Meigs, the prominent and respected obstetrician for whom Meigs Syndrome is named, weighed in: “Doctors are gentlemen and gentlemen’s hands are clean.” Thank you, Dr. Meigs.

Arrogance: The act or habit of making undue claims in an overbearing manner; that species of pride which consists in exorbitant claims of rank, dignity, estimation, or power, or which exalts the worth or importance of the person to an undue degree; proud contempt of others; lordliness; haughtiness; self-assumption; presumption.2

The universal phenomenon of operating from “I already know” prevents real, true, or accurate science. It goes as completely unnoticed today in medicine (a purportedly scientific endeavor) as it did in the days of Dr. Semmelweis. Accurate science accounts for all errors and distortions introduced by the instruments of observation through a thorough understanding of the instruments. The problem is: the observation does not take place at the instruments’ displays; the observation occurs in the minds of the observers. The part of the instrumentation that is not taken into account is the mental processing of the observation, the part of the observational loop that is between the observers’ ears.

If you do not remember history you are condemned to repeat it.

1879: Louis Pasteur discovers streptococcus in the bloodstream of women with childbed fever. Now it’s a visible particle. The rejection of the lifesaving procedure of handwashing with chlorinated lime solution persists.

1900: Routine hand washing is adopted by medicine. This happened over fifty years after Semmelweis demonstrated if you wash your hands in chlorinated lime solution after autopsies your obstetrical patients die about ten times less often. That’s arrogance.

The Semmelweis Reflex: a metaphor for the reflex-like rejection of new knowledge because it contradicts entrenched norms, beliefs, or paradigms. It is the automatic rejecting out-of-hand of something without any investigation whatsoever. It is unscientific to rule something out without investigation.3 Surely it does not occur in something as powerful and scientific as modern medicine!

Here is the abstract from a paper that uncharacteristically came from a 1996 surgery journal:

A 19th century image of the medical profession's attitude toward disease transmission is introduced through Ignaz Semmelweis' hypothesis: Infection can be caused by an external agent transmitted when physicians fail to sterilize their hands between patient examinations. Semmelweis' test of his hypothesis reduced the obstetrical death rate from 18% to almost 1%. However, he was degraded, defrocked, and driven to death by a profession whose emotions contradicted the evidence. Medical professionals like to believe they are not gullible, a trait defined as being easily duped. They rightly believe in their ability to avoid the error of accepting a result not supported by adequate evidence. They are not so free of the complementary error: refusing to accept a result that is supported by adequate evidence, which might be thought of as reverse gullibility. It is just as bad a logical error and just as serious a denial of the best medical care for our patients. Clearly Semmelweis, and later Louis Pasteur and others who were disbelieved, were correct. The profession was duped by its emotional adherence to current practice. To be truly professional, let us believe our evidence rather than our biases and not suffer from reverse gullibility.4

There could be no better description of the Semmelweis Reflex. Dr. John Sarno is getting the Semmelweis Reflex. For decades, Dr. Sarno has been curing chronic pain in the vast majority of his patients. (A noteworthy observation and suggestive his diagnosis is correct.) Back pain, quite uncommon 50 years ago, now costs the U.S. over $100 billion a year. In a truly scientific community, as soon as word got out that a doctor was curing most of his patients of chronic pain, there would be a flurry of scientific investigation to rule it in or rule it out. Oddly, Dr. Sarno does not get flak from the medical community. His work is ignored. That’s unscientific. It is the product of arrogance and ignorance. It is the cause of unimaginable iatrogenic suffering, disability, and death.