The Heretics · III of V
The Man Who Asked Doctors to Wash
the life of Ignaz Semmelweis, set down by the author
Vienna and Pest · 1818 – 13 August 1865
after Franz Kafka and Louis-Ferdinand Céline · 7 min
IThe Two Doors
Of all the stories on this shelf, this is the one I find hardest to forgive, and I will tell you why at the end. It begins with two doors in the same Vienna hospital, in the 1840s — the largest maternity clinic on Earth, free care for the poor, the pride of imperial medicine. Behind the First door, mothers were delivered by doctors and medical students. Behind the Second, by midwives. Women were admitted to each on alternating days — an accidental experiment vaster than any ever designed — and here is what it showed, year after year, in ink, in the hospital's own ledgers: behind the midwives' door, childbed fever killed perhaps one new mother in twenty-five. Behind the doctors' door, one in ten — in the worst months, nearly one in three.
The women of Vienna knew the arithmetic before the doctors did. They begged on their knees at admission to be sent to the midwives. Some gave birth in the street, deliberately, in the cold, because a street birth was safer than the First Clinic and still qualified them for care afterwards. Read that again: it was measurably safer to give birth on the cobblestones of Vienna than in the hands of its professors. The professors, for their part, blamed miasmas, the weather, the season, the women's offended modesty, cosmic-telluric influences — a fog of learned nonsense with one property in common: no explanation was permitted to pass through the doctors' own hands.
Into this walked Ignaz Semmelweis — Hungarian, a grocer's son, blunt as a spade, assistant of the First Clinic at twenty-eight. The deaths tormented him physically; colleagues found his distress somewhat unprofessional. He eliminated the fashionable explanations one by one — climate identical behind both doors, crowding identical, ventilation, position, religion, all identical — until nothing remained but the single difference nobody would look at: the people. Who touched the women, and what those people had been touching before.
IIKolletschka
In March 1847 his friend Jakob Kolletschka, professor of forensic medicine, was nicked in the finger by a student's scalpel during an autopsy. He sickened and died within days — and at his autopsy Semmelweis, grieving, saw the thing that broke the case open: pus and inflammation everywhere, the same corrupted tissues, the same signature, organ for organ, as the mothers dying upstairs. A man had caught childbed fever. From a corpse. Through a cut.
Then the light, terrible and total. The doctors and students of the First Clinic began their mornings in the mortuary, dissecting the women who had died the day before, and went straight from the corpses to the living — to internal examinations of labouring mothers — with unwashed or merely soaped hands. There was no germ theory; Pasteur was twenty years away; Semmelweis could only call the agent 'cadaverous particles' clinging to the fingers. But the logic closed like a trap: the midwives did no autopsies. The doctors were the vector. He was the vector — he, who had dissected more diligently than anyone, had been carrying death upstairs on his own conscientious hands. He wrote later, plainly, that God alone knew the number of women he himself had sent early to the grave. Very few people in history have had to swallow such a sentence about themselves. He swallowed it whole, and then he acted.
From May 1847 he stationed a basin of chlorinated lime at the clinic door: every examiner would scrub until the corpse-smell was gone from his hands. That was the entire intervention — a bowl, a chemical, an order. Mortality in the First Clinic fell within months from double digits to around one per cent, below the midwives'. In two months of the following year, not one woman died. Not one. The ledgers again, in ink. Thousands of lives a year, purchasable for the price of humility and lime.
IIIThe Refusal
Now I must explain the refusal, because a reader of good will assumes there must have been evidence on the other side. There was none. There was something stronger than evidence: an insult. Semmelweis's doctrine said, in effect: gentlemen, you are the plague — your learned hands, your diligent mornings of dissection, are the engine of the deaths. Accepting it meant every senior obstetrician in Europe re-reading his own career as a career of accidental killing. Refusing it required only the ordinary human machinery: pride, seniority, and a theory of one's own. An eminent American professor put the creed in a single sentence — doctors are gentlemen, and gentlemen's hands are clean. Under that sentence, mothers died for another thirty years.
His chief, Professor Klein, a mediocrity guarding a hierarchy, took the doctrine as insubordination and blocked his reappointment; Vienna's grandees closed ranks; the failed revolution of 1848, in which Semmelweis had marched, supplied the pretext of politics. In 1850, humiliated, he left Vienna abruptly, without farewells, and went home to Pest — where, given charge of the maternity ward at St. Rochus, he did it all again: chlorine at the door, mortality under one per cent, year upon year. The experiment now had three arms and thousands of subjects. It changed nothing. Prague sneered, Vienna sneered, the textbooks sneered. For fifteen years he watched the profession debate him politely while the wards of Europe filled and emptied, filled and emptied.
So he stopped being polite. His great book — six hundred obsessive pages of tables and fury — was reviewed with condescension. Then came the open letters, which cost him every remaining friend, and which I have read, and which are terrible the way a fire alarm is terrible: 'I denounce you before God and the world as a murderer.' He told one professor that his lectures sent young doctors forth as angels of death. Vienna shook its head: poor Semmelweis, so shrill. Note the trick, because it is timeless — the establishment first drives a man to the edge, then cites the view from the edge as proof he was never sound. Perhaps, by then, the line had truly begun to blur; grief that size, carried that long, alone, deforms a mind. But I ask you plainly: which is the madder document — his letter calling the deaths murder, or the serene annual reports in which they were not even a problem?
IVThe Asylum
By 1865 he was breaking — erratic, raging at the world's smooth face. His wife, his colleagues, the professors of Pest arranged what such circles arrange. He was invited to Vienna, ostensibly to visit a new medical institute; the carriage delivered him instead to the public madhouse. He understood at the door — and he fought. The attendants beat him, forced him into a straitjacket, and locked him in a dark cell. The beating opened wounds, and in that place the wounds were left to rot. Gangrene set in, then the fever, and on the thirteenth of August 1865, aged forty-seven, Ignaz Semmelweis died of sepsis — of childbed fever, in every way that matters: killed by the very class of infection he had spent his life teaching the world to wash away, inside an institution run by the profession that had refused to listen. Kafka was born eighteen years later in the same empire, and never wrote anything as Kafkaesque as the true last month of Semmelweis. Almost no one attended the funeral. The official account of his death stayed quietly false for a century.
And then — the ink barely dry on his file — the world turned. Two years later Joseph Lister, armed with Pasteur's new germs, began soaking surgery in carbolic acid, and was made a baron for it. Pasteur stood before the Academy of Medicine and drew the killer of mothers on a blackboard: a microbe, a chain of little beads. Within a generation, handwashing — his bowl, his lime, his insolent doctrine — was simply medicine, simply obvious, the way it is obvious to you. Budapest raised him a statue with a mother and child at his feet, and renamed its university of medicine Semmelweis. And the profession that broke him now teaches 'the Semmelweis reflex' — the reflexive rejection of evidence that shames the establishment — as a formal warning, in ethics lectures, to students who wash their hands two hundred times a week without once wondering who paid for the custom.
I said I would tell you why this one is hardest for me to forgive. Hypatia was killed by a mob in a dark age; Bruno by an institution defending its heaven. But Semmelweis was destroyed in the age of statistics, by men who could read his tables and simply preferred their standing to their patients' lives. No scripture commanded them. No inquisitor compelled them. It was only vanity, wearing the white coat of reason — proof that the ill nature this shelf documents does not live in any one church or century. It lives in the certainty of comfortable men. Wash your hands of nothing. Remember him.