Contents
Niccolò Machiavelli writes that nothing is more difficult, more uncertain and more dangerous than introducing a new order. Anyone who tries has everyone who benefits from the old order against them, and only lukewarm helpers among those whom the new order would benefit. The story of Ignaz Semmelweis is a textbook case of Resistance to the New. He was right, he had numbers, and he still failed in his lifetime.
Two wards, two death rates
Situation
Ignaz Philipp Semmelweis, born in Buda in 1818, becomes an assistant at the First Obstetric Clinic of the Vienna General Hospital on July 1, 1846. The clinic has two divisions. Doctors and medical students work in the first, midwives in the second. In 1846, 11.4% of the women in the first division die of childbed fever, compared with 2.8% in the second. The women of Vienna know this. Some would rather give birth in the street.
Link to the principle
The problem is visible; the numbers are out in the open. Yet the difference is treated as a puzzle, not as an alarm. The existing order has explanations that put the blame on no one: bad air, the patients’ sense of shame, chance.
The trail of the corpses
Situation
Semmelweis tests one explanation after another and rejects them. Then his colleague Jakob Kolletschka dies after being cut by a student’s scalpel during an autopsy. His illness resembles childbed fever. Semmelweis concludes: doctors and students are carrying “cadaverous particles” from the pathology department straight to the women giving birth. Midwives do not perform dissections.
Link to the principle
The new explanation strikes precisely those who would have to accept it. It says: you yourselves are killing these women. Machiavelli would say that it is not only habits that stand against the new here but also self-image and professional standing.
Chlorinated lime
Situation
In mid-May 1847, Semmelweis makes it mandatory to wash hands in a chlorinated lime solution before examinations. In April 1847, the death rate in the first division had been 18.3%. In June, it falls to 2.2%, in July to 1.2%.
Link to the principle
The result is unambiguous. If you think change fails for lack of evidence, you see the opposite here. The evidence is there. What is missing is the profession’s willingness to give up an order in which it looks good.
The rejection
Situation
Few in the medical world accept the teaching. There is no germ theory yet to explain why washing works. Many doctors see every illness as an individual case. Some find it insulting that a gentleman’s hands could be unclean. Semmelweis’s contract expires on March 20, 1849; his boss, Johann Klein, chooses a different assistant. Political tensions after the revolution of 1848 are also cited as a reason. The influential pathologist Rudolf Virchow rejects the teaching. In 1850, Semmelweis leaves Vienna.
Link to the principle
The opponents are determined, the supporters lukewarm. Some colleagues stand by Semmelweis, but no one risks much for him. Added to this is Semmelweis’s own weakness: for a long time, he publishes hardly anything, leaves it to others to present his findings and wins no allies.
The unarmed prophet
Situation
In Pest, Semmelweis introduces handwashing again, with similar success. In 1861, his book “The Etiology, Concept, and Prophylaxis of Childbed Fever” is published. He answers criticism with open letters in which he calls his opponents irresponsible and murderers. In 1865, he is taken to an asylum in Vienna, where he dies of blood poisoning on August 13, 1865. Only with Louis Pasteur and Joseph Lister do germ theory and antisepsis prevail.
Link to the principle
Machiavelli distinguishes between armed and unarmed prophets. The armed ones prevail; the unarmed ones perish. Here, “weapons” means a theory, allies and a language that does not back opponents into a corner. Semmelweis had the truth, but no weapons.
Key takeaways
Key lessons
- Don’t expect good numbers alone to convince anyone.
- Check whom your proposal blames or devalues, and address it.
- Win allies before you fight in public.
- Explain why the new works, not just that it works.
- Keep your tone calm, even when you are right.
Summary
In 1847, Ignaz Semmelweis proved that handwashing saves lives. The medical profession rejected his teaching because it incriminated the doctors themselves, because a theory was missing and because he himself won no allies. His fate shows Machiavelli’s principle: if you introduce something new, being right is not enough. You need support, an explanation and patience.
Sources
- Ignaz Philipp Semmelweis: Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers. Pest, Vienna and Leipzig: C. A. Hartleben 1861 (in German).
- Niccolò Machiavelli: Der Fürst (in German). Translated by Philipp Rippel. Stuttgart: Reclam 1986, Chapter 6.
