Mastery (30 page)

After much thinking and studying of the literature on the subject, Semmelweis came to the startling conclusion that it was the direct, hand-to-hand contact between doctor and patient that caused the disease—a revolutionary concept at the time. As he was formulating this theory, an event occurred that seemed to prove it conclusively: A leading doctor in the department had been accidently pricked in the finger by a knife while conducting an autopsy on a woman who had had childbed fever, and the doctor died within a few days of a massive infection. When they dissected his body, he had the same white pus and putrid flesh as the woman.

It now seemed clear to Semmelweis that in the autopsy room the physicians’ hands became infected, and in examining the women and delivering the babies, they passed the disease into the women’s blood through various open wounds. The physicians were literally poisoning their patients with childbed fever. If this was the cause, it would be simple to solve—doctors would have to wash and disinfect their hands before handling any patients, a practice no one followed in any hospital at the time. He instituted this practice in his ward, and the number of mortalities was instantly halved.

On the brink of perhaps a major discovery in science—the connection between germs and contagious disease—Semmelweis seemed to be on his way to an illustrious career. But there was one problem. The head of the department, Johann Klein, was a most conservative gentleman who wanted his doctors to adhere to strict medical orthodoxies established by previous practice. He believed that Semmelweis was an inexperienced doctor turned radical, who wanted to overturn the establishment and make a name for himself in the process.

Semmelweis argued with him incessantly over the subject of childbed fever, and when the young man finally promulgated his theory, Klein became furious. The implication was that doctors, including Klein himself, had been murdering their patients, and this was too much to take. (Klein himself ascribed the lower number of mortalities in Semmelweis’s ward to a new ventilation system he had installed.) When in 1849 Semmelweis’s assistantship was nearing its end, Klein refused to renew it, essentially leaving the young man without a job.

By now, however, Semmelweis had gained several key allies within the medical department, particularly among the younger set. They urged him to conduct some controlled experiments to strengthen his case, and then to write up his findings in a book that would spread his theory throughout Europe. Semmelweis, however, could not turn his attention away from the battle with Klein. Day by day his anger rose. Klein’s adherence to a ridiculous and disproven theory about the fever was criminal. Such blindness to the truth made his blood boil. How could one man have such power in his field? Why should Semmelweis have to take so much of his time to do experiments and write books, when the truth was already so apparent? He decided instead to give a series of lectures on the subject, in which he could also express his scorn toward the closed-mindedness of so many in the profession.

Doctors from all over Europe attended Semmelweis’s lectures. Although some remained skeptical, he won over more converts to his cause. His allies at the university pressed him to continue the momentum by doing more research and by writing a book on his theory. But within a few months of the lectures, and for reasons no one could understand, Semmelweis
suddenly left town and returned to his native Budapest, where he found the university and medical position that had eluded him in Vienna. It seemed he could not endure another moment in the same city as Klein, and required complete freedom to operate on his own—even though Budapest was somewhat of a medical backwater at the time. His friends felt completely betrayed. They had staked their reputations on supporting him, and now he had left them in the lurch.

In the Budapest hospitals where he now worked, Semmelweis instituted his disinfection policies with such a rigor and tyrannical intensity that he cut the mortality rates but alienated almost all of the doctors and nurses he worked with. More and more people were turning against him. He had forced upon everyone his novel ideas on disinfection, but without books or the proper experiments to back them up it seemed that he was merely promoting himself, or obsessed with some fanciful idea of his own creation. The vehemence with which he insisted on its truth only called more attention to the lack of scholarly rigor to back it up. Doctors speculated about other possible causes for his success in cutting the incidence of childbed fever.

Finally in 1860, under pressure from colleagues yet again, he decided to write the book that would explain his theory in full. When he was finished with it, what should have been a relatively small volume had ballooned into a 600-page diatribe that was nearly impossible to read. It was hopelessly repetitive and convoluted. His arguments would turn into polemics as he enumerated the doctors who had opposed him and who were therefore murderers. During such passages his writing became almost apocalyptic.

Now his opponents came out of the woodwork. He had committed himself to writing but had done such a bad job that they could poke holes through his arguments, or merely call attention to his violent tone, which was self-damning enough. His former allies did not rally to his cause. They had come to hate him. His behavior became increasingly grandiose and erratic, until his employers at the hospital had to dismiss him. Virtually penniless and abandoned by almost everyone, he fell ill and died in 1865 at the age of forty-seven.

B.
As a medical student at the University of Padua in Italy in 1602, the Englishman William Harvey (1578–1657) began to entertain doubts about the whole conception of the heart and its function as an organ. What he had been taught in school was based on the theories of the second-century Greek physician Galen, which stated that some blood was manufactured in the liver and some in the heart, and was transported by veins and absorbed by the body, supplying it with nutrition. According to the theory, this blood flowed ever so slowly from the liver and heart to the various parts of the body that needed it, but did not flow back—it was merely consumed. What troubled
Harvey was how much blood the body contained. How could it possibly produce and consume so much liquid?

Over the ensuing years his career prospered, culminating in his appointment as Royal Physician to King James I. During these years, he continued to ponder the same questions about blood and the role of the heart. And by the year 1618 he had come up with a theory: blood flows through the body not slowly but rapidly, the heart acting as a pump. Blood is not produced and consumed; instead it circulates continually.

The problem with this theory was that he had no direct means of verifying it. At the time, to open the heart of a human to study it would spell instant death. The only means available for research was vivisection of animals and the dissection of human corpses. Once the heart was opened in animals, however, it would behave erratically and pump far too rapidly. The mechanics of the heart were complex, and for Harvey they could only be deduced through controlled experiments—such as using elaborate tourniquets on human veins—and could never be observed directly with the eyes.

After many such controlled experiments Harvey felt certain he was correct, but he knew he would have to carefully strategize his next step. His theory was radical. It would overturn many concepts about anatomy that had been accepted as fact for centuries. He knew that to publish his results so far would only stir up enmity and create many enemies for himself. And so, thinking deeply about people’s natural reluctance to accept new ideas, he decided to do the following: he delayed publishing the results of his findings, waiting until he had firmed up his theory and amassed more evidence. In the meantime, he involved his colleagues in further experiments and dissections, always eliciting their opinions. Increasing numbers of them were impressed and supported his new theory. Slowly winning most of them to his side, in 1627 he was appointed to the highest position within the College of Physicians, virtually ensuring him of employment for the rest of his life and freeing him from the worry that his theory would jeopardize his livelihood.

As the court physician, first to James I and then to Charles I who ascended the throne in 1625, Harvey worked diligently to gain royal favor. He played the court diplomat, and avoided aligning himself with any faction or becoming involved in any intrigues. He behaved humbly and with self-deprecation. He confided his discoveries to the king early on to gain his trust and support. In the country, there was a young man who had severely broken ribs on the left side of his chest, leaving a cavity through which one could see and touch the heart. He brought the young man to the king’s court and used him to demonstrate to Charles the nature of the heart’s contractions and expansions, and how the heart worked as a pump for the blood.

Finally, in 1628 he published the results of his years of work, opening the book with a very clever dedication to Charles I: “Most serene King! The
animal’s heart is the basis of its life, its chief member, the sun of its microcosm; on the heart all its activity depends, from the heart all its liveliness and strength arise. Equally is the King the basis of his kingdom, the sun of his microcosm, the heart of the state; from him all power arises and all grace stems.”

The book naturally created a stir, particularly on the Continent, where Harvey was less known. Opposition primarily came from older physicians who could not reconcile themselves with a theory that so completely overturned their idea of anatomy. To the numerous publications that came out to discredit his ideas, Harvey remained mostly silent. An occasional attack from eminent physicians would cause him to write personal letters in which he very politely and yet thoroughly refuted their ideas.

As he had foreseen, with the strength of his position within the medical profession and the court, and with the great amount of evidence he had accumulated over the years, which was clearly outlined in his book, his theory slowly gained acceptance. By the time of Harvey’s death in 1657, his work had become an accepted part of medical doctrine and practice. As his friend Thomas Hobbes would write: “[Harvey was] the only man I know, who, conquering envy, hath established a new doctrine in his life-time.”

The common historical accounts of Semmelweis and Harvey reveal our tendency to ignore the critical role of social intelligence in all fields, including the sciences. For instance, most versions of the Semmelweis story emphasize the tragic shortsightedness of men like Klein who pushed the noble-minded young Hungarian over the edge. With Harvey, they emphasize his theoretical brilliance as the singular cause of his success. But in both cases, social intelligence played a key role. Semmelweis completely ignored its necessity; such considerations annoyed him; all that mattered was the truth. But in his zeal, he unnecessarily alienated Klein, who had faced other disagreements with students before but never to such a degree. Through constant arguing, Semmelweis had pushed Klein to the point of having to fire him, and thus lost an important position within the university from which he could spread his ideas. Consumed with his battle with Klein, he failed to express his theory in a clear and reasonable form, displaying a monumental disregard for the importance of persuading others. If he had merely devoted his time to making his case in writing, he would have saved far more lives in the long run.

Harvey’s success, on the other hand, was greatly due to his social agility. He understood that even a scientist must play the courtier. He involved others in his work, making them emotionally attached to his theory. He published his results in a thoughtful, well-reasoned, and easy-to-read book. And then he quietly allowed his book to speak for itself, knowing that by asserting himself after its publication, he would merely call attention to the person and not the work. He did not give fuel to the foolishness of others by engaging in petty battles, and any opposition to his theories withered away on its own.

Understand: your work is the single greatest means at your disposal for expressing your social intelligence. By being efficient and detail oriented in what you do, you
demonstrate
that you are thinking of the group at large and advancing its cause. By making what you write or present clear and easy to follow, you
show
your care for the audience or public at large. By involving other people in your projects and gracefully accepting their feedback, you
reveal
your comfort with the group dynamic. Work that is solid also protects you from the political conniving and malevolence of others—it is hard to argue with the results you produce. If you are experiencing the pressures of political maneuvering within the group, do not lose your head and become consumed with all of the pettiness. By remaining focused and speaking socially through your work, you will both continue to raise your skill level
and
stand out among all the others who make a lot of noise but produce nothing.

2. Craft the appropriate persona