Dr. Semmelweis vs. the World
Some of your opinions are probably wrong. What are you going to do about it?
Vienna General Hospital is haunted by the sound of screaming mothers.
It is 1846. Puerperal fever, a putrid cocktail of pus, sweat, and blood, is ravaging the maternity ward. Mothers and their newborn babies are dying by the hundreds.
Into this dreadful scene steps the 28-year-old Dr. Ignaz Semmelweis.
Determined to stem the torrent of death, Semmelweis begins to run some experiments.
He notices that of the two clinics comprising the maternity hospital, one alone bears the brunt of the Puerperal plague, recording a mortality rate of 11% (the second clinic boasts a rate of under 3%).
In fact, so severe is the reputation of the former, that mothers are desperately pleading to avoid it. Writes Semmelweis:
“The patients really do fear the first clinic. Frequently one most witness moving scenes in which patients, kneeling and wringing their hands, beg to be released in order to seek admission to the second clinic.”
Trained scientist that he is, Semmelweis begins to test hypotheses. Maybe overcrowding is the cause? Perhaps it is fear, accelerated by the mournful toll of the priest’s bell echoing down the hallways? Perhaps conception itself is the problem?
No, no, no. One by one, Semmelweis dismisses these theories. He is beginning to lose hope.
But then, a tragic breakthrough. His friend, who had suffered a minor cut from a dirty scalpel used during a post-mortem, dies. His symptoms suggest he has been slain by the same killer who has been stalking the maternity ward.
Though the Great Detective would not be introduced to the world for another 40 years, Semmelweis now engages in a Holmesian act of deduction.
He has known for a while that, while the relatively safe second clinic is populated primarily by midwives, the death-ridden first clinic is filled by doctors, men whose pre-birth routines could quite literally involve picking through corpses.
Perhaps there’s a connection? If his friend died from a dirty scalpel used in an autopsy, could the same thing be happening to the poor women who are being treated by doctors?
Emboldened, Semmelweis imposes a dictum. Doctors and students should wash their hands after the act of autopsy and before examining mothers.
You can guess the results. The mortality rate plummets. The curse seems to have been lifted.
Alas, beliefs are stubborn things.
Not only does Semmelweis’ revolutionary, madcap theory contradict medical consensus, it proves awfully embarrassing for the proud doctors who would, of course, never do anything to cause the deaths of the patients they were sworn to protect.
In any event, everybody knows it’s a simple fact of life that gentlemen simply do not have unclean hands.
In 1848, a wave of revolutionary fervor sweeps through Vienna. Semmelweis is caught in the turmoil. His relationship with the establishment crumbles. In 1849, he retreats into self-imposed exile. His hand-washing policy is brushed back under the carpet from which it came. It wouldn’t be until near the end of the century that hand-washing became a universally accepted medical practice.
Fast-forward 16 years. It is 1865. Semmelweis lies alone in a mental asylum, clutching a wounded hand. He is dying.
The cause?
Sepsis.
During his last visit to the show,
said:“So many people right now have problems that already have solutions and they just don't have a connection to the solution […] Any case study we discuss, we can find that the fact that a solution exists or could exist is a sign that we live in a very possible, possibility-bubbling world, but the fact that it hasn't happened yet means that we got work to do.”
Point is, Semmelweis’ success didn’t require any grand new invention or development (the theory underpinning his hand-washing dictum was actually wrong). The elegantly simple solution — wash your hands! — was in front of him all the time.
We’re all guilty of assuming certain problems are unsolvable without some sort of external breakthrough. Well, perhaps the lesson of Semmelweis is that the solution we’re looking for is already under our noses. ‘All’ we need to do is reframe the problem.
But finding the solution is only half the battle.
Semmelweis had persuasive data. He was ensconced in a hub of European medicine. He was young, ambitious, and intelligent. Yet he could not persuade the medical establishment of his theory. He failed on his own terms. Following his exile, he resorted to writing incendiary letters that merely entrenched the opposition. Argues Greg Satell:
“Semmelweis, thinking his results were enough, didn’t see the value in communicating his work effectively, formatting his publications clearly or even collecting data in a manner that would gain his ideas greater acceptance […] The truth is that ideas alone, even breakthrough ideas, rarely amount to much. Innovations need to be communicated effectively if they are to spread and make an impact on society.”
Harsh, perhaps, but a useful way to frame (that word again) this story. Whether it’s a theory, a creative project, or a startup idea, the solution alone isn’t sufficient. If you can’t communicate, if you can’t coalition build, you’re cooked.
Easier said than done. For a start, as Jason Zweig argued on the show, Semmelweis’ story shows us how it is seriously f*cking hard to change someone’s mind.
At the time, medical consensus was wedded to the “four humors” model of disease — a complex theory dating back to the fourth century BCE.
The theory is too complicated to explain here, but suffice it to say, it hasn’t aged well. Nor has its primary mode of treatment: bloodletting.
It’s easy to dismiss this as barbaric quackery, but this wasn’t the Dark Ages. This was fewer than 200 years ago, in one of the most advanced medical institutions in the world.
So institutionalized was the four humors theory that the establishment simply could not accept a paradigm-shifting perspective like Semmelweis’, even when supported by compelling empirical data.
It didn’t help that their identities — as doctors and gentlemen — had become wrapped up in their beliefs.
Cultural change did eventually happen, of course. Semmelweis won, if not in his lifetime. But it took decades. Cultural lag is real. As the saying goes, science progresses one funeral at a time. Its plans are measured in centuries.
This raises uncomfortable questions. What paradigms are we clinging to today? What consensus views will our descendants look back on with embarrassment in 10, 100, 1000 years’ time? What does this tell us about the importance of intellectual humility in the face of the great unknown?
Perhaps, as Jim often argues, we should treat our assumptions not as core parts of our identities but as gentle, loose, provisional hypotheses. They are not castles to be defended but theories to be prodded, tested, teased, and, when necessary, washed away.
Sources & Further Reading
The Doctor Who Championed Hand-Washing And Briefly Saved Lives; by Rebecca Davis (NPR)
In 1850, Ignaz Semmelweis saved lives with three words: wash your hands; by Dr. Howard Markel (PBS)
The man who discovered that unwashed hands could kill -- and was ridiculed for it; by Meagan Flynn (Washington Post)
‘Wash your hands’ was once controversial medical advice; by Nina Strochlic (National Geographic)
The Semmelweis Myth And Why It’s Not Really True; by Greg Satell (DigitalTonto)
Keep it clean: The surprising 130-year history of handwashing; by Amy Fleming (The Guardian)
The Tragic Fate of Ignaz Philipp Semmelweis; by Julius Bauer, M.D. (California Medicine)
HUMORAL THEORY (CURIOSity Collections)
Ignaz Semmelweis (Wikipedia)
Buen día espero estén bien quisiera preguntarle cómo hago para cambiar los artículos que ustedes ponen en inglés a español con esta aplicación con la que ustedes trabajan ? Gracias