Handwashing? Crazy! Dr. Semmelweis and the ugly power of peer pressure.

"I forbid any to welcome him...or give him water for his hands to wash.
I command all to drive him from their homes, since he is our pollution"
Sophocles - Oedipus Rex

do no harmJune 2020. The findings and fate of Dr. Ignaz Semmelweis are increasingly well known, given the ease with which infectious diseases are transmitted by human hands. The Covid-19 pandemic has brought handwashing into sharp focus, reviving discussion of the obstacles encountered by Dr. Semmelweis, a Hungarian obstetrician at Vienna's General Hospital in 1847.

What Semmelweis learned was that doctors would perform autopsies and then proceed to the obstetrics clinic where they attended women in childbirth, 10% of whom died of childbed fever.* The hospital had another clinic, staffed by midwives and the mortality rate there was 3-4%. This was well known among prospective patients who pleaded to be treated by the midwives. Semmelweis concluded that harmful particles were being brought from the cadavers to the patients, and after introducing handwashing, brought down the mortality rate among obstetric patients very significantly. Note that the mechanisms of bacterial infection were discovered later by Pasteur, Koch and Lister.

Semmelweis & handwashingYou'd think that the medical authorities would be thrilled at this finding but no, Dr. Semmelweis was dismissed because his views conflicted with conventional "wisdom", which held that gentlemen doctors could not possibly be dirty and that miasma (toxic vapour) was the culprit in these cases. In his new position in Budapest, childbed fever deaths diminished to less than one percent, thanks to chlorinated washing of hands and equipment.

Though Semmelweis published and tirelessly presented his findings, they were persistently rejected by the prevailing medical establishment. In 1865 He became depressed, behaved erratically and was deceptively –and violently– confined by colleagues to a mental institution, where he soon died and was forgotten. It was only when the reality of germs, bacteria or microbial pathogens was later determined empirically by Pasteur, Koch and Lister that the specific benefit of handwashing was firmly established.

Dr. Semmelweis' reputation was subsequently rehabilitated, especially in Hungary. His experience has been the subject of behavioral theories –the Semmelweis effect and belief perseverance– as well as biographies, films, plays, and fictional novels.

do no harmA new play, Doctor Semmelweis by Mark Rylance is being planned in London and should do well, given the present circumstances, if theaters ever open again. However, from an interview in The Guardian, Rylance's own words (inadvertently) reveal the hubris of science - "We praise rational behaviour so much, but it was heat or a fire that forged his brilliant mind...The lesson for me is that we should be allowed to be emotional. If we exclude people because they are emotional we may well be missing things in our institutions. That is important, I think.” An instance of exalting rationalist behaviour can be provided by Stephen Pinker, who wrote ironically: "As we care about more of humanity, we’re apt to mistake the harms around us for signs of how low the world has sunk rather than how high our standards have risen.”

In fact this conventional idea that rational behaviour can do no harm should be turned on it's head. The instances where science, technology and industry – all rational activities – do great harm has been overwhelmingly demonstrated by the effects of pollution, disease spillovers and nuclear threats, to name a few. Not only is the idea of allowing the inclusion of emotion by Established Society somewhat arrogant, but the opposite is true; rational instruments should be employed (when they do no harm) by a world of good judgement, comprehensive reason, wisdom and empathy. Nothing else makes any sense. QED.
* The Encyclopedia Britannica puts European maternity hospital mortality rates as high as 30% in the mid-nineteenth century.


See also:
McGilchrist, Iain , The Master and his Emissary: The Divided Brain and the Making of the Western World (Yale UP)
Pinker, Stephen, Enlightenment Now: The Case for Science, Reason, Humanism and Progress (Allen Lane)

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"The Progress Trap - and how to avoid it" Copyright Daniel O'Leary, registered at
the Copyright Office, Consumer and Corporate Affairs, Canada on April 5, 1991 (ref 405917)