4 November 2013

It Makes (No) Sense

I ask of you to make an exercise of imagination and think that you are a medical doctor in the city of Vienna at one of the world’s best hospitals. You are a true gentleman, member of an elite profession with outstanding education and highly respected by the entire society. You have spent many years learning medicine and you exercise your profession in good faith, doing what you know is best for your patients. You strive to fulfill your duties to the best of your capabilities. Your goal is to make people healthy again and, if the case, save their lives. Despite of your best efforts, some of your patients die. You think that this is the way of nature and even God’s will. After all, not everyone can be saved even if you apply the best of your knowledge in medicine.

The year is 1849 and Vienna is the capital of one of the world’s most powerful empires. Naturally, the hospital in Vienna has the best physicians in (central) Europe. Many smart and highly educated people are practicing the noble science of medicine. However, there are some diseases that can’t be cured and one of them is childbed fever which kills many women very soon after they gave birth. Despite the fact that the women who gave birth in this world-class hospital benefited from the care of some of the best doctors of the time, many of them (up to one third) die soon after their children were born. This must be the will of God or just nature’s way, since even the best doctors in the empire can’t help the new mothers. Certainly this condition - childbed fever – is caused by something that is beyond human understanding. It must have some cosmic origins.

If you detect something that is not quite as it should be, do not forget that it is the year 1849.

One of your colleagues, a fellow doctor, who works in one of the maternity units of the hospital, has a wacky idea that childbed fever can be prevented. This is a bit awkward since the condition is known to be the way of nature, the price that nature sometimes asks for bringing a new life into the world. This weird doctor is Ignaz Philipp Semmelweis. He made the students and trainee doctors who are under his supervision to perform an unusual activity in the middle of their daily routine. Usually, doctors, students and trainee doctors would work on the cadavers in the basement of the hospital. (Cadavers were, and still are, used for teaching and research purposes). Afterwards they would perform their work with (living) patients. The wacky doctor Ignaz Philipp Semmelweis asked his students and trainee doctors to do something very unusual and that made absolutely no sense exactly after finishing the work with the cadavers and just before starting their patient duties. He asked them to wash their hands (with chlorinated lime solutions). The students and trainee doctors were surprised by the unusual request. They couldn’t understand why doctor Semmelweis would ask them to do this since it made absolutely no sense. (Remember, the year is 1849). Some of the trainee doctors complained to the hospital’s management and an investigation was launched since the wacky doctor has created a new protocol and established new rules without the express approval of the management.

Doctor Semmelweis told the hospital’s management board that he noticed that when he washed his hands before working with the women in the maternity, the number of women who got childbed fever decreased dramatically from about 30% to about 1%. He also said that he asked his students and trainee doctors to do the same and that this rule of washing hands before working with patients should be introduced to the entire hospital.

The board wasn’t very happy with this outrageous suggestion and asked doctor Semmelweis to give an explanation. The doctor could only say that cadaveric particles on the doctors’ hands would cause blood poisoning to the women in the maternity. This made no sense to the doctors in the hospital management, since doctors by their very nature could not have dirty hands as factory workers and farmers had. They were true gentlemen. How could they be the cause of a disease which is due to cosmic influences? Clearly doctor Semmelweis is not in his right mind anymore.

Let’s leave the mid-nineteenth century Vienna and come back to today.

For you it makes no sense that for the doctors in the board of the hospital it made no sense to wash their hands before working with (live) patients. This is because you know that bacteria exist. You have the notion of bacteria and of micro-biology. The doctors in those days didn’t have these notions. For them such things simply didn’t exist and naturally since they didn’t exist they can’t cause childbed fever or any other disease.   

This was true also for doctor Ignaz Philipp Semmelweis. He had no notion of bacteria or micro-biology; he used the term of cadaveric particles. 1849 was twenty years before the recognition of Louis Pasteur’s work on micro-biology and its applications in medicine.   

The doctors in the board of the Vienna Hospital were acting to the best of their knowledge. Can you blame them for not knowing something that wasn’t known by anyone? For them, it actually made no sense to wash their hands since they did not know that bacteria (on their hands) existed. The (only) reasonable explanation was that Ignaz Philipp Semmelweis has gone crazy.

In fact, Ignaz Philipp Semmelweis was fired from the hospital in Vienna and soon after was committed into a mental asylum where, fourteen days later he was beaten to death by the guards. Ignaz Philipp Semmelweis died being considered mad, with shame instead of glory. Only twenty years after his death his work received the proper merit.

Earlier I said that the doctors on the board of the Vienna Hospital can’t be blamed for not knowing something that was not known by anyone. What they can be blamed for is: not knowing that there are things they don’t know. They can be blamed for holding too firmly to their existing beliefs and giving too much credit to the mystic explanation. They can be blamed for not accepting that they are not omniscient, that they didn’t accept that they can make mistakes or simply hold invalid opinions. They can be blamed for Ignaz Philipp Semmelweis dyeing in disgrace, but most importantly they are to be blamed for all the women who died from childbed fever in between the time that they rejected Semmelweis’s proposition and the time it was finally accepted that washing hands before working with patients makes sense.

The story of Ignaz Philipp Semmelweis is a sad and bitter one. His story tells us that we should know that there are many things we don’t know. His story tells us that it may very well be the case that what we think makes no sense, in fact, makes all the sense in the world once you add a bit of (missing) knowledge. 

Watch a movie on Ignaz Philipp Semmelweis ...

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