
A doctor who championed hand-washing and briefly saved lives (2015) - Anon84
https://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives
======
tptacek
I think Semmelweis is interesting for other reasons. From what I understand,
hand-washing was routine in Semmelweis' time; what he specifically championed
was antiseptic washing (in his case with a solution of lime). And: he was an
asshole about it. He had a particular theory of why his particular routine
worked, and it was the wrong one: he believed particles from corpses were
becoming airborne and landing in the wounds of patients. That theory was
tested and falsified by numerous infections occurring in places no corpses had
been present. Challenged with countervailing evidence, he doubled down,
maintaining that childbed fever was caused by the cadaveric particles
generated internally by necrotizing tissue crushed during the birthing
process. Through it all, he was outrageously rude, hurled insults at his
colleagues, stormed into operating theaters, and generally did everything he
could to make sure his life-saving contribution was ignored.

The rudeness is a little interesting, I guess, but the big thing for me is the
idea that just a little bit of intellectual humility --- stick to the
empirical observation and stop yelling at people about corpses! You almost had
it! --- would have made him a household name centuries later.

~~~
vezycash
Hindsight bias is coloring your view of the man.

The article mentions unwashed hands is STILL a problem with physicians TODAY -
with all the years of training, knowledge, books, microscopes that can see
germs in action and most importantly, hundreds of years of evidence.

Changing people's minds is not easy - then or now. Shaming works way better
than just talking. You can see how shaming has helped the cause of open
source, black lives matter, pollution... But even with multiple champions,
these causes are struggling, not a runaway success as you'd expect.

Compare this man to Richard Stallman - see any similarities? I'm sure Stallman
would have been remanded to mental institution if he lived in the 1800s.

Even if this doctor was a giant asshole, I applaud his use of scientific-ish
methods - methodologically cutting off unlikelies until arriving at the root
cause - unwashed hands.

~~~
tedunangst
Are the surgeons who aren't washing their hands today not doing so because
they don't believe in bacteria?

~~~
sammalloy
There was an article that explored this question many years ago, and IIRC, the
answer was because the surgeons were in a hurry and didn’t have much time.
This problem isn’t as common today with the ubiquity of hand sanitizer
dispensers.

~~~
corty
Also, try washing and desinfecting your hands 20 times a day. Your skin will
start causing problems after a few days, usually dryness, itching, rashes,
blisters. Cream helps a bit, but not always. Medical personnel invariably do
have skin problems on hands and forearms.

------
moron4hire
This underscores something that is going on with the COVID-19 pandemic. There
are a lot of complaints about face-mask ordinances that claim there is no
"hard science" to show that masks are effective, followed by some sort of
statement that public policy should be "based on hard science".

For a lot of reasons, hard science isn't all it's cracked up to be, certainly
not by the lay public, who seem to treat it as a "final, definitive word" on
subjects. First of all, it gives a lot more credit to science than even
scientists give. But most importantly, you don't need to know the mechanism of
a problem if you have statistical evidence that your actions are having an
impact. You might not even know it's the direct result of the actual action
you're taking, it might be a knock-on effect from some other action people are
taking in response to the mandated action.

But that doesn't matter. What matters is that lives are saved. You can figure
out the mechanism later. In the meantime, do the superstitious sky-god dance.
Especially when it's really not that big of an imposition.

We know for a fact that most places that have strict mask ordinances are
seeing large reductions in infection rate. Some aren't, but that's actually
not an argument for not wearing masks. Indeed, it's the exact opposite. While
the "hard science" is supposedly unclear, you absolutely should still wear the
mask, so that the confounding variables are easier to discover.

~~~
matz1
>Especially when it's really not that big of an imposition

This is my biggest issue, dismissing it as something trivial. Everybody is
different, for some people it can be huge inconvenience.

~~~
moron4hire
If a specific person's respiratory system is really so bad that a mask would
have a significant, deleterious effect, then a mask ordinance is of no
consequence because that person really should not even be going out in public
at all during the pandemic.

~~~
matz1
Then Its for them to decide that. They may very well knew and accept the what
you called "deleterious" effect.

~~~
corty
It is not just for them to decide that. They are in a risk group and therefore
get infected more easily and spread the infection more easily. It is in their
and all our best interest for them to stay home.

~~~
matz1
>It is not just for them to decide that

So you get to decide it for them ?

>It is in their

This is the issue, you assume its their interest.

~~~
moron4hire
In interests of the public health during an emergency, yes, society gets to
decide. You rights end where your neighbor's nose begins.

~~~
matz1
Right, society eventually get to decide, which society is it? The winner get
to decide. Both side are part of the society. Both side fight for their
interest. The against mask side will fight for its interest, just like the pro
mask people fight for their interest.

>You rights end where your neighbor's nose begins

It goes both ways when you decide to force people who don't want to wear mask
to wear mask.

~~~
moron4hire
So now you're talking about "want". Before you were talking about "can't". So
which is it? Because if it's just "want", that's not people interested in
living in a society.

~~~
matz1
>Because if it's just "want", that's not people interested in living in a
society

Agree, people who don't want to wear mask certainly not interested in living
in a society where they are forced to wear it against their will, thats why
they fight for their interest just like the pro mask people fight for their
interest to live in a society that they want.

------
tropdrop
> _For one thing, doctors were upset because Semmelweis ' hypothesis made it
> look like they were the ones giving childbed fever to the women._

This, I think, is a point that needs amplifying:

Doctor hubris causing harm and even death is not an isolated incident to this
case. This is alluded to with the line about how difficult it is to convince
health care providers to take hand-washing seriously today. One can look to
some horrifying practices in medical history to see a track record of "I'm a
doctor, so I know better than you" that caused needless deaths and sometimes
despicably cruel outcomes. Rosemary Kennedy's case is an example of that
happening all throughout her life, with first this:

 _During her birth, the doctor was not immediately available and the nurse
ordered Rose Kennedy to keep her legs closed, forcing the baby 's head to stay
in the birth canal for two hours._ (caused Rosemary's intellectual
disabilities)

And then lobotomy [1].

On a personal note, my close family member is dealing with cancer. His last
chemotherapy just about killed him - he lost 40 lbs in a week and went from
being in full heath to severely underweight. When he told the doctor that he
just could not do another therapy session - he feels that it will kill him -
the doctor said exactly the above - "I'm a doctor, so I know better than you."
He left that doctor - his tumor was already gone, he continued his last
radiotherapy sessions. He was just like the people mentioned in this article
[2] -

 _The surprising part was that people who were feeling the best at the start
of the therapy ended up feeling the worst. They are the ones most harmed and
who had the most to lose... without significant benefit for their cancer._

1 -
[https://en.wikipedia.org/wiki/Rosemary_Kennedy#Lobotomy](https://en.wikipedia.org/wiki/Rosemary_Kennedy#Lobotomy)
2 - [https://time.com/3968918/when-chemotherapy-does-more-harm-
th...](https://time.com/3968918/when-chemotherapy-does-more-harm-than-good/)

~~~
lordgrenville
Sorry to hear about your family member's bad experience, but glad to hear
they're on the mend. I'd highly recommend Atul Gawande's book _Being Mortal_
which has a lot to say about doctor hubris in treating the terminally ill. He
describes how the patient should guide the treatment based on their own
preferences, informed by the doctor's expertise.

~~~
tropdrop
Thank you for the suggestion!

------
99_00
>Even today, convincing health care providers to take hand-washing seriously
is a challenge. Hundreds of thousands of hospital patients get infections each
year, infections that can be deadly and hard to treat. The Centers for Disease
Control and Prevention says hand hygiene is one of the most important ways to
prevent these infections.

When I wash my hands several times a day they become raw. Moisturizer helps a
bit.

Can't the process be made a bit better?

~~~
opan
I wash my hands at least twenty times a day, probably, and they don't become
raw. I don't use moisturizer either. It could be you have to build up a
tolerance. Some people who don't brush their teeth often will similarly have
discomfort and bleeding when they do brush (like right before a dentist's
appointment).

~~~
refurb
Relative humidity has a _huge_ impact on how dry your hands get. Winter in the
mid-West my hands would crack even with moisturizer. Winter in SF? Never had
an issue.

~~~
99_00
This could be the reason for me. I started washing my hands a lot In winter
when the virus was spreading and my office hadn't allowed work from home.

------
pella
related:

 _" The Semmelweis reflex or "Semmelweis effect" is a metaphor for the reflex-
like tendency to reject new evidence or new knowledge because it contradicts
established norms, beliefs, or paradigms."_
[https://en.wikipedia.org/wiki/Semmelweis_reflex](https://en.wikipedia.org/wiki/Semmelweis_reflex)

\----

Bonus: "Look at yourself objectively" (by Aaron Swartz )

[http://www.aaronsw.com/weblog/semmelweis](http://www.aaronsw.com/weblog/semmelweis)

------
8bitsrule
From 'The Plight of the Obscure Innovator in Science' (Moti Nissani, 1995) [0]
:

"Semmelweis was laughed at in part because he was unable to explain the
observed effect of soiled hands on childbed fever. So, to be believed,
widespread resistance to obscure innovators must be documented and
explained....

"Bernard Barber commented [1962] that 'one of the interesting aspects of the
social process of discovery--the resistance on the part of scientists
themselves to scientific discovery...has been largely neglected as a subject
for systematic investigation.' A third of a century later, the subject has not
yet received the methodical attention it so richly deserves. Only a time-
consuming comprehensive historical survey will help to unravel the extent,
nature, causes, consequences, and cures of this resistance."

[0]
[http://drnissani.net/MNISSANI/PAGEPUB/HISTORY.HTM](http://drnissani.net/MNISSANI/PAGEPUB/HISTORY.HTM)

Semmelweis died in an insane asylum in 1865. Joseph Lister = who'd discovered
the use of carbolic acid that same year - published _Antiseptic Principle of
the Practice of Surgery_ in 1867. He'd read about Louis Pasteur's experiments
confirming germ theory.

------
sammalloy
As much as we like to focus on the past, let’s not forget that we still have a
long way to go. On average, nosocomial infections (hospital-acquired) kill
100,000 Americans per year in US hospitals. There are many issues that have
yet to be resolved. The problem with adequately cleaning and disinfecting
medical scopes, for example, was a recent topic in technology circles (Olympus
TJF-Q180V).

------
cj
Side note: The Knick was a great TV show about a hospital in the early 1900's
before standard treatments for common conditions existed. If you liked this
article, check out this show.

------
dang
Discussion from 2015:
[https://news.ycombinator.com/item?id=8897387](https://news.ycombinator.com/item?id=8897387)

------
ninja3925
Looks like this work led the way to Germ Theory (Pasteur). Pretty cool. Thanks
Semmelweis and Pasteur. [https://hardydiagnostics.com/wp-
content/uploads/2016/05/Semm...](https://hardydiagnostics.com/wp-
content/uploads/2016/05/Semmelwise-and-Handwashing-by-Raquel-Kahler.pdf)

------
deckarep
I’m just gonna leave this right here on the matter:
[https://youtu.be/JwzDG_kIq68](https://youtu.be/JwzDG_kIq68)

~~~
tingletech
interesting, seems to be a reupload of
[https://www.youtube.com/watch?v=WKfolJv6Kx8](https://www.youtube.com/watch?v=WKfolJv6Kx8)

------
berbec
I missed the "A" at the beginning of the article title, and was wondering how
hand-washing helped defeat the Daleks.

------
4ndrewl
Anyone else expecting this to be a Doctor Who story?

~~~
tfitz237
Unnecessary Capitalization Creates Unnecessary Clicks

~~~
iso1210
Unnecessary Capitalization Creates Necessary Revenue

~~~
aspenmayer
Necessary to Whom?

------
michaelkeenan
> Semmelweis was not very tactful. He publicly berated people who disagreed
> with him and made some influential enemies. Eventually the doctors gave up
> the chlorine hand-washing

Something Matthew Benjamin wrote stuck with me: "It is way more important to
preserve trust, goodwill and respect than to get what you want, no matter how
good what you want seems."

It seems like this can't be true - some things are surely more important than
trust, goodwill and respect. What could be more important than saving lives?
But this is an example of that being more true than I'd naively think.

~~~
joe_the_user
_" It is way more important to preserve trust, goodwill and respect than to
get what you want, no matter how good what you want seems."_

That is true if someone is leader of a group. You can't let the thread break
because then you can't anything. But someone is pushing an idea, it's a
different balance, I think. Maybe people understanding the idea is more
important than them liking you.

------
user_50123890
Handwashing is overrated IMO. Yes, it's important for doctors and nurses(who
touch dozens of sick humans a day), people who are in contact with animals,
and small kids who don't have any concept of hygiene.

But for the average adult, they just do not have that many harmful bacteria or
viruses randomly on their hands.

This caused some major issues with the Coronavirus. Eg. if you googled
anything related to it in march, the search results displayed a "wash your
hands message" even though the virus is spread by droplets AKA sharing air
indoors with an infected person.

I can only imagine how many unnecessary infections and deaths this caused when
people thought they were safe if they just washed their hands often. To this
day, I'd say about half of the population has no clue how respitory diseases
spread.

~~~
DanBC
> Eg. if you googled anything related to it in march, the search results
> displayed a "wash your hands message" even though the virus is spread by
> droplets AKA sharing air indoors with an infected person.

There's a fecal-oral route for covid-19, which is why the protocols for people
who share a home with someone infected with covid-19 all mention using a
separate (if possible) toilet, or making sure the room is cleaned thoroughly
after each use.

EG, this from CDC: [https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-
sick/ca...](https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/care-
for-someone.html)

> If possible, have the person who is sick use a separate bedroom and
> bathroom. If possible, have the person who is sick stay in their own “sick
> room” or area and away from others. Try to stay at least 6 feet away from
> the sick person.

Handwashing remains a crucial part of the set of protection measures against
covid-19 and other respiratory disease.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446461/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446461/)

> Improvements in hand hygiene resulted in reductions in gastrointestinal
> illness of 31% (95% confidence intervals [CI]=19%, 42%) and reductions in
> respiratory illness of 21% (95% CI=5%, 34%). The most beneficial
> intervention was hand-hygiene education with use of nonantibacterial soap.
> Use of antibacterial soap showed little added benefit compared with use of
> nonantibacterial soap.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5781206/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5781206/)

> There was moderate to low‐quality evidence of a reduction in both influenza
> and respiratory tract infection with hand hygiene interventions in schools,
> greatest in a lower–middle‐income setting. There was high‐quality evidence
> of a small reduction in respiratory infection in childcare settings. There
> was high‐quality evidence for a large reduction in respiratory infection
> with a hand hygiene intervention in squatter settlements in a low‐income
> setting. There was moderate‐ to high‐quality evidence of no effect on
> secondary transmission of influenza in households that had already
> experienced an index case. While hand hygiene interventions have potential
> to reduce transmission of influenza and acute respiratory tract infections,
> their effectiveness varies depending on setting, context and compliance.

