Dr. Ignaz Semmelweiss– A Martyr to the Germ Theory of Disease, or “All great truths begin as blasphemies.” (GB Shaw)

Followers of political news will by now know of Donald J. Trump’s announcement of his intention to appoint Robert F. Kennedy Jr. head of the Department of Health and Human Services. Mr. Kennedy has no medical degree nor any other scientific training, a fact which makes him completely unqualified to be in charge of a large number of scientists.

Kennedy is also well known for his claim that vaccines cause autism, a claim that has been thoroughly debunked. The original article alleging autism from vaccines, in 1998, has been retracted and the doctor who wrote it lost his license in the UK– but that didn’t change Mr. Kennedy’s mind. A study in the Journal of the American Medical Association with 95,000 subjects, published in 2015, definitively ruled out vaccines as a cause of autism. That didn’t change his mind either.

Among other changes that Mr. Kennedy has announced is a plan to substantially reduce the National Institutes of Health’s emphasis on infectious diseases, switching to an emphasis on chronic disease, lifestyle diseases, nutritional issues, and especially alternative and complementary medicine. This prompted my belated tribute to Dr. Ignaz Semmelweiss, in anticipation of the overthrow of his scientific observations on germs.

Mr. Kennedy is apparently unaware of the numerous divisions within NIH that specifically address such issues as degenerative and autoimmune diseases, aging, toxic substances, nutrition, and so on. There is even a branch for alternative and complementary medicine. It’s not well funded and is ostracized by actual alternative practitioners, but it does focus on non-mainstream medicine.

Back to Semmelweiss (1818-1865). He was a Hungarian doctor who practiced in Vienna, Austria, at a maternity hospital (details of his life are available on Wikipedia). The germ theory of disease was not fully accepted until the 1880’s and doctors were not advised that germs could contaminate any surface. Doctors in his time did not wear gloves, gowns, or masks, and they used no disinfectants. Neither did they wash their hands.

Semmelweiss was impressed by the high incidence of childbed fever at his hospital. About one in ten of the women who delivered babies at the hospital died of the fever. More patients came down with the fever in the doctor’s wards than in the midwife’s wards (roughly 8-12% for the doctors and 3-4% for the midwives). The disease also killed a few of the staff. This happened to Semmelweiss’ colleague after he was inadvertently poked with an instrument during an autopsy. The doctor’s hand became swollen and red, and he soon died with a high fever and signs of sepsis.

Semmelweiss himself did the autopsy on his colleague, and he was struck by the similarity of the disease between the women at his hospital and the young doctor who succumbed after being poked. He immediately theorized that some maleficent particle had been transferred from the deceased autopsy patient to the doctor’s hands, to his blood, and to the next female victim. The doctors did autopsies in the morning and worked on women in the afternoon, without washing their hands or changing their coats (the midwives did no autopsies, which accounted for their lower death rates).

Faced with a threefold difference in mortality rates between midwife’s wards and doctor’s wards, Semmelweiss knew there was something wrong. That something was the autopsies on victims of childbed fever, now known to be usually caused by a virulent Streptococcus bacterium.

Semmelweiss knew that a solution of chlorinated lime was already used at the hospital to remove the stench of death, so in 1847 he ordered the doctors to start washing their hands with this stuff after doing autopsies and before touching patients. The death rate in the doctor’s wards fell to below the rate in the midwife’s wards.

Semmelweiss was rewarded for pushing this innovation by being fired from the hospital and blacklisted in Vienna. He had to return to Hungary and his work was attacked in medical journals. He didn’t publish his results in a journal until 1861. The underlying identity of the “maleficent particle” on the doctor’s hands was not identified until Pasteur established in the mid-1860’s that germs caused many, if not most, fatal diseases in that era (now the fatal diseases are mostly cancer and blood vessel blockages from atherosclerosis).

After he returned to Hungary, Semmelweiss continued his revolutionary practices and saved many women from the fever. However, he continued to face opposition and lashed out at his detractors. His mental health deteriorated after 1861, until he was committed to an insane asylum in 1865. He was beaten by the guards, treated very harshly (as was normal in those days), and suffered a wound on his right hand which quickly became gangrenous (infected). Two weeks after he was admitted, he died of the infection– something that could have been prevented if his theory had been accepted.

Joseph Lister was the first to successfully use antiseptics in surgery, first with phenol, then carbolic acid. He used carbolic acid on wounds in 1865 with great success. Ironically, Semmelweiss went mad and died in an asylum the same year.

An extensive reference to this sad tale is found in an article in Forbes published eight years ago that you may or may not find interesting:https://www.forbes.com/sites/brentdykes/2016/02/09/a-history-lesson-on-the-dangers-of-letting-data-speak-for-itself/ The author, Brent Dykes, has a blog on how to tell effective stories with data. He organizes the storytelling into data, narrative, and visuals.

The article is a speculation about why Semmelweiss failed to convince his colleagues that his theory was correct. He had eighteen months of data showing the drop in death rates after introducing chloride of lime, and its resurgence when handwashing stopped. At first, the doctors lost 12.2% from infections in the wards. After they started handwashing, the rate dropped to 2.2%. Death rates in the midwive’s wards remained at roughly 3-4%. You would think that such numbers would be instantly convincing. But no. He was ridiculed and demeaned in the press.

The attitudes of many contemporary doctors are summed up by a quote: “Doctors are gentlemen and gentlemen have clean hands.” While Semmelweiss had many followers among his close associates, others dismissed the idea of invisible, impalpable particles on people’s hands and clothes. They were unable to understand new concepts like germ theory– on which his results did not depend but which explained how his results worked.

The post by Mr. Dykes is supplemented with basic graphs that instantly show the obvious reductions in death rates. 150 years ago, such graphs were as scarce as hen’s teeth, and were not used in Semmelweiss’ article. The first such illustrations are landmarks like the cholera maps drawn by physician John Snow in London in 1854. These showed the dynamic locations of cholera cases in relation to local water pumps used by every member of the community. Florence Nightingale used charts in 1858 to show how unsanitary conditions were contributing to the spread of wound infections among soldiers in Crimea.

The article by Dykes points out four ways in which Semmelweiss’s data failed to break through to the general public:

First, timeliness of publication: it was fourteen years before Semmelweiss’ data was published in book form, in 1861. Prior to publication, he transmitted the information by word of mouth and his auditors often misinterpreted, exaggerated, or minimized what he meant. The second or third-hand voices about his work muddied the impact of his story.

Second, Mr. Dykes blames the “curse of knowledge” and the ignorance of his audience. The curse was that he forgot what it was like to not know what he knew. He became impatient with those who wouldn’t accept his simple handwashing advice. He thought the worst of them and, instead of trying to persuade them, he insulted and demeaned them. This simply alienated them.

Third, Semmelweiss lacked a good story to weave into his results. He should have invoked the women who were saved by preventative hand-washing. Numbers of deaths alone are not emotionally charged. In addition to numbers, he should have invoked names and relationships, asking his audience, “What if this was your mother?”

Fourth, the data was not visualized in graphs, being presented mainly in data tables. This was due to the low level of graphics development generally at that time. Today, you could highlight a row of numbers in an Excel spreadsheet and convert it to a graph in moments. In 1850, Semmelweiss had nothing to work with as an exemplar so it wouldn’t even come to mind. People have difficulty visualizing what a number means: 4 and 9 are just numbers until it’s pointed out that 9 is more than twice 4.

The bottom line is that people weren’t ready for the germ theory. A lot of people still aren’t. I feel bad when I think it, but the truth is that half of people are below average. This means that a significant number of people will not understand even the simplest logical argument.

Therefore, when you tell someone that Trump is a liar, they don’t make the connection to his promise to lower prices of consumer goods. He is lying, and he is not even going to try to lower the price of eggs and bacon. If he was successful in lowering grocery prices, it would be a sign of deflation, which is a disaster for the economy since it would mean that nobody has any money to buy groceries at the normal price. That’s too complicated of an argument.

So this is why Trump was re-elected: his propaganda was aimed at the lowest common denominator. Besides being all-pervasive, lying without shame, and loudly repeating the same lies over and over, his propaganda was the best lies available. There is no way to beat him or the forces he represents without engaging in a more effective propaganda campaign. Sadly, we must pander to the lowest intelligence and blanket the airways with repetitive stories and claims. The four factors in Mr. Dykes’ article are a good framework: early publication (post on social media first and frequently), persuasive communication instead of argument (don’t insult your audience), tell a story about identifiable people who are affected by your issue(what if this happened to your mother?), and finally, use the best visualization methods available, like videos, TikToks with music, and line graphs.

Remember, as Voltaire said, “It is dangerous to be right in matters on which the established authorities are wrong.” (thanks to Mr. Dykes for the quotations)