Meet the Unacknowledged Hero Who Discovered That Handwashing Saves Lives
Liesl Schillinger on Misinformation, Anti-Scientism, and the Tragic Life and Times of Ignaz Semmelweis
Last weekend, Google featured a Doodle on its browser banner that paid tribute to Ignaz Semmelweis; a 19th-century doctor who did more in his lifetime to protect public health than practically anyone besides Louis Pasteur (with his advances in germ theory and vaccines); or Alexander Fleming (the inventor of penicillin). Semmelweis would have appreciated the distinct irony of his 21st century resurrection, in an age, like his own, plagued by two deathly contagions: disease and disinformation.
The severity of the global pandemic of coronavirus COVID-19, which emerged in China late last year, arrived in the United States in January, and currently has infected some 86,000 Americans, is no longer doubted by any but the obdurately purblind. America is now First—in number of cases. President Trump, who downplayed the crisis for two months, and compared the furor surrounding it to a Democratic “hoax” on the last Friday of February, lately has grudgingly acknowledged its gravity.
Two Fridays ago, evidently feeling the need to appear proactive, he announced at a White House coronavirus covfefe rally that 1,700 Google engineers were creating a website at his behest to facilitate countrywide testing for the novel coronavirus, and that they had “made tremendous progress.” This was a lie, no such national project was in the works at Google. When members of the press said so, the president lashed out at them, furious that the truth they reported did not put him in a good light. Google, however, stayed mum, recognizing Trump’s tit-for-tat animus.
The following weekend, as Ignaz Semmelweis made his Doodle début, Google put up a website, presumably to pacify the President, a kind of anodyne tip sheet for the pandemic (avoid “people who are unwell;” “consult your local medical authority for advice”) which was not remotely a countrywide test-locator-tool. In his own time, Ignaz Semmelweis did not show Google’s understandable, self-interested prudence when facts of public health were under attack. He spoke his mind. And he paid for that with his life.
You wouldn’t suspect Semmelweis’s complicated history from the genial Google Doodle. Smiling and mustached, taking a doughty stance in front of the first “O” in Google, he appeared with his arms bent upward from the elbows as if he were doing the Macarena. A pair of dripping-wet hands emerged from the “O” next to him. He wore a bow tie, which made him look as if he’d stepped away from a barbershop quartet singing “Lida Rose” to make this cameo. A tinny old-time tune cranked out if you pressed the “Play” arrow, as an animated short showed the cartoon hands lathering and rinsing. A text line above read: “Recognizing Ignaz Semmelweis and Handwashing.” This naturally raised the questions: Ignaz who? He’s hardly a household word. And… what’s the connection with handwashing?
By startling coincidence, I taught my students all about Ignaz Semmelweis only three Fridays ago. This was on March 6th—the last time I held my Facts/Alternative Facts seminar at The New School (in New York City, where as of this Friday morning, there were 23,112 confirmed cases of COVID-19), before the coronavirus pandemic shut down campus and sent New Yorkers to shelter at home. (Class will resume, remotely, next week, after a prolonged spring break.)Did his peers thank him? Did they rally to institute his healthful change systematically and broadly? No. They mocked and reviled him.
Ignaz Semmelweis is a funny name. Every time I bring it up for the first time in this course (six semesters, thus far) the students think I’m joking. If you’ve seen the Preston Sturges screwball comedy “The Miracle of Morgan’s Creek,” you remember the character Ignatz Ratskywatsky (Eddie Bracken), a kooky nebbish in a midwestern town in World War II, who (spoiler alert) purportedly fathers sextuplets—all male— making him a hero of paternity.
But Ignaz Semmelweis wasn’t funny, or kooky. Time and science would prove him to be a bona fide hero; but a hero of maternity, not paternity. On July 1, 1846, in what was then the Austrian Empire, on his 28th birthday, Semmelweis became chief resident of the First Division maternity ward in the Vienna General Hospital, where doctors and medical students worked side by side. He was horrified to discover that an epidemic of puerperal fever (aka childbed fever) was raging through his ward, killing as many as one in three of the young mothers who gave birth there. The rates were not nearly so high in the hospital’s humbler ward, the Second Division, which was mostly staffed by midwives. Women in labor would cry and plead when they arrived at the hospital, if they were assigned to the First Division “charnel house.” They would beg to be assigned to a midwife instead of a doctor. If they were refused, they would give birth on the sidewalk rather than risk delivery in Semmelweis’s ward. They knew something was wrong, even if nobody could see what it was, or prove it.
A decade ago, the British author Johanna Kavenna wrote a novel inspired by Semmelweis, “The Birth of Love.” In it she imagines the young doctor’s guilt and horror as he recognized that he and his colleagues were somehow causing the gruesome deaths of their patients. She writes, in Semmelweis’s imagined voice, “These are women who only a few days earlier were young, beautiful, at the height of their strength, birthing a child in all their vigor,” only to die in unspeakable agonies of puerperal fever. This fatal affliction was first described 2,400 years ago by Hippocrates, the Father of Medicine, in De Mulierum Morbis. In Vienna in the 1840s it was epidemic; and even today, it kills about 10 percent of women who contract it. There is no vaccine. Semmelweis racked his brain. What could it be that was causing the epidemic? Conventional wisdom put it down to sociological and ineffable factors: the women were poor, or unclean, or unlucky; perhaps it was God’s will. Nothing could be done about it. Semmelweis disagreed.
When one of his colleagues, a friend, died after being nicked by a scalpel of a medical student who’d been performing an autopsy, Semmelweis belatedly made a connection. The doctors and interns in the First Division often came to the delivery room straight from working with cadavers. They didn’t wash their hands in between. There must be something invisible but lethal on their hands, he guessed. To test his theory, in May of 1847, he started making the doctors in his hospital wash their hands in chlorinated lime before they touched patients. Two months after that, the maternal death rate in First Division dropped from 18.3 percent to 1.2 percent. Semmelweis wrote articles about his discovery; he tried to spread the news. He was panicked by the need to save women from this cruel and preventable death.
Did his peers thank him? Did they rally to institute his healthful change systematically and broadly? No. They mocked and reviled him. They thought Semmelweis was a kook, like Ignatz Ratzkywatzky. They were insulted that he dared criticize their professional practices, disturb their regular working habits, and question their hygiene. Semmelweis became a pariah. The clinic let him go when his term was up; and society’s rejection of his lifesaving discovery drove him mad. He died in 1865, aged 47, in an asylum, of septicemia contracted after a beating. Pasteur’s germ theory was already catching on by then; but widespread acceptance came too late to save Semmelweis’s reputation, or his skin.
The course week in which Semmelweis pops up is called “Angels and Atoms”—the name cribbed from the title of my favorite college lecture, given by the brilliant young historian John Boswell, who died of AIDS in the 1990s. The point of his lecture, and of my March 6 class, was to prompt the students to ask themselves why people believe what they believe, and why they disagree so vehemently about which facts are true and what action should be taken when facts that are in dispute affect the public good.
This question has especial urgency this week, as President Trump has sought to bluster the pandemic away in White House rallies and Twitter cannonades, placing the country’s economic health ahead of the physical health of its citizens, calling for citizens to return to the workplace before the pandemic has crested, much less receded. He regards the disease, it would seem, as an abstraction that must not get in the way of profit. Camus had something to say about that attitude, in his novel The Plague, when public officials try to downplay that fictional epidemic, hoping to preserve business as usual: “When abstraction sets to killing you, you’ve got to get busy with it.”
Even before the COVID-19 pandemic went on the march, another epidemic was at large in the world’s population: a virulent contagion corroding the integrity of objective facts. The technology of digital media has abetted the spread of both contagions, feeding a rise in tensions between faith (gut instinct, opinion and belief) and fact (provable information). Misinformation, disinformation, and malinformation circulate on Twitter, the internet and the airwaves, undermining the power of fact to protect the public, just as word of mouth doomed Ignaz Semmelweis in imperial Vienna. This conflict between fact and faith is nothing new; tensions between them flare every time a new technology arises, upsetting longstanding assumptions—whether that be cave painting, written language, the telegraph, antisepsis, or the internet. There’s always a learning curve, even when there isn’t a pandemic to test it.
We discussed this phenomenon in the Semmelweis class, as we mulled Plato’s famous “Allegory of the Cave,” which he wrote not long after Hippocrates described the malady that haunted Semmelweis. Plato had dreamed up a cave (not unlike an underground cinema) in which viewers lived eternally, shackled to their seats, watching projections on the cave wall and assuming that what they saw reflected the limits of reality. Plato surmised that any man who escaped from the cave, saw real sunlight, and tried to spread the news to the cave dwellers would not be thanked. He would be “exposed to ridicule;” he might even be killed. Today—at least before this coronavirus moment of sheltering in place—the world’s citizens are not confined to a cave; but technology has shackled each person to their own media bubble, which serves the same purpose.
Theories about the human tendency to reject unwelcome information don’t have to be left to philosophers and novelists anymore. That tendency can be tracked and charted in neurology labs. In the last few years, at the “Affective Brain Lab” at London’s University College, the cognitive neuroscientist Tali Sharot conducted studies that show that the brain reacts strongly and negatively to evidence that challenges pre-existing views. Subjects in her studies reliably tuned out or rejected evidence that contradicted their beliefs, and became angry when forced to confront it. She writes about this in her book The Influential Mind. A Fox viewer who flicks onto the Rachel Maddow Show by accident, or an MSNBC viewer who lands on Sean Hannity, can imagine the strong feeling of antipathy produced by the clash of opposing mindsets. That is the reflexive reaction Ignaz Semmelweis encountered in 1847 when he came up with the counterintuitive idea of washing hands to save lives.
Last weekend, by making Semmelweis the star of their Doodle, Google showed that the internet can helpfully inform the public, when it chooses. But the internet cannot control how much attention the public pays to the information they’re shown; or how people will react to facts they do not want to think about, or accept. Semmelweis’s visionary solution—curbing a lethal epidemic through antiseptic handwashing—has saved the lives of thousands in his own time; has gone on to save the lives of countless millions; and is saving people today; during the current health crisis. But it could not save the man who thought of it from his hidebound contemporaries, who refused to adjust their beliefs to accommodate new ideas they found objectionable. Semmelweis was thwarted, Kavenna writes, by prominent people who were “applauded for their efforts to maintain everything, to conserve untruth and protect fiction.”
Almost two centuries on, as COVID-19 spreads, and as cities, states and countries go on lockdown, prominent men and women are even more visible and influential than they were in Semmelweis’s age. Some of them resist adjusting their opinions in order to block out facts of the pandemic that they do not want to face. By exploiting technology across multiple media platforms, they are able to “conserve untruth” and protect their individual interests, for the time being. But an epidemic doesn’t care about anyone’s self-interest; it looks for an opportunity to infect as many carriers as it can.
Today and going forward, the best way to honor Ignaz Semmelweis and to preserve your fellow citizens and yourselves is to do what he did. Question received wisdom. Seek and respect sound information. And above all: wash your hands.