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Tuesday 16 August 2011

Semmelweiss

I mentioned Semmelweiss in my previous post. Here is a link to a Wikipedia article about him:

http://en.wikipedia.org/wiki/Ignaz_Semmelweis

In brief, Ignaz Semmelweiss was a Hungarian doctor in the Vienna General Hospital, appointed in 1846.

There were three categories of maternity patients in the hospital: those who had given birth before they were admitted to hospital, those who gave birth in hospital, cared for by midwives and those who gave birth in hospital and were cared for by doctors.

Puerperal fever (which we now know to be an infection caused by bacteria) is now practically unknown in advanced societies. In the Vienna General Hospital it was common: less so in the first group, more so in the second group and alarmingly so in the third group.

Why should the patients who enjoyed the care of professionally trained doctors be more likely to contract the condition than those cared for by less expensively educated midwives (and much more likely than those who received no professional care)?

Semmelweiss proposed an explanation. He observed that the lethal doctors spent some of their time conducting autopsies and some of their time delivering babies. They wore the same clothes for both duties. They did not wash their hands after cutting up corpses and before entering the delivery room. He suspected that they might be carrying "cadaverous material" (what we now call infectious agents, bacteria etc), which caused the deadly fever.

He followed the practice of washing his hands with chlorinated lime. This is essentially the chlorine bleach we use to disinfect toilets. He begged his colleagues in vain to follow his example. His patients died in far smaller numbers than those of other doctors in the hospital, who continued to sneer.

Twenty years later Louis Pasteur, following on from Semmelweiss' observations and practices, developed the Germ Theory of Disease, without which you might never have come into existence.

Semmelweiss flourished (if you can call it that) only a century and a half ago. Has humanity (or society) come so far since then that reliance on "received wisdom" or "current theory" is never at risk from good observation and careful theorising? Nope.

I once had a conversation with a nurse about AIDS. She said I was wrong and clinched it by telling me that she had been on a special AIDS course. It was useless to point out that if the ruling theory was wrong, "trained" people (like her) were the least likely to get it right.

I'd like to see this quotation from Oliver Cromwell prominently displayed in every place of scientific education

"I beseech you, in the bowels of Christ, think it possible you may be mistaken."

2 comments:

  1. Hi kiffy, I haven’t been following all your posts so forgive me if my questions have already been answered elsewhere. I am not sure what aspect of the HIV-AIDS discourse you are uncomfortable with. Is it how it is transmitted? How it affects different people with different immune systems? How it should be treated? The first question has a straight forward answer.I cannot believe that after 3 decades of epidemiological studies they've got that one wrong. If you are not born with it and you don’t exchange bodily fluids of any kind with anybody, then you cannot get the hiv virus. The second question is less straight forward. The virus will affect individuals with different immune systems in different ways. Some individuals are immune to the hiv virus, their immune system actually kills the virus off. Clearly, individuals with a depressed immune system (because they are starving or take too much crack and alcohol or have an autoimmune disease) will be more likely to develop Aids and die from it. The same will happen with the human papillomavirus, you might get it by having sexual intercourse and in some cases it will develop into cervical cancer and in other cases it will not, and there will be hundreds of cofactors involved: genetics, existing infections, lifestyles etc. And this links to the third question. Perhaps more could be done to reduce the aids pandemic in Sub-Saharan Africa by feeding the hungry and boosting up people’s immune systems than by selling them costly antiretrovirals. But I am not the first one to say so. Most doctors would agree on this point. They would also agree on the point that the Catholic Church’s opposition to the use of condoms in aids infested regions is absolutely abhorrent and criminal and that hundreds of thousands of lives could be saved if the Pope would just shut up and let a man put a sock on it.

    Barcelona says hi,
    Elisa

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  2. Perhaps a better story to illustrate how difficult it is to trigger a paradigm shift in science and medicine once an ‘official version’ is out would be that of stomach ulcers stress and the Helicobacter pylori http://news.bbc.co.uk/2/hi/4304290.stm
    Or the ME/CFS saga. It will take decades to move the debate beyond traumatic childhoods and psychosocial disorders as underlying the condition – because there are some practitioners and companies that are very comfortable with the discourse as it is.

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