Semmelweis is a favorite "management science" topic; there's even a pop-psych phenomenon called the "Semmelweis Reflex"; the Wikipedia article on it recapitulates much of what Aaron wrote here. The Gladwell formula of using Semmelweis' personal narrative to articulate a frailty of human reasoning was employed to great effect in Ayres _Super Crunchers_; the Semmelweis section is, for instance, noted prominently in the NYT book review.
Aaron has oversimplified the Semmelweis story in some material ways:
* Semmelweis didn't institute "handwashing" in Vienna hospitals. Contrary to the conventional wisdom, which suggests that doctors in the 1840s were sticking horse-manure-covered hands into the exposed wounds of patients, handwashing was apparently already a norm. What Semmelweis did differently was to use lime to wash hands.
* Semmelweis' actual theory of the cause of childbed fever was wrong, and it was wrong in ways that made his recommendations hard to take seriously. Semmelweis' contention was that "cadaveric particles" were making their way into patients, and that those particles could only be removed by lime. But doctors observed cases in which no contact with either cadavers or injected or symptomatic patients lead to the same cluster of illnesses. It was thus difficult for Semmelweis to make a "scientific" case for why the lime worked; it obviously didn't help that he was wrong about why it did (his work predates the germ theory of disease, which would have taught him that rather than lime being effective at removing specific particles, it was instead effective at killing bacteria).
* Aaron's story (and Ayre's) has a heroic Semmelweis pleading for doctors to simply wash their hands in a specific way to save lives. But that's not necessarily what Semmelweis was arguing. Instead, the case he could have been making, loudly, was for an actual, specific, incorrect cause of childbed fever.
* Semmelweis himself was, apparently long before he lost his post, a notorious asshole. It did not help his cause that instead of carefully reasoning about the actual evidence, he instead seized on a single explanatory theory of childbed fever and then demanded (often by barging into hospital wards and berating the staff) that his peers adhere to it.
The point is not that Semmelweis didn't make an important discovery, or that we shouldn't be mindful of warped-sounding new knowledge that contradicts our existing theories. Of course we should be objective when considering facts that threaten our existing theories. But there's a reason John Snow and Joseph Lister [and Pasteur] are better known in the development of the germ theory of disease, and there's more to learn from the Semmelweis story than how the audience to a new theory should behave.
I actually first learned about Semmelweis as an ethical case study. IIRC, Semmelweis did a formal experiment with a control group: only some of the doctors in the First Clinic washed their hands with chlorinated lime; the others deliberately went directly from handling cadavers to delivering babies. The question was whether killing a few innocent women and children in the course of the experiment was justified by all those that would be saved if he proved that washing with lime reduced the death rate.
Maybe a better illustration would be Peter Pronovost's efforts to get hospitals to use checklists. His studies show that using a checklist for routine procedures like inserting a catheter dramatically reduces infection rates, saving lives and money. It's such a huge win that you'd think checklists would take the medical world by storm, but that hasn't happened. Convincing doctors to use a checklist requires overcoming their self-image of competence; it's too easy for a doctor to think, "I know I have to wash my hands before inserting a catheter, I don't need some nurse with a checklist to remind me."
Of course, Pronovost's story is less dramatic than Semmelweis. Pronovost has been more carefully about drawing conclusions from his observations, done a better job of presenting his ideas, and been more successful—hospitals are adopting his methods, if slowly and sometimes grudgingly. He's not likely to die alone in an asylum. To my mind, though, that makes a better illustration of Aaron's thesis.
>It was thus difficult for Semmelweis to make a "scientific" case for why the lime worked
Aren't you supposed to regard empiricism above all else in science? While holding to that rule would force Semmelweis to alter his theory as well, the observation of the highly reduced mortality rates should have forced the medical powers that be to reconsider things also - the burden is on them to make a scientific case for why lime had nothing to do with the decreased mortality rates.
I agree there were probably other reasons they fired him, but I think that only helps Aaron's points.
It is not evident that Semmelweis himself regarded empiricism above all else. Rather, it seems like Semmelweis made an empirical observation (death rates plummeted when attendants washed their hands in lime), but then jumped to a conclusion (lime was removing cadaverine particles) and fixated on that conclusion instead of of the observation. Convert the narrative (lossily) to modern science, and imagine someone far more focused on their journal article than on saving lives.
Semmelweis went "on tilt" with his hypothesis. Even after doctors adopted a regime of disinfecting hand washes, hospitals still saw a significant rate of childbed fever. Semmelweis demanded of the scientific establishment that they recognize cadaverine tissue as the cause, going so far as to suggest that tissues in the mother were occasionally being crushed during childbirth, and later becoming gangrene, and thus mothers were infecting themselves.
Again: my point isn't that Semmelweis didn't make an important discovery, or that the scientific establishment of the time didn't miss a critically important opportunity; my point is that there is more to the story than the missed opportunity of Semmelweis' detractors.
I don't much care about the injustice of Semmelweis losing his post at a hospital in the 1840s. I am, on the other hand, fascinated by how poor framing and communication, close-mindedness, and overall bloody-mindedness prevented Semmelweis himself from becoming the godfather of the germ theory of medicine.
This added context really drives the OP point's home.
After all, it's relatively easy to be objective when the facts are overwhelming and communicated by a sensible and rational messenger. Under these circumstances, only the most pig headed caricature would cling to preconceived, faulty, notions.
However, it's much harder to take seriously criticism that originates from a volatile and unpopular source. Doubly so if their own theory or notion is flawed. Under this circumstance, it's extremely easy to avoid self-observation.
For instance, in this case it should not have mattered too much that Semmelweis's theory was demonstrably incorrect. What should have mattered was the clear causality linking disinfectant hand washing and a reduced rate of labor mortality. They had an easy out, and they took it. That reaction is all too common.
The doctors of Semmelweis' day definitely missed an opportunity. (Note that it was contended that chlorinated hand washes were common in England at the same time.)
That he named the things that were killed by lime "cadaveric particles" and not "bacteriae" at the time nobody knew that bacteriae exist can't be considered wrong.
How he named them was irrelevant. His explanation was good enough -- there WAS something on the hands of the doctors that was small enough and not visible that lime was able to destroy. Why was it hard to take it seriously then? Certainly not because others knew better -- nobody had "bacteria" in their language. He had to call that what was neutralized somehow.
You're rationalizing what Semmelweis said with a modern understanding of medicine. Of course, today, it's obvious that thoroughly clean hands help eradicate pathogens, and so it seems obvious that to note in 1840 that handwashing in chlorinated lime lowers death rates is to come immediately to the crux of the problem.
In fact, doctors in the 1840s were well aware of the concept of contaminants. They had already assumed a regime of handwashing. Moreover, Semmelweis himself was not content to lobby attendants to wash their hands. He was instead fixated on the idea of cadaverine particles, going so far as to invent new vectors for their creation in cases where no contact with dead bodies could have occurred. Semmelweis wasn't even correct about the mechanism of action in cleaning hands; he believed the chlorinated lime more thoroughly removed particles, when in fact the key was to kill the pathogens.
A simple way to sum the problem up: Semmelweis advocated handwashing... for staff who had been conducting autopsies. Semmelweis was on to something, but he himself seems to have missed it by a wide margin. Things could have been different if Semmelweis himself stuck with the evidence, rather than seizing the first bit of it that confirmed his theory and running away with it.
I hope you recognize that when you say "A simple way to sum the problem up: Semmelweis advocated handwashing... for staff who had been conducting autopsies" you also confirm that there were actually the doctors that did autopsies who didn't disinfect their hands. So he was obviously right. You can just claim that he set his goals too narrow, but even that much was not accepted by others.
Not at all. Semmelweis thought something associated with death was what was killing people (eg, he chose chlorinated limes which he found best removed the stink of death).
I suspect the focus on death and dead people meant people focused on that, and "proved" to themselves he was "wrong".
I can imagine scenarios where doctors dealt with one woman who had a good birth experience, didn't use the Semmelweis handwashing method (because the first woman didn't have the death particles) and then the next woman got infected and died. To many (unfortunately), that would prove his theory was wrong.
Citation needed, since you claim that doctors actually used the results of experiments to disprove him but at the same time didn't heed to the results of the experiments that showed that using lime was obviously beneficial.
No I didn't. I was very careful to make clear this was my opinion only ("I suspect" and "I can imagine scenarios").
As I noted, lime wasn't obviously beneficial, because Semmelweis claimed it removed the "cadaveric particles", and yet people were still dying when there should have been no "cadaveric particles" around (ie, no one had died).
It's like the story of how scurvy started happening again in the early 20th century with Scott in the Antarctic[1]. In the 18th century scurvy had been defeated by drinking (fresh) lime juice on long sea voyages, without a correct understanding of the mechanisms involved.
I think you've mistaken the point of my comment; you appear to think I'm sticking up for 1840s surgical hygiene. If you read my comment all the way through, you'll see that that's not at all my point.
The error was: instead of making a thesis to prove there's was a correlation, he instead made a thesis trying to explain (poorly) why it happened.
His peers, instead of investigating further, chose to just disregard it completely, and keep killing women.
This history is a perfect example about how being correct doesn't mean you're right. It's the difference between being logic or wise. Sadly, I see this reaction all too often.
All knowledge in the world is worth nothing if people can't reason, use intuition, be empathic and remove the ego out of the equation. Western-culture prides itself about scientifical feats and economical progress, but still has much to evolve about developing human beings. That was in 1800, but can easily happen today - just look at global warming theory.
It's not about drawing conclusion from intuition - you need to validate your hypothesis - but about following your intuition.
See Einstein: his findings started as hunches and creative exercises. Nobody though about light being a particle-wave, or combining space and time, because they were limited to preconceived notions ("it's either a particle or a wave", "time as conceived by Newton").
It's often necessary to start from intuition to get to new places.
That's a good lesson too, but the problem wasn't just that Semmelweis was an asshole. It is admittedly hard to come up with a coherent lesson from the narrative Swartz provided here, except to confirm truism ("don't be an asshole", "be open minded", "listen to the evidence, especially when it contracts you") that we obviously already know.
I'm sure that Semmelweis's bumbling associates would have agreed with you. But the fact remains that empirically he was saving lives; there was more truth in Semmelweis's claims than in theirs, and it was a matter of life and death.
Aaron has oversimplified the Semmelweis story in some material ways:
* Semmelweis didn't institute "handwashing" in Vienna hospitals. Contrary to the conventional wisdom, which suggests that doctors in the 1840s were sticking horse-manure-covered hands into the exposed wounds of patients, handwashing was apparently already a norm. What Semmelweis did differently was to use lime to wash hands.
* Semmelweis' actual theory of the cause of childbed fever was wrong, and it was wrong in ways that made his recommendations hard to take seriously. Semmelweis' contention was that "cadaveric particles" were making their way into patients, and that those particles could only be removed by lime. But doctors observed cases in which no contact with either cadavers or injected or symptomatic patients lead to the same cluster of illnesses. It was thus difficult for Semmelweis to make a "scientific" case for why the lime worked; it obviously didn't help that he was wrong about why it did (his work predates the germ theory of disease, which would have taught him that rather than lime being effective at removing specific particles, it was instead effective at killing bacteria).
* Aaron's story (and Ayre's) has a heroic Semmelweis pleading for doctors to simply wash their hands in a specific way to save lives. But that's not necessarily what Semmelweis was arguing. Instead, the case he could have been making, loudly, was for an actual, specific, incorrect cause of childbed fever.
* Semmelweis himself was, apparently long before he lost his post, a notorious asshole. It did not help his cause that instead of carefully reasoning about the actual evidence, he instead seized on a single explanatory theory of childbed fever and then demanded (often by barging into hospital wards and berating the staff) that his peers adhere to it.
The point is not that Semmelweis didn't make an important discovery, or that we shouldn't be mindful of warped-sounding new knowledge that contradicts our existing theories. Of course we should be objective when considering facts that threaten our existing theories. But there's a reason John Snow and Joseph Lister [and Pasteur] are better known in the development of the germ theory of disease, and there's more to learn from the Semmelweis story than how the audience to a new theory should behave.