When Being Right Is Not Enough

Ignaz Semmelweiss

Joseph Lister

It is difficult, when faced with someone who knows more than you about something to decide when he is moving beyond what he knows to territory when he is just as ignorant as you are.

Your third grade teacher knew how to write cursive handwriting, do long division and locate Bolivia on a map; who were you to question,  if she says little Black boys should not be allowed to drink from Whites Only water fountains, because they will contaminate them and give white children diseases?

She was an authority and knew more and better than you did.

The surgeon who operates in a bloody apron, caked with the blood and pus from his ten prior surgeries, says rinsing his instruments in carbolic acid is unnecessary and even harmful, and rinsing a wound with carbolic acid will injure healing tissues, and he knows more than you about surgery. He knows the anatomy of the abdomen and can remove a gall bladder. But how much does he know about microbiology?

When Ignaz Semmelweiss noticed that women who delivered at home in Vienna, Austria in the middle 1800's rarely developed "child bed fever" a febrile illness which killed many hospitalized women post partum, his observations were ignored. When he noticed one of his colleagues died after being inadvertently stabbed with a scalpel during an autopsy, and the autopsy of the unfortunate colleague showed findings which looked like those of women who had died from  childbirth fever, Semmelweiss put two and two together and said, perhaps the disease seen in hospitalized women was somehow connected to the practice of physicians going from the autopsy room to the bedside of women who had just delivered babies, and examining those women with unwashed fingers.

Semmelweiss did not have an explanation for the mechanism by which infectious disease could be transmitted. He was working in the mid 19th century, as the Civil War was raging in America,  and the idea of unseen, invisible organisms causing disease was just emerging in the laboratories of Louis Pasteur in Paris.

When the British surgeon, Joseph Lister suggested cleaning instruments with carbolic acid, he had a better idea of how and why infectious can be transmitted from one human being to another. It was not "bad air" or miasma, it might be bugs. Lister could read French and German, and he had gone to Paris to see Pasteur. Students of Semmelweiss had published what this modest Hungarian physician had seen and concluded. The idea of a transmittable thing which could be conveyed from one wound to another was emerging, inchoate, but powerful.

Lister spoke at American surgical meetings, but his advice about sterile technique was largely ignored.  That ignorance cost thousands of lives during and after theCivil War.  As late as 1881, antisepsis was simply not considered proper in the practice of medicine or surgery.

Semmelweiss was caught up in the politics of revolution in the Austro/Hungarian empire and he found himself unemployed, stripped of his positions at Viennese hospitals, because he was Hungarian and Austrians were in charge and because he had offended too many colleagues by suggesting their own behavior might have contributed to the deaths of their patients.  He wound up in an insane asylum, and died within days of a beating there, administered by attendants.

He may have succumbed to the dementia of tertiary syphilis, acquired from examining patients or doing autopsies, before he had appreciated the possibilities for transmission of infectious particles. 

Aware of the mistakes of the past, American medicine maintains journals which serve not just to report the prevailing ideas of truth but to serve, even more importantly, as a forum for challenging the proffered nuggets of truth and wisdom. The correspondence sections of these journals contain the letters of criticism of each paper previously published and the reply from the author of the original article.

Would that we had the same mechanism for public consumption in American newspapers. We have letters to the editor, editorials but only rarely a really interactive forum, a point counter point, so the reader can see the questions which have been raised about ideas.  The Internet was supposed to provide this sort of interactivity, but the Internet is too vast and blogs too voluminous. There really is not enough give and take. Even the Sunday talk shows which may have a Krauthammer sitting opposite a liberal do not allow for much more than phrase making and shouting. Public Television's The News Hour once attempted spirited and civil interchange, but in an effort to ensure civility, the edge has been lost, and the people selected for appearance are selected because of government or academic titles, for their rings of authority rather than for the quality of their thinking.  Even the longstanding Shields and Brooks duo has degenerated into quips and winks, all real passion and clarity having been lost long ago.

What this country needs is not a good 5 cent cigar, but a good forum for vigorous exchange of ideas among engaged, knowledgeable people who can trade barbs and draw blood. 

The Brits were once good at this sort of discourse--their questions for the Prime Minister seen on American television Wednesday evenings was an enviable exercise. But for some time there has been more style than substance coming to us from across the pond.

Personally, I'd love to see Paul Krugman demolishing Paul Ryan, Mitch McConnell and Rush Limbaugh on TV regularly. I'd love to see Barney Frank square off against any right wing nut. And I'd like to see real, acerbic scientists dismantle the global warming deniers, the coal burner fanatics and the vaccine antagonists. Put up Michele Bachmann, Sarah Palin, Limbaugh, Beck, any of those South Carolina, Texas or Arizona Senators or Congressmen. What joy that would be.