The Semmelweis Paradox

How science can reduce our understanding as well as increasing it

In mid-19th century Vienna, the local obstetrical clinics had a terrible reputation. Women who gave birth there had a strong tendency to contract “childbed fever,” a terrible, painful, and often fatal disease. Women looked with horror upon the idea of giving birth at one particular clinic, to the point where many preferred to literally stop and have their baby in the middle of the street while pretending to have been on their way to the clinic when the baby just came out right then. A “street birth” was just as terrible an experience as you’re probably imagining, but women who gave birth in the streets didn’t come down with childbed fever.

A man by the name of Ignaz Semmelweis, who worked at the local clinics, wondered why this might be. He started looking into various hypotheses and ended up discarding most of them because they didn’t fit the evidence. Then something eye-opening happened. One of his coworkers accidentally cut himself with a scalpel while performing an autopsy… and shortly thereafter, he came down with childbed fever!

This inspired two leaps of logic in Semmelweis’ mind. First, that there was some “cadaverous particle” in dead bodies that was the cause of childbed fever, that was getting transferred from cadavers to birthing mothers by doctors who worked on both. And second, that a certain chemical that was known to remove the stench of death and decay did so by destroying cadaverous particles. He had enough clout at his workplace to get them to institute a policy of hand-washing with this chemical before attending to a birth, and after doing so, the rates of childbed fever among mothers who gave birth at the clinic dropped like a rock, and didn’t take too long to fall all the way to zero.

An open and shut case?

You’d think that would be the end of it. He could show cause and effect, he came up with a solution that demonstrably worked, and his theory even explained why women who gave birth with doctors caught childbed fever far more often than those who gave birth with midwives: the midwives didn’t perform autopsies.

There were just two problems. First, a lot of doctors didn’t like being told that their lack of cleanliness was killing people. They took it personally, rather than rationally, seeing Semmelweis’ work as an insult. And second, Semmelweis lived in scientific times. He was unable to produce any proper explanation for what a cadaverous particle actually was or why it could create childbed fever. That made his hypothesis of cadaverous particles unscientific, which gave people reason to disbelieve it.

His life’s story is a tragic one. After decades fighting with the medical establishment to get them to take hand-washing seriously and stop killing women in their care, he was eventually pronounced insane and committed to a mental asylum, where he ended up dying.

Of an infection, ironically enough. Because today you can look back at the evidence and say “childbed fever was obviously some sort of infection, and the ‘cadaverous particles’ were germs that could be killed by the cleaning chemicals Semmelweis advocated for using in handwashing.” And you’d be correct: that’s exactly how it worked. But Semmelweis lived before Pasteur’s Germ Theory provided a scientific explanation of such matters.

We already knew this

That’s where most tellings of Semmelweis’ story end. There’s a decent chance you’ve heard it before. And that’s a shame, because it leaves out one of the most relevant parts: although germ theory was new, the basic principle is ancient.

Have a look at Numbers chapter 19. It begins with the description of a ritual in which a cow is sacrificed, and the body burnt, with cedar wood and other materials thrown into the fire, and then the ashes gathered and mixed with clean running water gathered into a vessel. Hang onto that, I’ll come back to it.

It then goes over a long list of ways to become Unclean, a ritual condition that prevented one from participating fully in Israelite religious worship. It repeats over and over again several variations on the basic theme of “touching dead bodies makes you Unclean.” If you touch a dead body, you’re Unclean. If you go into a tent where there’s a dead body, you’re Unclean. If there’s an open vessel in that tent, it’s Unclean and so are you if you touch the contents of the vessel. If you touch the body of a soldier killed in battle, you’re Unclean. If you touch a person who is Unclean because of touching a dead body, they just contaminated you with their Unclean-ness. Et cetera, et cetera.

To stop being Unclean took two steps. 1) wait seven days. 2) wash yourself with the ritual ash-water described above. Now, if you’re paying attention, you might be thinking, “water, plus wood ashes, plus animal fat… that sounds a lot like the classic folk recipe for lye soap, a powerful if caustic cleansing and disinfecting agent. And all that talk in the book of Numbers sounds like a list of ways to get infected by germs from dead bodies, either directly or indirectly through contact with another source that’s already infected.”

…yup.

They didn’t have a scientific formulation of germ theory, but they didn’t need one to know how to deal with contamination effectively. And these concepts aren’t exclusive to the Law of Moses; similar ideas can be found in other ancient cultures. We already knew this stuff!

But somewhere along the way, we got science (this was a good thing) and then started to discount or even flat-out deny that which could not be proven by science (this was very much not a good thing.)

Gödel and Semmelweis

Not only is the notion that anything not provable scientifically can’t be true a bad idea because it can cause us to reject truths we already know, it’s a bad idea because it’s demonstrably false. About 90 years ago, Kurt Gödel proved that no matter how good your system of logic becomes, there will always necessarily be true statements that cannot be proven to be true. There will always be some things you simply have to accept on faith, and surprise surprise, capital-F Faith tends to work really well in such areas!

My wife recently mentioned to me that the well-known television personality Dr. Phil used to be a professional psychiatrist, but several years ago he gave up his license to practice psychotherapy, because a lot of the advice he gives out on his show is common sense stuff that everyone knows is true, but which has not been proven and accepted as true by the modern psychology establishment. And apparently it can create legal liability for an official psychiatrist to give advice that’s not proven and officially accepted. Even if it’s true. Even if it’s obvious and everyone knows it. If it’s not Officially Scientifically Proven, it’s not real and you can’t say it.

The Semmelweis Paradox lives on to the present day.