TCS Daily

'Ridiculous Fiction'

By Sallie Baliunas - January 15, 2003 12:00 AM

A committee of the Danish government has officially ruled that Bjorn Lomborg's commercial book The Skeptical Environmentalist is "systematically biased." Lomborg's book documents environmental improvements in areas of the world where major investments have been made. This view contradicts the cultural belief that the environment is getting uniformly worse.

Yet the remit of the committee excludes an assessment of facts that would determine "who is right in a contentious professional issue."

One wonders what a committee whose members represented the prevailing view of science would have ruled about the heroic efforts of physicians Oliver Wendell Holmes at Harvard and Ignaz Semmelweis in Vienna to reduce the deathrate of women from childbed fever in the mid-19th century. Their opposition to the mainstream view exemplifies why the freedom to dissent in science must be carefully protected.

In the 1840s Holmes and Semmelweis independently advocated hand cleansing by obstetricians attending women in childbirth as a way to stem the spread of the disease and its death toll, based on their impressive medical research. Many authorities in the medical community opposed hand disinfection. The consensus view on diseases was based on superstitions, including bad air or punishment from God, rather than an infection carried by physicians.

Holmes was a brilliant essayist and poet, father of the Supreme Court Justice of the same name and Harvard medical professor from 1847 to 1882. He tracked cases of childbed fever to particular doctors attending births. His detailed paper in 1843 pointed to medical personnel who spread the contagion because they did not disinfect themselves between patients.

Semmelweis in Vienna saw that doctors at his hospital often aided childbirth between cadaver dissections, with only perfunctory hand washing between activities. As a result, death from childbed fever reached a toll as high as 25% of women who gave birth in the clinic. Semmelweis contrasted the high death rate in the clinic with the low death rate of women who gave birth at home or even on the streets of Vienna by accident (or design, because the death reports from the hospital drove some women to avoid giving birth there - even by risking birth on a city street dappled with horse manure).

Like Holmes, Semmelweis suspected the fever was caused by an agent that traveled from cadavers to women giving birth, or between women, on carelessly cleaned physicians' hands. In the 1840s Semmelweis had and exercised the authority to force younger doctors to wash their hands in a disinfectant solution he devised. As a result, the death rate fell to around 1%. Semmelweis carefully documented his findings and finally published them in 1861.

Neither Holmes nor Semmelweis knew the agent that caused childbed fever, because the theory of disease-bearing bacteria had yet to be established by bacteriologist Robert Koch and chemist Louis Pasteur. Today the cause of this infection is known to be bacteria like Streptococcus pyogenes or Staphylococcus aureus.

Scientists adhered to consensus for decades by retreating behind the invisibility of the contagion, rather than the demonstrated results from hand cleansing. Preeminent European physicians denounced Semmelweis and his vulgar hand washing. Even in the face of accumulating evidence on the germ theory of Pasteur and Koch, in 1872 Pierre Pachet, a professor of Physiology in Toulouse, stated, "Louis Pasteur's theory of germs is ridiculous fiction."

The National Health Museum describes an incident during a seminar in 1879 at the L'Academie de Medicine in Paris when a prestigious doctor disparaged hand cleaning. Compelled to interrupt the speaker, Pasteur shouted from the audience, "The thing that kills women with [childbirth fever]... is you doctors that carry deadly microbes from sick women to healthy ones."

Semmelweis and Holmes defied scientific consensus and saved the lives of many women with careful medical work. Semmelweis was fired from his job at the clinic for insisting on hand washing. He suffered from severe mood disorder and died in 1865. Holmes lived to see his work vindicated.

Should a governmental committee had been convened in the 1840s to judge hand cleansing to prevent the deaths of women from childbed fever, membership would have been physicians holding the prevailing view. Holmes and Semmelweis fought consensus for decades without the threat of a committee; with it, would their accomplishments have prevailed at all?

Editor's note
For more reading on this subject:

"This long catalogue of melancholy histories assumes a still darker aspect when we remember how kindly nature deals with the parturient female, when she is not immersed in the virulent atmosphere of an impure lying-in hospital, or poisoned in her chamber by the unsuspected breath of contagion."
- Oliver Wendell Holmes, "Contagiousness of Puerperal Fever" 1843

"Everything was in question; everything seemed inexplicable; everything was doubtful. Only the large number of deaths was an unquestionable reality."
- Ignaz Semmelweis, "The Etiology, Concept and Prophylaxis of Childbed Fever" 1861.

TCS Daily Archives