[HN Gopher] A doctor who championed hand-washing and briefly sav...
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A doctor who championed hand-washing and briefly saved lives (2015)
Author : Anon84
Score : 83 points
Date : 2020-07-11 15:16 UTC (7 hours ago)
(HTM) web link (www.npr.org)
(TXT) w3m dump (www.npr.org)
| michaelkeenan wrote:
| > Semmelweis was not very tactful. He publicly berated people who
| disagreed with him and made some influential enemies. Eventually
| the doctors gave up the chlorine hand-washing
|
| Something Matthew Benjamin wrote stuck with me: "It is way more
| important to preserve trust, goodwill and respect than to get
| what you want, no matter how good what you want seems."
|
| It seems like this can't be true - some things are surely more
| important than trust, goodwill and respect. What could be more
| important than saving lives? But this is an example of that being
| more true than I'd naively think.
| joe_the_user wrote:
| _" It is way more important to preserve trust, goodwill and
| respect than to get what you want, no matter how good what you
| want seems."_
|
| That is true if someone is leader of a group. You can't let the
| thread break because then you can't anything. But someone is
| pushing an idea, it's a different balance, I think. Maybe
| people understanding the idea is more important than them
| liking you.
| sammalloy wrote:
| As much as we like to focus on the past, let's not forget that we
| still have a long way to go. On average, nosocomial infections
| (hospital-acquired) kill 100,000 Americans per year in US
| hospitals. There are many issues that have yet to be resolved.
| The problem with adequately cleaning and disinfecting medical
| scopes, for example, was a recent topic in technology circles
| (Olympus TJF-Q180V).
| user_50123890 wrote:
| Handwashing is overrated IMO. Yes, it's important for doctors and
| nurses(who touch dozens of sick humans a day), people who are in
| contact with animals, and small kids who don't have any concept
| of hygiene.
|
| But for the average adult, they just do not have that many
| harmful bacteria or viruses randomly on their hands.
|
| This caused some major issues with the Coronavirus. Eg. if you
| googled anything related to it in march, the search results
| displayed a "wash your hands message" even though the virus is
| spread by droplets AKA sharing air indoors with an infected
| person.
|
| I can only imagine how many unnecessary infections and deaths
| this caused when people thought they were safe if they just
| washed their hands often. To this day, I'd say about half of the
| population has no clue how respitory diseases spread.
| DanBC wrote:
| > Eg. if you googled anything related to it in march, the
| search results displayed a "wash your hands message" even
| though the virus is spread by droplets AKA sharing air indoors
| with an infected person.
|
| There's a fecal-oral route for covid-19, which is why the
| protocols for people who share a home with someone infected
| with covid-19 all mention using a separate (if possible)
| toilet, or making sure the room is cleaned thoroughly after
| each use.
|
| EG, this from CDC:
| https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/ca...
|
| > If possible, have the person who is sick use a separate
| bedroom and bathroom. If possible, have the person who is sick
| stay in their own "sick room" or area and away from others. Try
| to stay at least 6 feet away from the sick person.
|
| Handwashing remains a crucial part of the set of protection
| measures against covid-19 and other respiratory disease.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446461/
|
| > Improvements in hand hygiene resulted in reductions in
| gastrointestinal illness of 31% (95% confidence intervals
| [CI]=19%, 42%) and reductions in respiratory illness of 21%
| (95% CI=5%, 34%). The most beneficial intervention was hand-
| hygiene education with use of nonantibacterial soap. Use of
| antibacterial soap showed little added benefit compared with
| use of nonantibacterial soap.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5781206/
|
| > There was moderate to low-quality evidence of a reduction in
| both influenza and respiratory tract infection with hand
| hygiene interventions in schools, greatest in a lower-middle-
| income setting. There was high-quality evidence of a small
| reduction in respiratory infection in childcare settings. There
| was high-quality evidence for a large reduction in respiratory
| infection with a hand hygiene intervention in squatter
| settlements in a low-income setting. There was moderate- to
| high-quality evidence of no effect on secondary transmission of
| influenza in households that had already experienced an index
| case. While hand hygiene interventions have potential to reduce
| transmission of influenza and acute respiratory tract
| infections, their effectiveness varies depending on setting,
| context and compliance.
| [deleted]
| tptacek wrote:
| I think Semmelweis is interesting for other reasons. From what I
| understand, hand-washing was routine in Semmelweis' time; what he
| specifically championed was antiseptic washing (in his case with
| a solution of lime). And: he was an asshole about it. He had a
| particular theory of why his particular routine worked, and it
| was the wrong one: he believed particles from corpses were
| becoming airborne and landing in the wounds of patients. That
| theory was tested and falsified by numerous infections occurring
| in places no corpses had been present. Challenged with
| countervailing evidence, he doubled down, maintaining that
| childbed fever was caused by the cadaveric particles generated
| internally by necrotizing tissue crushed during the birthing
| process. Through it all, he was outrageously rude, hurled insults
| at his colleagues, stormed into operating theaters, and generally
| did everything he could to make sure his life-saving contribution
| was ignored.
|
| The rudeness is a little interesting, I guess, but the big thing
| for me is the idea that just a little bit of intellectual
| humility --- stick to the empirical observation and stop yelling
| at people about corpses! You almost had it! --- would have made
| him a household name centuries later.
| andi999 wrote:
| I am confused. So it was not the corpses? Can you spell out
| what the problem then was? (I presume general bacterial
| infections then), but then why was the other ward not affected
| (so much)?
| lilyball wrote:
| It's just germs in general. Autopsies on infected cadavers
| were leaving germs on the doctors' hands that would then
| spread to other patients, so in this particular case the
| elevated rate is tied to the cadavers, but it's not
| cadaverous particles specifically.
| sammalloy wrote:
| The puerperal fever that was killing the women laboring in
| the delivery room was caused by doctors doing autopsies
| beforehand. The doctors would bring bacteria back to the
| delivery room on their unwashed hands which then infected the
| women with group A streptococcus (GAS).
| andi999 wrote:
| Thanks. So what did Semmelweiss get wrong then ('he almost
| had it'in the parent comment)
| sammalloy wrote:
| He was wrong about cadaverous poisoning. There was no
| such thing as corpse particles. This was before the
| acceptance of germ theory. He was right about hand
| washing, particularly with disinfectants like chlorine.
| wahern wrote:
| > he believed particles from corpses were becoming airborne and
| landing in the wounds of patients.
|
| That sounds like this:
| https://en.wikipedia.org/wiki/Miasma_theory
| vezycash wrote:
| Hindsight bias is coloring your view of the man.
|
| The article mentions unwashed hands is STILL a problem with
| physicians TODAY - with all the years of training, knowledge,
| books, microscopes that can see germs in action and most
| importantly, hundreds of years of evidence.
|
| Changing people's minds is not easy - then or now. Shaming
| works way better than just talking. You can see how shaming has
| helped the cause of open source, black lives matter,
| pollution... But even with multiple champions, these causes are
| struggling, not a runaway success as you'd expect.
|
| Compare this man to Richard Stallman - see any similarities?
| I'm sure Stallman would have been remanded to mental
| institution if he lived in the 1800s.
|
| Even if this doctor was a giant asshole, I applaud his use of
| scientific-ish methods - methodologically cutting off
| unlikelies until arriving at the root cause - unwashed hands.
| umvi wrote:
| > Shaming works way better than just talking. You can see how
| shaming has helped the cause of open source, black lives
| matter, pollution
|
| It "works" but has hidden bad side effects. Shaming is a
| terrible way to enact change and should only be a last resort
| as it sows seeds of resentment and discord that push people
| to political extremes. It's like saying violent crusades are
| the most effective form of Christian missionary work.
| Technically true in terms of measured "conversions", but...
| also the side effects are really bad.
|
| Plus, if you shame people and you turn out to be wrong,
| well... what should your punishment be?
| newacct583 wrote:
| > Changing people's minds is not easy - then or now. Shaming
| works way better than just talking.
|
| Tell that to the "masks are oxygen-depriving freedom
| infringement devices" set. I mean... I agree that on the
| margins most people aren't nuts and even if they don't
| understand masks will put one on just to avoid a scene.
| But... yeah, we haven't come very far, have we?
| umvi wrote:
| Is there any reason we should ever stop wearing masks? From
| a public health perspective I think they are here to stay -
| possibly for the rest of my life.
| ghaff wrote:
| There are a lot of more or less inconvenient things that
| people can do to improve societal safety. Never drive
| your car over 40 mph. Don't let subway cars get so
| crowded. And so forth.
|
| Arguably masks fall on the less inconvenient side of
| things but they're not even the norm in Asia during
| normal times in countries which have had their share of
| epidemics. So, no, I don't expect they'll be the norm
| most places and that will make some people unhappy.
| chrisseaton wrote:
| > Shaming works way better than just talking.
|
| I think shaming is _never_ acceptable, under any
| circumstance. It 's trying to make someone feel emotional
| pain in order to force them to do something. It's basically
| applying torture, except instead of physical pain it's
| emotional pain.
| newacct583 wrote:
| > It's trying to make someone feel emotional pain in order
| to force them to do something.
|
| But the "something" in this case is "not kill people". I'm
| sorry, I can't understand that absolutism. If I can save a
| million people by making some innocent babies cry from an
| immunization shot, I should be able to make their parents
| angry by shaming them into wearing a mask or washing their
| hands, right?
| chrisseaton wrote:
| > But the "something" in this case is "not kill people".
|
| Yes it's a worthwhile cause to speak up for!
|
| > I'm sorry, I can't understand that absolutism.
|
| I don't believe in 'the ends justify the means' except in
| some limited cases such as an imminent existential
| threat.
|
| > If I can save a million people by making some innocent
| babies cry from an immunization shot, I should be able to
| make their parents angry by shaming them into wearing a
| mask or washing their hands, right?
|
| I think you should use your logic to campaign for
| legislation or regulation, not try to force people by
| applying pain.
| Klinky wrote:
| >I think you should use your logic to campaign for
| legislation or regulation, not try to force people by
| applying pain.
|
| There are already legal mandates around mask wearing and
| there are many who still refuse.
| chrisseaton wrote:
| So call the police or begin a private prosecution if a
| law is being violated.
|
| If you are in imminent actual physical danger with no
| means to extract yourself from the situation, then use
| self defence.
|
| But if a law isn't being violated, and you're free to
| leave, then mind your own business.
|
| Feel free to lobby for new legislation or regulation.
|
| In whatever situation: don't try to force your will by
| applying mental health pain. That's truly a 'dark side'
| solution to any problem.
| Klinky wrote:
| >So call the police or begin a private prosecution if a
| law is being violated.
|
| You could certainly call the police on someone violating
| the mask mandate, but wouldn't calling the police also
| result in "mental health pain" for the perpetrator?
| Calling the police immediately would be extreme, and more
| likely someone is going to ask staff to intervene and ask
| the perpetrator to put on a damn mask, but that too will
| cause shame for the perpetrator.
|
| All you're doing is is outsourcing who is causing the
| shame, but you're still the originating source of it.
| tedunangst wrote:
| Are the surgeons who aren't washing their hands today not
| doing so because they don't believe in bacteria?
| redis_mlc wrote:
| Youtuber SerpentAZ has reported that in China, doctors
| generally don't wash their hands because:
|
| 1) washrooms are not stocked with soap. (In general, after
| something is built, there's no on-going maintenance.)
|
| 2) the older generations of doctors don't believe in
| bacteria
|
| 3) the current generations of doctors halfway believe
| Chinese traditional medicine and Western medicine.
|
| With corona and a shortage of PPE, it's also likely gloves
| are not being changed between patients.
|
| OTOH, most of the hospitals in Silicon Valley are on a
| watch list for MERSA contamination, so hygiene is a
| struggle even with hand-washing.
| sammalloy wrote:
| There was an article that explored this question many years
| ago, and IIRC, the answer was because the surgeons were in
| a hurry and didn't have much time. This problem isn't as
| common today with the ubiquity of hand sanitizer
| dispensers.
| corty wrote:
| Also, try washing and desinfecting your hands 20 times a
| day. Your skin will start causing problems after a few
| days, usually dryness, itching, rashes, blisters. Cream
| helps a bit, but not always. Medical personnel invariably
| do have skin problems on hands and forearms.
| Orou wrote:
| >You can see how shaming has helped the cause of open source,
| black lives matter, pollution...
|
| I think there's a stronger argument to be made that shaming
| has _hurt_ each of these causes more than it has ever helped.
| If you want to make people antagonistic towards you,
| belittling or demonizing them for not holding ${belief} is a
| great strategy. Public shaming is a threat-by-example to the
| broader community that certain behaviors and beliefs are
| forbidden. It doesn 't encourage individuals to seek the
| truth, whatever it is, but to conform to safe beliefs (and if
| you're playing the status game, evangelizing those beliefs is
| a great fast-track to power).
|
| Semmelweis may well have succeeded if he hadn't shamed people
| with an air of absolute certainty (an attitude which seems to
| be increasingly in-vogue for any kind of popular issue today)
| but had acknowledged the complexities of the problem and
| focused on ascertaining the truth.
| IAmEveryone wrote:
| Not just handwashing...
|
| There's a theory popular with jaded biologists that neckties
| alone may have killed more people than some minor genocides.
|
| And the failure to perfect the practice of hand-washing is
| somewhat easy to understand: it's tedious, especially when
| done dozens of times per day. Some people suffer skin
| irritation. The cause of any infection can almost never be
| traced, making it hard to learn and/or punish the guilty.
|
| Banning neckties is a rather binary policy decision, and
| compliance would be extremely easy to monitor. One would
| think people with advanced academic degrees would see the
| upside, and don't need to signal status with superfluous
| items of clothing in addition to that doctorate.
| jraby3 wrote:
| How do neckties cause deaths?
| nextaccountic wrote:
| some links:
|
| https://www.infectioncontroltoday.com/view/hospital-ban-
| phys...
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878945/
| stemcc wrote:
| Seems like they can be vectors for bacterial spread.
|
| https://pubmed.ncbi.nlm.nih.gov/18205553/
| mattkrause wrote:
| A possible source of infection.
|
| Ties are pretty mobile and can easily brush against a
| patient or instrument, especially if the doctor is
| leaning forward. Unlike other clothing, they are also
| rarely washed and they seem less essential than, say,
| pants.
|
| A few studies have isolated MRSA and other nosocomial
| nasties from ties. However, it's unclear how much of an
| actual risk this is, and ties are thought to convey some
| sense of professionalism that makes the patients take
| medical advice more seriously and...tradition (ugh). This
| bit from _The Lancet_ has some back-and-forth about it.
|
| https://www.thelancet.com/pdfs/journals/lancet/PIIS014067
| 360...
| kerkeslager wrote:
| > Changing people's minds is not easy - then or now. Shaming
| works way better than just talking. You can see how shaming
| has helped the cause of open source, black lives matter,
| pollution... But even with multiple champions, these causes
| are struggling, not a runaway success as you'd expect.
|
| I keep seeing this narrative, that shaming is the most
| effective strategy, and it continues to puzzle me. You're
| literally saying this in response to an example of shaming
| not working, and the examples you're using are pretty bad
| examples of shaming working.
|
| Everything I see here is that _putting the truth in front of
| people_ is what works. The video of George Floyd is powerful
| because it shows us the truth. I 've seen more of my white
| friends realize their privilege in 8 minutes and 46 seconds
| of video than I've seen in decades of shaming people over dog
| whistles.
|
| If shaming works, when why hasn't it worked yet? Where are
| the results?
| vezycash wrote:
| >I keep seeing this narrative, that shaming is the most
| effective strategy
|
| I never said it's the most effective strategy. I said, it's
| more effective than just talking.
|
| >If shaming works, when why hasn't it worked yet? Where are
| the results?
|
| As far as i'm concerned, this question is like someone
| doubting the existence of gravity. The effects of shaming
| is all around us.
|
| Fashion is an industry that built its foundations on
| shaming. Kids are shamed into buying iphones, and designer
| shoes. Millions of kids are being shamed into early sex
| (ashamed of being virgins), and trying out drugs to be
| deemed COOL.
|
| For programmers - PHP programmers are being shamed right
| here on HN.
|
| When Google and other high profile companies do something
| really stupid like locking someone's account unjustly or
| some new policy, Twitter and Hacker news use shaming to get
| these guys to speedily reverse course.
|
| >The video of George Floyd is powerful because it shows us
| the truth.
|
| Isn't the video in question is an example of shaming - the
| police?
|
| Why do you think police, FBI and the rest works hard to bar
| public access to ALL their activities?
| tropdrop wrote:
| > _For one thing, doctors were upset because Semmelweis '
| hypothesis made it look like they were the ones giving childbed
| fever to the women._
|
| This, I think, is a point that needs amplifying:
|
| Doctor hubris causing harm and even death is not an isolated
| incident to this case. This is alluded to with the line about how
| difficult it is to convince health care providers to take hand-
| washing seriously today. One can look to some horrifying
| practices in medical history to see a track record of "I'm a
| doctor, so I know better than you" that caused needless deaths
| and sometimes despicably cruel outcomes. Rosemary Kennedy's case
| is an example of that happening all throughout her life, with
| first this:
|
| _During her birth, the doctor was not immediately available and
| the nurse ordered Rose Kennedy to keep her legs closed, forcing
| the baby 's head to stay in the birth canal for two hours._
| (caused Rosemary's intellectual disabilities)
|
| And then lobotomy [1].
|
| On a personal note, my close family member is dealing with
| cancer. His last chemotherapy just about killed him - he lost 40
| lbs in a week and went from being in full heath to severely
| underweight. When he told the doctor that he just could not do
| another therapy session - he feels that it will kill him - the
| doctor said exactly the above - "I'm a doctor, so I know better
| than you." He left that doctor - his tumor was already gone, he
| continued his last radiotherapy sessions. He was just like the
| people mentioned in this article [2] -
|
| _The surprising part was that people who were feeling the best
| at the start of the therapy ended up feeling the worst. They are
| the ones most harmed and who had the most to lose... without
| significant benefit for their cancer._
|
| 1 - https://en.wikipedia.org/wiki/Rosemary_Kennedy#Lobotomy 2 -
| https://time.com/3968918/when-chemotherapy-does-more-harm-th...
| lordgrenville wrote:
| Sorry to hear about your family member's bad experience, but
| glad to hear they're on the mend. I'd highly recommend Atul
| Gawande's book _Being Mortal_ which has a lot to say about
| doctor hubris in treating the terminally ill. He describes how
| the patient should guide the treatment based on their own
| preferences, informed by the doctor 's expertise.
| [deleted]
| ninja3925 wrote:
| Looks like this work led the way to Germ Theory (Pasteur). Pretty
| cool. Thanks Semmelweis and Pasteur.
| https://hardydiagnostics.com/wp-content/uploads/2016/05/Semm...
| moron4hire wrote:
| This underscores something that is going on with the COVID-19
| pandemic. There are a lot of complaints about face-mask
| ordinances that claim there is no "hard science" to show that
| masks are effective, followed by some sort of statement that
| public policy should be "based on hard science".
|
| For a lot of reasons, hard science isn't all it's cracked up to
| be, certainly not by the lay public, who seem to treat it as a
| "final, definitive word" on subjects. First of all, it gives a
| lot more credit to science than even scientists give. But most
| importantly, you don't need to know the mechanism of a problem if
| you have statistical evidence that your actions are having an
| impact. You might not even know it's the direct result of the
| actual action you're taking, it might be a knock-on effect from
| some other action people are taking in response to the mandated
| action.
|
| But that doesn't matter. What matters is that lives are saved.
| You can figure out the mechanism later. In the meantime, do the
| superstitious sky-god dance. Especially when it's really not that
| big of an imposition.
|
| We know for a fact that most places that have strict mask
| ordinances are seeing large reductions in infection rate. Some
| aren't, but that's actually not an argument for not wearing
| masks. Indeed, it's the exact opposite. While the "hard science"
| is supposedly unclear, you absolutely should still wear the mask,
| so that the confounding variables are easier to discover.
| matz1 wrote:
| >Especially when it's really not that big of an imposition
|
| This is my biggest issue, dismissing it as something trivial.
| Everybody is different, for some people it can be huge
| inconvenience.
| amanaplanacanal wrote:
| And exceptions for those few people are good. But that's not
| a good reason for the vast majority.
| matz1 wrote:
| Good enough reason is subjective, if someone says they
| don't like mask because its uncomfortable, its obviously
| significant enough reason for them.
| moron4hire wrote:
| If a specific person's respiratory system is really so bad
| that a mask would have a significant, deleterious effect,
| then a mask ordinance is of no consequence because that
| person really should not even be going out in public at all
| during the pandemic.
| matz1 wrote:
| Then Its for them to decide that. They may very well knew
| and accept the what you called "deleterious" effect.
| corty wrote:
| It is not just for them to decide that. They are in a
| risk group and therefore get infected more easily and
| spread the infection more easily. It is in their and all
| our best interest for them to stay home.
| mnd999 wrote:
| I read a piece on the chemistry of how soap acts on Covid-19
| early on and I've been washing my hands ever since. Google
| returns several now.
|
| Previously I was guilty of dismissing it also. "Hand washing?
| Really? Is that all we've got?". Hard science worked for me.
| klenwell wrote:
| My favorite example of this is Pasteur's revolutionary work in
| immunology itself:
|
| _A careful reading of Pasteur's presentations to the Academy
| of Sciences reveals that Pasteur was entirely mistaken as to
| how immunity occurs, in that he reasoned, as a good
| microbiologist would, that appropriately attenuated microbes
| would deplete the host of vital trace nutrients absolutely
| required for their viability and growth, and not an active
| response on the part of the host._
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342039/
| berbec wrote:
| I missed the "A" at the beginning of the article title, and was
| wondering how hand-washing helped defeat the Daleks.
| 4ndrewl wrote:
| Anyone else expecting this to be a Doctor Who story?
| tfitz237 wrote:
| Unnecessary Capitalization Creates Unnecessary Clicks
| iso1210 wrote:
| Unnecessary Capitalization Creates Necessary Revenue
| aspenmayer wrote:
| Necessary to Whom?
| ModernMech wrote:
| Yeah, I had problems parsing the headline.
| brian_herman wrote:
| Yes!
| cj wrote:
| Side note: The Knick was a great TV show about a hospital in the
| early 1900's before standard treatments for common conditions
| existed. If you liked this article, check out this show.
| 99_00 wrote:
| >Even today, convincing health care providers to take hand-
| washing seriously is a challenge. Hundreds of thousands of
| hospital patients get infections each year, infections that can
| be deadly and hard to treat. The Centers for Disease Control and
| Prevention says hand hygiene is one of the most important ways to
| prevent these infections.
|
| When I wash my hands several times a day they become raw.
| Moisturizer helps a bit.
|
| Can't the process be made a bit better?
| opan wrote:
| I wash my hands at least twenty times a day, probably, and they
| don't become raw. I don't use moisturizer either. It could be
| you have to build up a tolerance. Some people who don't brush
| their teeth often will similarly have discomfort and bleeding
| when they do brush (like right before a dentist's appointment).
| Baeocystin wrote:
| Dawn dish soap works very well- you don't need much at all per
| wash, and your hands don't get dry and cracked after repeat
| washings.
| DanBC wrote:
| The CDC has "When is clean too clean" which explains some of
| the problems. Health care professionals may be washing their
| hands many times a day.
|
| https://wwwnc.cdc.gov/eid/article/7/2/70-0225_article
| [deleted]
| IG_Semmelweiss wrote:
| Hello,
|
| I am Ignaz Semmelweiss.
|
| Ask me anything!
| pella wrote:
| related:
|
| _" The Semmelweis reflex or "Semmelweis effect" is a metaphor
| for the reflex-like tendency to reject new evidence or new
| knowledge because it contradicts established norms, beliefs, or
| paradigms."_ https://en.wikipedia.org/wiki/Semmelweis_reflex
|
| ----
|
| Bonus: "Look at yourself objectively" (by Aaron Swartz )
|
| http://www.aaronsw.com/weblog/semmelweis
| deckarep wrote:
| I'm just gonna leave this right here on the matter:
| https://youtu.be/JwzDG_kIq68
| tingletech wrote:
| interesting, seems to be a reupload of
| https://www.youtube.com/watch?v=WKfolJv6Kx8
| dang wrote:
| Discussion from 2015:
| https://news.ycombinator.com/item?id=8897387
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(page generated 2020-07-11 23:00 UTC)