The Wall Street Journal - 21.03.2020 - 22.03.2020

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I

t’s difficult to feel any sense

of optimism during the

Covid-19 pandemic, but one

source of encouragement is

that simple soap and water

can be a powerful defense. The cor-

onavirus that causes the disease is

enveloped in fatty layers that are

easily dissolved by detergents, ex-

posing the core of the virus and

causing it to perish. That’s why pub-

lic health authorities keep stressing

the importance of washing our

hands.

Handwashing to kill germs might

seem like basic hygiene today, but it

is a relatively recent discovery in

the history of medicine. In the early

19th century, even hospitals had no

inkling of the importance of cleanli-

ness. They were breeding grounds

for infection, often referred to as

“houses of death.” Hospitals pro-

vided only the most primitive facili-

ties for the sick and dying, many of

whom were housed on wards with

little ventilation or access to clean

water. In 1825, visitors to St.

George’s Hospital in London discov-

ered mushrooms and maggots thriv-

ing in the damp, dirty sheets of a

patient recovering from a com-

pound fracture. Mortality rates for

hospital patients were three to five

times higher than for people treated

in domestic settings.

The first doctor to understand

the importance of hygiene in stop-

ping the spread of infectious dis-

ease was Ignaz Semmelweis, a Hun-

garian physician, who in the 1840s

was working in the maternity de-

partment of Vienna’s General Hospi-

tal. At the time, the idea that the

squalid conditions in hospitals

played a role in spreading infection

didn’t cross many doctors’ minds.

Among those most at risk were

pregnant women. When they suf-

fered vaginal tears during delivery,

the wounds provided openings for

the bacteria that doctors and sur-

geons carried on them wherever

they went.

Semmelweis, then in his late 20s,

noticed an interesting discrepancy

between the hospital’s two obstet-

ric wards. One was attended by

male medical students, while the

other was under the care of female

midwives. Although each ward pro-

vided identical facilities for its pa-

tients, the one overseen by the

medical students had a mortality

rate that was three times higher.

Those at the hospital who noticed

the imbalance attributed it to the

idea that male students handled pa-

tients more roughly than female

midwives did, thus making the new

mothers more susceptible to devel-

oping puerperal fever, a dangerous

postpartum infection.

Semmelweis wasn’t convinced. In

1847, he had a breakthrough when

one of his colleagues became ill af-

ter cutting his hand during a post-

BYLINDSEYFITZHARRIS

REVIEW

right set of virtues, describing

such a woman as “rara avis in

terris nigroque simillima cygno,”

or “a bird as rare upon the earth

as a black swan.”

From this famous line, “rara

avis” came to mean a person or

thing rarely encountered, and

“black swan” became a common

figure of speech for something

with vanishingly little chance of

being discovered. In Juvenal’s

era, swans were only known to

have white feathers.

In early modern English, the

“black swan” was a frequent

point of comparison for remark-

able, hard-to-find figures. In a

1570 sermon, the English clergy-

man Thomas Drant recalled Cor-

nelius, the Roman centurion said

to have been the first Gentile to

convert to Christianity. Drant

was hard-pressed to find such a

virtuous soul in his day: “Cap-

taine Cornelius is a blacke Swan

in this generation.” And “The La-

dies’ Dictionary,” published in

1694, wryly mentions “husbands

without faults (if such black

Swans there be).”

Soon thereafter, in 1697, the

Dutch navigator Willem de

Vlamingh made a startling dis-

covery while exploring south-

western Australia. There were

large numbers of black swans

living there, though Europeans

might have disbelieved early ac-

counts of creatures long held to

be as fanciful as unicorns.

The philosopher John Stuart

Mill seized on the image of the

black swan in “A System of

Logic” in 1843 to demonstrate

the perils of inductive reasoning:

Since Europeans had never seen

a black swan before the explora-

tion of Australia, the statement

“All swans are white” appeared

to be true. Following Mill’s lead,

Karl Popper and Bertrand Rus-

sell invoked the black swan in

their philosophical works as an

example of the risks of declaring

something impossible based only

on one’s limited experience.

Mr. Taleb sought to move be-

yond this logical fallacy by pro-

viding a more precise framework

for “black swan events” in terms

of their statistical improbability

and unexpected impacts. But

some have argued that the

Covid-19 health crisis should not

be considered a black swan be-

cause it was not so improbable.

Nate Silver of FiveThirtyEight

told Fox News that it would be

better described as a “fat tail

kind of black swan,” with “fat

tail” referring to a statistical sce-

nario in which extreme out-

comes are more likely to occur.

Policy analyst Michele

Wucker has a different name for

the pandemic and the attendant

economic chaos. She calls it a

“gray rhino,” her term for events

that are “obvious, visible, com-

ing right at you, with large po-

tential impact and highly proba-

ble consequences.” Writing this

week in the Washington Post,

Ms. Wucker observed that “the

black swan, only visible in hind-

sight, is a convenient narrative”

for political and financial au-

thorities who want to wash their

hands of “unforeseeable” calami-

ties when there were plenty of

warning signs. “Paying attention

to the gray rhino,” she argues,

“would be a far better use of our

time than retroactively spotting

black swans.” JAMES YANG

GRAPPLING WITHthe coronavi-

rus pandemic and its disastrous

impact on financial markets,

commentators have reached for

a familiar metaphor: the “black

swan.”

“Coronavirus is the black

swan of 2020,” read a memo

that the Silicon Valley venture-

capital firm Sequoia Capital is-

sued on March 5. Since then, the

Covid-19 outbreak has borne out

the warning, with businesses

facing dire economic prospects

as the global health crisis con-

tinues spiraling out of control.

A “black swan,” for market

prognosticators, is a rare, unpre-

dictable event with serious and

unavoidable effects. The theory

of “black swan events” was de-

veloped by Nassim Nicholas Ta-

leb in his 2001 book, “Fooled by

Randomness: The Hidden Role of

Chance in Life and in the Mar-

kets,” and then

fleshed out in his

2007 follow-up, “The

Black Swan: The Im-

pact of the Highly Im-

probable.”

Mr. Taleb drew on

an expression with classical

roots, going all the way back to

the Roman poet Juvenal and his

“Satires,” penned in Latin in the

early 2nd century. Juvenal de-

spairingly observed how difficult

it is to find a wife with just the

[Black Swan]

WORD ON

THE STREET

BEN

ZIMMER

mortem examination. Semmelweis

noticed that the man’s symptoms

were remarkably similar to those of

women suffering from puerperal fe-

ver. What if doctors working in the

dissection room were carrying “ca-

daverous particles” with them onto

the wards when they assisted in the

delivery of babies?

At the time, doctors didn’t wear

protective gear such as gloves when

dissecting the dead, or take care to

wash their hands afterward. Per-

haps the big difference between the

students’ ward and the midwives’

ward was that the students were

the ones performing autopsies.

Believing that puerperal fever

was caused by “infective material”

from dead bodies, Semmelweis set

up a basin filled with chlorinated

lime solution in the hospital and re-

quired all doctors to wash their

hands in it before attending to pa-

tients. In April 1847, the mortality

rate for new mothers on the stu-

dents’ ward was 18.3%. After hand-

washing was instituted in May, it fell

to just over 2%

Semmelweis’s results were com-

pelling, and no doubt he saved the

lives of many mothers during that

period. However, he was not able to

convince his colleagues that puer-

peral fever was caused by contami-

nation through contact with dead

bodies. Even doctors willing to carry

out trials of his methods often did

so inadequately, producing discour-

aging results. And Semmelweis him-

self could never completely elimi-

nate cases of puerperal fever, even

when his protocols were strictly en-

forced. After a number of negative

reviews of a book he published on

the subject, in 1861, Semmelweis

lashed out at his critics, going so far

as to call doctors who didn’t wash

The Unsung Pioneer

Of Handwashing

In 19th-century Vienna, Ignaz

Semmelweis fought to convince

his fellow doctors that washing

their hands could save

patients’ lives.

their hands “murderers.”

In time his behavior became er-

ratic, an embarrassment to the hos-

pital. Later historians have sug-

gested he may have been suffering

from the effects of Alzheimer’s dis-

ease or syphilis. On July 30, 1865,

one of Semmelweis’s colleagues

lured him to a Viennese insane asy-

lum, under the pretense that he

would be visiting a new medical in-

stitute. When Semmelweis surmised

what was happening and tried to

leave, he was severely beaten by sev-

eral guards, secured

in a straitjacket and

confined to a dark-

ened cell. Two

weeks later, he died

of a wound on his

right hand that had

become gangre-

nous.

Semmelweis’s theories about hy-

giene and infection never won ac-

ceptance beyond the walls of his

own hospital. It wasn’t until the

1880s that pioneers of germ theory

such as Louis Pasteur, Joseph Lister

and Robert Koch proved to the

world that disease really could be

transmitted by microscopic parti-

cles, leading to a revolution in sani-

tary practices. Only then was the

crucial importance of handwashing

widely accepted and Semmelweis’s

contribution acknowledged.

Today, the term “Semmelweis re-

flex” is used to refer to the knee-

jerk tendency to reject new evi-

dence because it contradicts

established norms.

As a new pandemic tests the

world’s medical systems and its

ability to mount a coordinated re-

sponse, our minds need to remain

open to creative solutions that

don’t necessarily fit accepted

methodologies. Even in 2020, it re-

mains a challenge to convince peo-

ple that washing their hands is one

of the most effective ways to com-

bat Covid-19. If any positive change

comes from the pandemic, it may

be that handwashing will at last

become as universal as Semmel-

weis hoped.

Dr. Fitzharris is a historian of

medicine and the author of “The

Butchering Art: Joseph Lister’s

Quest to Transform the Grisly

World of Victorian Medicine.” FROM LEFT: GETTY IMAGES; ALAMY

A 19th-

century

woodcut

shows

Semmelweis

aiding a new

mother.

A Rare

Disaster,

NotasRare

As Once

Believed