The Wall Street Journal - 21.03.2020 - 22.03.2020

(Joyce) #1

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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

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