Medicine’s deadly obstinance: “I’m not washing my hands!”

On puerperal fever, heart attacks and structural corruption.

I found out on Twitter the other day that Dr. Peter McCullough just published a book. I had no option but to buy it. I certainly have far more books than I will ever read, a tsundoku, as the Japanese would say, but I live in the joyful hope that I will, eventually, one day, read them all.

The book is titled The Courage to Face Covid-19 and written with the non – fiction crime writer (which is highly appropriate), John Leake.

I was reading Leake’s first few pages and he chooses to open with the story of Puerperal fever and Dr. Ignaz Semmelweis. This was noticeable to me because within Dissolving Illusions that was a story that also stood out to me and I’d made a mental note to write a stack on it.

Let’s start off with Leake’s take on the story:

My work as a nonfiction (true crime) author had led me deep into the literature of forensic medicine. Forensic pathologists and scientists played major roles in my first two books. I’d also done some translation work (from German to English) for a doctor at the Vienna Institute of Forensic Medicine. During the 19th century, its faculty made key contributions to the development of modern medicine. While visiting I sometimes thought of Professor Jakob Kolletschka, the institute director who died in 1847 after he was accidentally cut by a student's scalpel during a post-mortem examination. Kolletschka's colleague and friend, Professor Ignaz Semmelweis, hypothesized that ptomaine (German Leichengift or "cadaver poison") was transferred from the cadaver to Professor Kolletschka's body by the scalpel. He further postulated that students were transferring "cadaver particles" from their hands to pregnant women whom they examined in a maternity clinic following their anatomy class. Wondering if this could be the cause of high rates of puerperal fever (an illness that emerges right after childbirth) in the clinic, he instructed the students to wash their hands with chlorinated lime before they examined the women.

Clearly Ignaz was a first principles thinker and using that thinking tool arrived at “wash your hands”.

I have to thank Musk for introducing me to the idea and the language of first principles thinking, if my memory is right, it was via this short clip.

On listening to it again I had forgotten his emphasis on “truth” as the starting point.

“First principles is kind of a physics way of looking at the world, and what that really means is you kind of boil things down to the most fundamental truths and then say okay, what are we sure is true or as sure as possible is true, and then reason up from there. That takes a lot more mental energy.”

The way I have come to say it is “what is true or likely to be true”, those are the only inputs I am interested in, in trying to understand this new world we are in. It is also the primary problem for the world because all sense making and “truth telling” institutions have been captured, so how can the masses think clearly when none of the inputs are “true or likely to be true” anymore?

Anyway, I digress…back to washing hands:

Soon puerperal fever mortality in the clinic dropped precipitously, thereby opening a seminal chapter in the germ theory of disease. Unfortunately for Dr. Semmelweis, and for many patients who could have benefitted from his insight sooner rather than later, his theory was vehemently rejected by many of his era's eminent medical authorities. Branded a quack and abandoned by everyone, including his wife, he ended up dying alone in a Vienna insane asylum, probably from the effects of a severe and untreated injury he sustained from an abusive staff member.

The moral of the Semmelweis story is clear: orthodoxy in medicine is deadly. The eminent authorities at one time may be revealed to be catastrophically wrong a few years later. The Semmelweis story is also a dreadful example of Groupthink - the belief in something not because it has been subjected to rigorous analysis, but because one's group embraces it.

Groupthink may be especially potent when it's propagated and reverberated by perceived authorities on the subject. Because scientific knowledge is always evolving, there can be no final arbiter of scientific truth.

This seems to be a recurring theme in medicine, the smallest deviance from orthodoxy will bring the whole system down on you. I’m fascinated with the dynamics that create this. It’s a recurring theme so it must have a particular machinery that causes it to repeat.

All he did was say that doctors should wash their hands before examining pregnant women. They went after him for that.

It reminds me of the story of Dr. Bernard Lown that I’ve written about before:

9 Thoughts on helping family + friends wake up from COVIDmania

In which I reference Dr. Malcolm Kendrick who first made me aware of the story. Here he elaborates on the story in more detail:

Another big medical idea is that of bed rest following a heart attack. It was thought, at one time, that all heart attacks were fatal. James Herrick, another US doctor, described the first non-fatal heart attack in 1912, then suggested that following such an attack, strict bed rest was important. This would take pressure off the heart and allow it a chance to heal. Again, this sounds perfectly reasonable. As described by Dr Bernard Lown, a professor of cardiology and the developer of the defibrillator:

“To a medical novice like me, the justification for enforced bed rest was persuasive. It was based on a sacrosanct therapeutic principle, the need to rest a diseased body part, be it a fractured limb or a tuberculosis-affected lung. Unlike a broken bone, which could be immobilized in a cast, or a lung lobe, which could be collapsed by inflating the chest cavity with air, the heart could not be cradled into quietude. The only approximation for a diseased heart was to diminish its workload. It was long known that during recumbency the heart rate slows, and blood pressure drops, both indices of less oxygen usage and therefore of decreased cardiac work. Heart rest was therefore equated with bed rest.”

And so it became standard practice. It was simply what you did:

“Patients were confined to strict bed rest for four to six weeks. Sitting in a chair was prohibited. They were not allowed to turn from side to side without assistance. During the first week, they were fed. Moving their bowels and urinating required a bedpan. For the constipated, which included nearly every patient, precariously balancing on a bedpan was agonizing as well as embarrassing.

“Because world events might provoke unease, some physicians prohibited their patients from listening to the radio or reading a newspaper. Visits by family members were limited. Since recumbency provoked much restiveness and anxiety, patients required heavy sedation, which contributed to a pervasive sense of hopelessness and depression. Around one in three patients died.” 

Bed rest started as a relatively mild thing. However, as it is with almost all things, it became increasingly ‘radical’. Lown, along with his mentor Dr Samuel Levine, tried to change this. He became involved in trying to get patients up out of bed to sit in a chair:

“Little did I realize that violating firmly held traditions can raise a tsunami of opposition. The idea of moving critically ill patients into a chair was regarded as off‑the‑wall. Initially the house staff refused to cooperate and strenuously resisted getting patients out of bed. They accused me of planning to commit crimes not unlike those of the heinous Nazi experimentations in concentration camps. Arriving on the medical ward one morning I was greeted by interns and residents lined up with hands stretched out in a Nazi salute and a ‘Heil Hitler!’ shouted in unison.”

Step six: Anyone who goes against the ‘idea’ is ruthlessly attacked. 

No evidence, no problem

Then, among all the other problems with ‘the idea’, between steps two and three, is one that I have not yet mentioned. It is that no study is ever done to find out whether or not the idea works. It is just conceived to be so obviously beneficial, such common sense, that there would be no point in wasting time and resources trying to prove that it worked.

No-one ever did a study to find out if the radical mastectomy improved survival. No-one ever did a study to prove that bed rest saved lives. They were both introduced on the back of absolutely nothing. In time, eventually, the folly of both was finally recognised. It took 70 years for radical mastectomy, 50 for bed rest.

Again, you can see the first principles thinking at play. The heart has been damaged, the heart is a muscle, muscles need to work to build up strength…let’s get the patient to sit up in bed. But it took 50 years for medicine to “change its mind”. I had no idea that radical mastectomy was also a rotten part of medical history. How much bullshit can one “profession” carry?

There is something very, very wrong with the framework of medicine that repeatedly creates this deadly obstinance. We are living through that very thing right now.

Very few have been granted the ability to prove of great and lasting service to mankind, and with few exceptions, the world has crucified and burned its benefactors. Still, I hope you will not tire in the honorable struggle that remains for you. DR. LOUIS KUGELMANN TO DR. IGNAZ SEMMELWEIS

Now let’s go back and take a longer stroll through the puerperal fever story where I first read it in Dissolving Illusions:

One of the ugliest, most tragic, and most avoidable chapters in the history of medicine is that of puerperal fever. Puerperal fever is the name given to a deadly infection that affected many mothers in the immediate post-partum period. Severe pain, pelvic abscesses, sepsis, high fever, and agonizing death were brought about by an ascending infection introduced by the contaminated hands of doctors and unsterile medical instruments. There is no single type of microorganism responsible, though the most common bacteria isolated after the germ theory was developed was Beta haemolytic streptococcus, Lancefield Group A.

In the United States, Europe, New Zealand, Sweden, and wherever conventional midwifery was abandoned and taken over by the new male midwives known as obstetricians and medical students, puerperal fever followed.

Man-midwifery was an uncertain but increasingly fashionable and sometimes quite lucrative area of practice for physicians; it may, for this reason, have been a field in which ideas about theory and practice were particularly strongly contested. Midwifery, formerly the preserve of women, was receiving increasing attention from medical men—both physicians and surgeons—during the eighteenth century.

Prominent within this area of practice were the surgeons, for whom midwifery was seen as a natural extension of their activities.

Surgeons had traditionally been called in to difficult births by midwives, usually when there was a need to extract an already dead foetus from the womb in order to save a mother’s life. During the eighteenth century, surgeons were increasingly finding ways to extend their practice into the area of normal childbirth. Men-midwives, although recognized by society as holding respectable positions and possessing expertise, found their status limited by the “hands-on” nature of their work. Nevertheless, within broader social terms, man- midwifery could be seen as a field of financial and career opportunity.

These ambiguities and uncertainties within the status of men- midwives may have contributed to the intensity and competitiveness of the debates which can be found in their writings.

Puerperal fever, also known as childbed fever, was a disease mediated by doctor arrogance. Dr. Oliver Wendell Holmes of the United States and Dr. Ignaz Semmelweis of Austria were prominent, long-suffering advocates for women, who tried to get the medical profession to wash their hands and practice more like the traditional midwives did. Both were ignored and even professionally attacked for their views. After years of mental anguish, watching women die needlessly, they left the field of medicine in disgust. Dr. Holmes became a writer. In 1865 Dr. Semmelweis was deceived into entering an insane asylum and when he tried to escape, he was severely beaten by guards. A gangrenous wound to his hand, probably caused by the beating, led to his untimely death two weeks later.

The reason it is important to never forget the history of puerperal fever is because the massive loss of maternal life impacted husbands, surviving infants, older surviving children, the family unit, society… and the statistics on life expectancy. Yet we rarely hear the words “puerperal fever” mentioned or discussed.

The epidemic of women and babies dying is documented from records as early as 1746, where more than 50 percent of mothers who gave birth in a Paris hospital died. However, the best and most comprehensive writing on the problem came from Dr. Ignaz Semmelweis in his book, Etiology, Concept, and Prophylaxis of Childbed Fever. After noting that the mothers who were tended by medical doctors had more than three times the rate of death than those who were tended by midwives and that those who were not internally examined lived, he suspected a contagious agent. Doctors often went from touching infected corpses in the cadaver dissection lab, to the maternity ward, where they examined women and delivered babies without handwashing.

Dr. Semmelweis directed the doctors of his hospital to use a chlorinated lyme solution on their hands prior to touching women. When doctors and medical students complied, the maternal mortality rate went from a high of 32 percent down to zero. Using a similar antiseptic technique, Dr. Breisky of Prague reported in 1882 that he delivered 1,100 women in succession without a single death.

You would think that would be it, case closed, let’s all wash our hands. No…that would be too easy. Ignaz woke up the beast that lives within medicine, and it went after him.

Dr. Semmelweis held several sequential staff positions, and wherever his hygiene method was followed, maternal mortality rates dropped. But most of his contemporaries ignored such outrageous and offensive “nonsense.”

Doctors were insulted at the suggestion that their hands were dirty, and many had the arrogance to continue to ignore factual evidence showing that they were the cause of maternal suffering and death up until the 1940s when antibiotics were invented.

Doctors are human before they are doctors. This is the same insult felt by a paediatrician if you suggested that stabbing a baby with 72 doses (US) of chemical compounds is a less than ideal idea.

This “insult” dynamic is an important part of the machinery I think that makes medicine “structurally prone to corruption”, but I will try to flesh that out another time.

After the invention of antibiotics, puerperal fever dropped significantly, but Semmelweis’ and Breisky’s records proved that doctors could have stopped almost all the puerperal fever deaths from occurring in the 1700s if they had only washed their hands and their instruments and stopped using unnecessarily invasive birthing techniques.

Another example, from Britain, was the widespread use of chloroform and forceps by general practitioners in uncomplicated deliveries between 1870 and the 1940s. This was described by one observer as a tendency a “little short of murder” and accounted for many unnecessary deaths.

Considering that one-fifth of the population consisted of women of childbearing age and that a higher than 30 percent maternal mortality rate was not uncommon, the impact on society, life expectancy statistics, and the infectious disease rate (infants whose mothers died around childbirth had a four times higher risk of dying, most commonly from infections) was enormous. Yet vaccine enthusiasts never mention this tragedy in their assessment of history and infectious disease. Instead, vaccines are lauded as the great gift to humanity when, in fact, had doctors simply washed their hands, they would have prevented countless millions of deaths and raised the life expectancy curve markedly.

Preventable medical error is well documented all throughout the world and is the third leading cause of death in the United States (225,000 deaths per year*), with similar numbers wherever the same medical paradigms are implemented.

Yet every time an unvaccinated person enters their office, zealously pro-vaccine doctors arrogantly overlook the truth that a person’s risk of dying or being maimed from accepted medical practice they offer, is far, far higher than any possible death or maiming from a supposedly vaccine-preventable disease.

*Barbara Starfield, MD, MPH, “Is US Health Really the Best in the World?” Journal of the American Medical Association, vol. 284, no. 4, July 26, 2000, pp. 483–485.

The end result of puerperal fever was millions of motherless children relegated to die, or to live a life of malnutrition and disease, often forced to work in mines, factories, and sweat shops. Puerperal fever fueled a social bonfire that left enormous damage in its path. If those infants had mothers to breastfeed them and love them and the older siblings had a mother at home to tend to their needs, the disease and misery of the 1700s to 1900s would have been far less prominent. Doctors today believe that vaccines would have reduced those diseases, while they ignore the fact that their own predecessors created one of the situations which resulted in high disease rates and low life expectancy.

There are numerous reputable sources that clearly demonstrate how improved living conditions, more nutritious food, better obstetric care, and other non-vaccine elements were responsible for the decline in infectious disease death rates. Despite this clear evidence, today’s vaccine proponents continuously and falsely claim that vaccines are the principal reason for the increase in life expectancy we enjoy today.

In the pages that follow, you will be able to decide for yourself what makes more sense. Was it the vaccines? Or were there other factors that corresponded with the timing of decline in death rates? If so, are they to thank for our longer life expectancy? If the answer is that it was not the vaccines, should the World Health Organization (WHO) be working in a different direction today, in poor countries that mirror the conditions of our past?

The more I learn about medical history the more I see the same story pattern emerge. Truth is discovered, then attacked and ignored at the expense of a suffering world.

I think there are a combination of factors that in aggregate are unique to medicine and that make it lean towards corruption more than any other profession. I need to gather my thoughts on that for another day and another stack.