The heroic act of washing hands

By : Fernando Neubarth
Médico e escritor. Especialista em Clínica Médica e Reumatologia. Chefe do Serviço de Reumatologia do Hospital Moinhos de Vento. Presidente da Sociedade Brasileira de Reumatologia/SBR 2006-2008. Presidente do Conselho Consultivo da SBR.

12 June, 2020

"In public health everything is recent. Demonstrations of which germs cause disease are just over a century and a half old. Pasteur, Lister, Koch... And before them, Ignaz Semmelweis believed in that, too. Without proof, he understood and prevented several deaths."

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From the windows, at the indicated time, applause and greetings to health professionals for the care of the victims of the pandemic. Tributes from a safe distance.

In desperate times, we need heroes.

The German-American writer and anthropologist Kurt Vonnegut (1922-2007) appropriately suggested in a 1981 essay choosing a true hero for our time. And I agree with the option: Ignaz Semmelweis. His argument is completely relevant.

“The Hungarian physician Semmelweis was born in Budapest in 1818 and died at the age of 47. An obstetrician, he devoted himself to the health of mothers and babies, which would in itself grant him the title of modern hero. Even today, there is very little care for mothers, babies, the elderly, or anyone, physically or financially weak. He was horrified when he went to work in a maternity hospital in Vienna and discovered that one out of every 10 mothers died of fever after childbirth. They were poor people. Wealthy people had their babies at home. Intrigued, he observed hospital routines and started suspecting it was doctors who infected their patients. He noticed that they came from the corpse dissection room, in the morgue, to examine the mothers in the maternity hospital. He suggested, as an experiment, that they wash their hands before touching the mothers. What could be more offensive? How dare he make such a suggestion to his superiors? He, a nobody?

Death gave no respite and Semmelweis insisted on asking them to wash their hands. Until they finally accepted, in a combination of play, satire and contempt.

Death stopped.

Imagine the surprise. Even though he couldn’t explain why, he stated, through statistical analysis, the importance of washing hands. He saved millions of lives, possibly including mine and yours.”

It is on observation, on the search for new knowledge and information that Kurt Vonnegut based his choice of a hero. In a speech on “the revolutionary fact that today we can speak based on what we know, if we so desire”, he states that an “act of bravery, honor and beauty, seeking education and obtaining concrete information that, when properly understood and used, can save us as a species." However, he warns that “all the accurate information that we have now, can be uncomfortable for some, from time to time”. This information revolution contains a bitter paradox. Information seems to be inconvenient. In the last millions of years, humanity depended on riddles. We had good and bad fortune tellers; Vonnegut cites two examples: Aristotle and Hitler. One good and one very bad. “The human masses, without concrete information, had few options because they did not believe in that or that fortune teller on duty”.

“The fortune tellers gave us the courage to overcome tests that we could not understand - loss of crops, plague, volcanoes, stillborn babies. They gave us the illusion that we were in control of our destiny. Persuasive guessing is always found in the durability of leadership, the surprising thing is that many of the leaders of this planet, despite all the accurate information we have today, want to continue being fortune tellers, only guessing.”

Announcements such as the restriction of funds for education and research, with the excuse of being inflationary, prevent new truths from inconveniencing bad politicians. They abhor solid information generated through scientific research, study grants, and research reports. It is not the gold model they ask for, it is the nail in the horseshoe. What is education good for?

Everything is recent when it concerns public health. Demonstrations of which germs cause disease are just over a century and a half old. Pasteur, Lister, Koch…and before them Ignaz Semmelweis believed in that too. Without proof, he understood and avoided those deaths.

“How much gratitude did Semmelweis receive from the leaders of his profession and from society - Those who only guessed? He was not taken seriously, they treated him like a crazy person. Forced to leave the hospital, banned in Austria, he ended his career in a provincial sanitarium in Hungary. There he stopped believing in humanity, in knowledge and in himself. One day, in the dissection room, he purposely stabbed the blade of a scalpel used on a corpse into the palm of his hand. He died, as he knew it would happen, by poisoning his blood.

The fortune tellers won. They are the true and nefarious germs. They are not really interested in saving lives. They only care about being heard, their riddles are essential to stay dominant.”

It is difficult to prevent what will come after the pandemic. We must appropriate history. If we face the unknown, good common sense shall follow science and not fortune tellers, soothsayers, or “beliefs” that oppose the brutal evidence of death and suffering, treats losses as inevitable, disclosing information false, disdainfully treating the projection curves, without real concern about the failures of a health system, which is barely not worse.

In Slaughterhouse 5, Kurt Vonnegut, creates an ironic critical phrase that is repeated to exhaustion, whenever death appears: “So it goes”. It is evocative of the phrase “such is life”. Perhaps it evokes his German ancestry: German grandmothers would signal the acceptance of existential designs with “So ist das Leben”. It is tragic is when it ceases to be synonymous with acceptance and indicates irresponsibility, insensitivity and neglect, a “so what?” lacking affection and poor in spirit.

Enough assumptions, let’s stop listening to the bad fortune-tellers, truth is tied to knowledge. Without this, nothing will be freed.



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