Ignaz Semmelweis: hand washing

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The Half-Life of Facts: Why Everything We Know Has an Expiration Date by Samuel Arbesman

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There are well over a hundred of these biases that have been cataloged. . . . IN the 1840s, Ignaz Semmelweis was a noted physician with a keen eye. While he was a young obstetrician working in the hospitals of Vienna, he noticed a curious difference between mothers who delivered in his division of the hospital and those who delivered at home, or using midwives in the other part of the hospital. Those whose babies were delivered by the physicians at the hospital had a much higher incidence of a disease known as childbed fever, which often causes a woman to die shortly after childbirth, than the women delivering with midwives. Specifically, Semmelweis realized that those parts of the hospital that did not have their obstetricians also perform autopsies had similarly low amounts of childbed fever as home deliveries. Ignaz Semmelweis argued that the doctors—who weren’t just performing autopsies in addition to deliveries but were actually going directly from the morgue to the delivery room—were somehow spreading something from the cadavers to the women giving birth, leading to their deaths.

Ignaz Semmelweis argued that the doctors—who weren’t just performing autopsies in addition to deliveries but were actually going directly from the morgue to the delivery room—were somehow spreading something from the cadavers to the women giving birth, leading to their deaths. Semmelweis made a simple suggestion: Doctors performing deliveries should wash their hands with a solution of chlorinated lime beforehand. And this worked. It lowered the cases of childbed fever to one tenth the original amount. However, rather than being lauded for an idea that saved lives for essentially no cost, Semmelweis’s ideas failed to gain traction. Some of this was due to the fact that there was no germ theory at the time to explain the spread of the disease. Therefore, those who had a stake in the then-current theories refused to recognize that Semmelweis was making important points.

Specifically, it found a large cluster of genes related to something known as programmed cell death. Programmed cell death is not nearly as scary as it sounds. Our bodies often require the death of individual cells in order to perform correctly, and there is a set of genes in our cells tailored for this purpose. For example, during embryonic development, our hands initially have webbing between the fingers. But prior to birth the cells in the webbing are given the signal to die, causing us to not have webbed hands. Webbed hands and feet only occur when the signal is given incorrectly, or when these genes don’t work properly. What CoPub Discovery computationally hypothesized is that when these programmed cell death genes don’t work properly in other ways, a cascade of effects might follow, eventually leading to the condition known as Graves’ disease.


pages: 588 words: 131,025

The Patient Will See You Now: The Future of Medicine Is in Your Hands by Eric Topol

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Much of medical practice will be conducted online, with online consultations routine.” —RICHARD SMITH, EDITOR, British Medical Journal2 “We can only see a short distance ahead, but we can see plenty there that needs to be done.” —ALAN TURING3 Profound change has not ever gone over well in the medical community. When Dr. Ignaz Semmelweis published findings in 1848 that hand washing could markedly reduce mortality, it was summarily dismissed by doctors who were offended at the suggestion they should wash their hands and saw no scientific explanation for the claim.4 Likewise, in 1990, there was strong opposition to the use of ultrasound during pregnancy. In the American Journal of Obstetrics & Gynecology (the leading medical journal of the specialty), in response to an article touting its use, Ewigman and colleagues wrote: “These authors’ ethical argument that patient autonomy justifies offering ultrasonography routinely would lead to unrealistic expectations of physicians and the health care system, cause an inappropriate legal liability, and may be harmful to patients.”5 Even the stethoscope, invented by Rene Laennec in 1816, was not received well by doctors, to put it mildly.

Schumpeter: A Theory of Social and Economic Evolution (New York, NY: Palgrave McMillan, 2011). 2. R. Smith, “Teaching Medical Students Online Consultation with Patients,” BMJ Blogs, February 14, 2014, http://blogs.bmj.com/bmj/2014/02/14/richard-smith-teaching-medical-students-online-consultation-with-patients/. 3. “Alan Turing,” Wikiquote, accessed August 13, 2014, http://en.wikiquote.org/wiki/Alan_Turing. 4. “Ignaz Semmelweis,” Wikipedia, accessed August 13, 2014, http://en.wikipedia.org/wiki/Ignaz_Semmelweis. 5. B. Ewigman et al., “Ethics and Routine Ultrasonography in Pregnancy,” American Journal of Obstetrics & Gynecology 163, no. 1 (1990): 256–257. 6. S. J. Reiser, Technological Medicine: The Changing World of Doctors and Patients (New York, NY: Cambridge University Press, 2009), 12. 7. H. J. West, D. deBronkart, and G. D. Demetri, “A New Model: Physician-Patient Collaboration in Online Communities and the Clinical Practice of Oncology,” Department of Thoracic Oncology, Swedish Cancer Institute, 2012, http://meetinglibrary.asco.org/sites/meetinglibrary.asco.org/files/Educational Book/PDF Files/2012/zds00112000443.pdf. 8.

in reporting on some hospitals that were publicly flogged for very serious or fatal errors but still could not get on track to avoid these subsequently.16 The patient perspective is especially poignant and well represented by Mary Brennan-Taylor, who works at the YMCA in upstate New York. Brennan-Taylor lost her mother and has become a national advocate for hospital safety. Her lessons of overriding medical paternalism, and the need to inspire patients to assert themselves are well stated: “I felt responsible for not being able to protect her. I was totally trusting. I never asked the doctors and nurses coming into her room to wash their hands. I never checked her medication.” In an article entitled “Survive Your Hospital Stay,” Consumer Reports rated 2,591 hospitals for safety, with quite striking findings.17 The differences in death rates for common diagnoses or surgery were analyzed as a function of low or high rating. The ratings factored in mortality, readmission to the hospital within thirty days from being discharged, infections, communications of the staff, and the use of medical scans.


pages: 100 words: 28,911

A Short Guide to a Long Life by David B. Agus

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Danny Hillis, Ignaz Semmelweis: hand washing, meta analysis, meta-analysis, Murray Gell-Mann, personalized medicine, placebo effect, risk tolerance, the scientific method

Although technically not a discovery on par with penicillin and the smallpox or polio vaccines, the mid-nineteenth-century recognition of the importance of hand washing was a huge medical breakthrough that saved a lot of people long before vaccines and antibiotics were widely available. In 1847, while working at an obstetrics clinic in Vienna, Hungarian-born physician Dr. Ignaz Semmelweis noticed that fatal fevers among mothers of newborn children happened more frequently in birthings assisted by medical students than in those assisted by midwives. This prompted him to look closer at the clinic’s practices, and he soon noted that the medical students who aided in childbirth often did so after performing autopsies on people who had died from bacterial sepsis—a whole-body blood infection in which the inflammatory response to a blooming bacteria turns deadly. He then established a strict policy of hand washing with a chlorinated antiseptic solution, and lo and behold, mortality rates dropped ten- to twentyfold within three months.

Had civilization figured this out sooner, perhaps we could have avoided many of the deaths associated with plagues and epidemics that wiped out millions of people in earlier centuries. Even today, we are inclined to trivialize the simple act of hand washing and would do well to keep it at the top of our priorities on a daily basis. You’ll give yourself an advantage in avoiding germs that can make you sick, and you’ll help prevent the spread of germs to others. All you need is a dollop of soap and water. Antimicrobial soaps aren’t necessary; the standard stuff is just as good. But if you don’t have access to water, then use an alcohol-based hand sanitizer. Some studies have shown that people who washed their hands at least five times a day were 35 percent less likely to catch the flu than those who lathered up less. In addition to hand hygiene, maintaining general hygiene throughout your body will go a long way to protect you from the ick factor—think about head lice, bad breath, body odor, pinworms, and athlete’s foot.

Confusion or changes in mental status 6. Any sudden or severe pain 7. Uncontrolled bleeding 8. Severe or persistent vomiting or diarrhea 9. Coughing or vomiting blood 10. Suicidal or homicidal feelings Top 10 Things to Do During Cold Season 1. Get your flu shot if you haven’t already. 2. Wash your hands routinely. 3. Avoid sharing food and drinks with others. 4. Stay away from sick people. 5. Don’t go to work (and avoid public places) if you’re feeling ill. 6. Keep zinc lozenges on hand. 7. Avoid touching your face and eating with your hands. 8. Carry hand sanitizer. 9. Avoid stuffy rooms that have poor ventilation. 10. Keep common surface areas clean. Top 10 Reasons to Take a Walk 1. You’ll prevent weight gain and perhaps walk off weight. 2. You’ll reduce your risk of cancer. 3. You’ll reduce your risk of heart disease and stroke. 4.


pages: 372 words: 111,573

10% Human: How Your Body's Microbes Hold the Key to Health and Happiness by Alanna Collen

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Asperger Syndrome, Barry Marshall: ulcers, Berlin Wall, biofilm, clean water, correlation does not imply causation, discovery of penicillin, Drosophila, Fall of the Berlin Wall, friendly fire, germ theory of disease, Ignaz Semmelweis: hand washing, illegal immigration, John Snow's cholera map, Louis Pasteur, Maui Hawaii, meta analysis, meta-analysis, microbiome, phenotype, placebo effect, the scientific method

In comparison with giving birth, often at home, in large areas of Africa, Asia and South America, giving birth in much of Europe, North America and Australasia is a highly medicalised, sterile process. Beds, hands and tools are all washed with antibacterial soaps and alcohol rubs before they come into contact with the labouring woman or her baby. Nearly half of American women are put on an anti biotic drip to prevent them from passing on harmful bacteria such as Group B strep to their babies. And all American babies receive a dose of antibiotics straight after they are born, just in case their mothers have gonorrhoea, which could, in rare cases, cause an eye infection. Ignaz Semmelweis would be pleased to see his antiseptic measures so thoroughly and effectively put into practice, and there’s no doubt that many thousands of mothers and babies are alive because of such hygiene.

Women suffered most as a result of the proliferation of hospitals, as the risks of labour and giving birth, rather than falling, actually rose. By the 1840s, up to 32 per cent of women giving birth in hospital would subsequently die. Doctors – all male at that time – blamed their deaths on anything from emotional trauma to uncleanliness of the bowel. The true cause of this horrifyingly high death rate would at last be unravelled by a young Hungarian obstetrician by the name of Ignaz Semmelweis. At the hospital where Semmelweis worked, the Vienna General, women in labour were admitted on alternate days into two different clinics. One was run by doctors, and the other by midwives. Every second day, as Semmelweis walked to work, he’d see women giving birth on the street outside the hospital doors. On those days, it was the turn of the clinic run by doctors to admit labouring women.

Muscles that should automatically follow the brain’s instructions seem to get multiple orders, and instead of smooth decisive actions, they produce Parkinson-like tremors. Routines are also messed with – turning the lights on, locking the doors, washing the hands. For those OCD sufferers who compulsively wash their hands, there’s an intriguing possibility. I mentioned earlier that some groups of bacteria become more abundant just after hand-washing, perhaps because they take the opportunity to bloom in the absence of their more vulnerable peers. I’ll save you the trouble of looking back: the streptococci are one such group. It’s by no means certain, but maybe these opportunistic pathogens gain enough ground on the hands and in the gut after a good hand-wash to persuade their host, via the habit-enforcing, reward-giving basal ganglia, to keep on washing. Perhaps it won’t come as a surprise that a number of ‘mental health’ disorders – more appropriately referred to as neuropsychiatric disorders – are connected to both basal ganglia dysfunction and to Streptococcus.


pages: 262 words: 66,800

Progress: Ten Reasons to Look Forward to the Future by Johan Norberg

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agricultural Revolution, anti-communist, availability heuristic, Bartolomé de las Casas, Berlin Wall, British Empire, business climate, clean water, Daniel Kahneman / Amos Tversky, demographic transition, desegregation, Donald Trump, Flynn Effect, germ theory of disease, Gini coefficient, Haber-Bosch Process, Hans Island, Hans Rosling, Ignaz Semmelweis: hand washing, income inequality, income per capita, indoor plumbing, Isaac Newton, Jane Jacobs, John Snow's cholera map, Kibera, Louis Pasteur, Mahatma Gandhi, meta analysis, meta-analysis, Mikhail Gorbachev, more computing power than Apollo, moveable type in China, Naomi Klein, open economy, place-making, Rosa Parks, special economic zone, Steven Pinker, telerobotics, The Wealth of Nations by Adam Smith, transatlantic slave trade, very high income, working poor, Xiaogang Anhui farmers

The germ theory of disease was an enormous breakthrough that made more focused measures possible. It seemed impossible that microorganisms, things that were too small to see, could be a cause of disease and death. But natural experiments began to change the prevailing view. In the mid-nineteenth century, the Hungarian obstetrician Ignaz Semmelweis famously noticed a high incidence of puerperal fever among pregnant women who delivered with the help of physicians, whereas it was much lower among those helped by midwives. He connected this with the fact that the physicians had often come straight from autopsies, and made them wash their hands with chlorinated lime water, which reduced maternal deaths by almost ninety per cent. New microscopes had made it possible to see microorganisms. Especially important was the achromatic microscope, invented by Joseph Jackson Lister. The French chemist Louis Pasteur showed that microorganisms could spoil milk and wine, and invented a technique to prevent bacterial contamination – pasteurization.

But even a local health worker admits to using the flying toilet all the time: ‘At night, it is so dark in Kibera that you cannot dare to get out of your room since you are not sure if you will fall in one of the abandoned toilets and, as a woman, you can never be sure that you will not be raped.’16 But things are changing even here. Two water pipes have been constructed, so Kiberans do not have to rely entirely on the unsafe water from the dam and from the rain. Several modern sanitation blocs have been built by entrepreneurs and non-governmental organizations (NGOs), where Kiberans can go to a clean toilet and get a hot shower at a low cost, and hand-washing facilities have been introduced in several schools. Cases of typhoid, dysentery and hookworm infestations are on the decline, and at last, so is child and infant mortality. Sub-Saharan Africa achieved a twenty-percentage-point increase in the use of improved sources of drinking water from 1990 to 2015. During this period, 427 million more Africans gained access.17 The process may be too slow to make the news, but we must remember that it is happening much faster than it did in the world’s richest countries.

As knowledge about microorganisms began to take hold, it gave an extra urgency to attempts to improve sanitation and water supplies and vaccination became routine. The knowledge about germs in itself also made people change behaviour. Until the theory was established, hotels did not change bed linens between guests, doctors used instruments that weren’t sterilized, and water was not always boiled to kill bacteria. It took time before health personnel were convinced to wash their hands and sterilize equipment, but when it happened it had an amazing effect on maternal death. In countries that hold data, such as Sweden and Finland, around 1,000 mothers died per 100,000 child births in 1800. Those are shocking numbers: the mother died in every hundredth childbirth. Since mothers gave birth much more often than today, this would have been a regular occurrence in a family. And 100 years later, the number was still around 500 per 100,000 births.


pages: 624 words: 104,923

QI: The Book of General Ignorance - The Noticeably Stouter Edition by Lloyd, John, Mitchinson, John

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Admiral Zheng, Albert Einstein, Barry Marshall: ulcers, British Empire, discovery of penicillin, Dmitri Mendeleev, Fellow of the Royal Society, Ignaz Semmelweis: hand washing, invention of the telephone, James Watt: steam engine, Kuiper Belt, Magellanic Cloud, Mars Rover, Menlo Park, Olbers’ paradox, On the Revolutions of the Heavenly Spheres, placebo effect, Pluto: dwarf planet, trade route, V2 rocket, Vesna Vulović

It was first used to describe a harmful microorganism in 1871 but it wasn’t until 1875 that Robert Koch finally demonstrated that anthrax was caused by a particular species of bacteria. Thirty-five years earlier, Ignaz Semmelweis, a Hungarian doctor had set up the first hygienic hospital ward in Vienna General Hospital. He noticed that the death rate of poor women attended by the nurse midwives was three times less than that of the wealthier women attended by the doctors. He concluded that this was a matter of cleanliness – the doctors used to go directly from the morgue to the obstetrics ward without washing their hands. When he presented his findings, his fellow doctors rejected his theory, unable to believe in what they could not see. In recent years, however, the hygiene itself has come under scrutiny. There seems to be evidence that indiscriminate use of anti-bacterial agents might have damaging side effects, allowing those bacteria that do survive to mutate into even more virulent strains.

It was crude and cumbersome but effective. There was a small foot-pedal driven version and a large steam-driven one. The latter, able to wash and dry 200 dishes in two minutes, was the sensation of the 1893 Chicago World’s Fair, and won first prize for the ‘best mechanical construction for durability and adaptation to its line of work’. At $250 each, however, the machines were too expensive for home use, but enough were sold to hotels and restaurants to keep Cochran’s Crescent Washing Machine Company in business until her death in 1913. Other mechanical dishwashers had been developed (and patented) in the US between 1850 and 1865 (all of them, it seems, by women) but none of them really worked. A hand-cranked wooden machine was invented and patented in 1850 by Joel Houghton. In 1870, Mary Hobson obtained a dishwasher patent, but even then it contained the word ‘improved’.

In 1976, the Department of Health urged pregnant mothers to wear rubber gloves when peeling potatoes and more than a kilogram (2.2 lb) of potatoes eaten at a single sitting would be certain death. Fortunately for smokers, most of the nicotine in a cigarette is burned before it ever gets to the lungs. The other good news is, it doesn’t stain your fingers or your teeth or the ceiling of the pub. It’s not only colourless but soluble in water, so it comes off when you wash your hands. The stain on a smoker’s fingers is caused by tar. The scientific name for tobacco is Nicotiana tabacum. The name of the plant and the word nicotine derive from Jean Nicot (1530–1604), French ambassador to Lisbon, and the man who first introduced tobacco to France in 1560. He originally promoted it as a medicine, believing it healed wounds and cured cancers, and sent some, in the form of snuff, to Catherine de Medici, Queen of France.


pages: 322 words: 107,576

Bad Science by Ben Goldacre

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Asperger Syndrome, correlation does not imply causation, experimental subject, Ignaz Semmelweis: hand washing, John Snow's cholera map, Louis Pasteur, meta analysis, meta-analysis, offshore financial centre, p-value, placebo effect, Richard Feynman, Richard Feynman, risk tolerance, Ronald Reagan, the scientific method, urban planning

Looking even further back, there was a strong anti-smallpox-vaccine movement in Leicester well into the 1930s, despite its demonstrable benefits, and in fact anti-inoculation sentiment goes right back to its origins: when James Jurin studied inoculation against smallpox (finding that it was associated with a lower death rate than the natural disease), his newfangled numbers and statistical ideas were treated with enormous suspicion. Indeed, smallpox inoculation remained illegal in France until 1769.* ≡ Disdain for statistics in healthcare research wasn’t unusual at the time: Ignaz Semmelweis noticed in 1847 that patients were dying much more frequently on the obstetrics ward run by the medical students than on the one run by the midwifery students (this was in the days when students did all the legwork in hospitals). He was pretty sure that this was because the medical students were carrying something nasty from the corpses in the dissection room, so he instituted proper handwashing practices with chlorinated lime, and did some figures on the benefits.

This water should be held in your mouth, they say, because then it can be absorbed directly from there into your brain. Is there anything else you can do to get blood and oxygen to your brain more efficiently? Yes, an exercise called ‘Brain Buttons’: ‘Make a ‘C’ shape with your thumb and forefinger and place on either side of the breastbone just below the collarbone. Gently rub for twenty or thirty seconds whilst placing your other hand over your navel. Change hands and repeat. This exercise stimulates the flow of oxygen carrying blood through the carotid arteries to the brain to awaken it and increase concentration and relaxation.’ Why? ‘Brain buttons lie directly over and stimulate the carotid arteries.’ Children can be disgusting, and often they can develop extraordinary talents, but I’m yet to meet any child who can stimulate his carotid arteries inside his ribcage.

If that sounds obvious, I should say they have an effect which has been measured, elegantly, in carefully designed trials. Gryll and Katahn [1978] gave patients a sugar pill before a dental injection, but the doctors who were handing out the pill gave it in one of two different ways: either with an outrageous oversell (‘This is a recently developed pill that’s been shown to be very effective…effective almost immediately…’); or downplayed, with an undersell (‘This is a recently developed pill…personally I’ve not found it to be very effective…’). The pills which were handed out with the positive message were associated with less fear, less anxiety and less pain. Even if he says nothing, what the doctor knows can affect treatment outcomes: the information leaks out, in mannerisms, affect, eyebrows and nervous smiles, as Gracely [1985] demonstrated with a truly ingenious experiment, although understanding it requires a tiny bit of concentration.


pages: 453 words: 132,400

Flow by Mihaly Csikszentmihalyi

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Albert Einstein, Bonfire of the Vanities, centralized clearinghouse, conceptual framework, correlation does not imply causation, double helix, fear of failure, Ignaz Semmelweis: hand washing, invisible hand, Isaac Newton, job satisfaction, Mahatma Gandhi, meta analysis, meta-analysis, Necker cube, pattern recognition, place-making, Ralph Waldo Emerson, the scientific method, Thomas Kuhn: the structure of scientific revolutions

In one of our studies the list of admired persons included an old lady who, despite her paralysis, was always cheerful and ready to listen to other people’s troubles; a teenage camp counselor who, when a swimmer was missing and everybody else panicked, kept his head and organized a successful rescue effort; a female executive who, despite ridicule and sexist pressures, prevailed in a difficult working environment; and Ignaz Semmelweis, the Hungarian physician who in the last century insisted that the lives of many mothers could be saved at childbirth if obstetricians would only wash their hands, even though the rest of the doctors ignored and mocked him. These and the many hundreds of others mentioned were respected for the same reasons: They stood firm for what they believed in, and didn’t let opposition daunt them. They had courage, or what in earlier time was known simply as “virtue”—a term derived from the Latin word vir, or man.

This fact results in two seemingly opposite outcomes. On the one hand, having a feeling of ownership of her decisions, the person is more strongly dedicated to her goals. Her actions are reliable and internally controlled. On the other hand, knowing them to be her own, she can more easily modify her goals whenever the reasons for preserving them no longer make sense. In that respect, an autotelic person’s behavior is both more consistent and more flexible. 2. Becoming immersed in the activity. After choosing a system of action, a person with an autotelic personality grows deeply involved with whatever he is doing. Whether flying a plane nonstop around the world or washing dishes after dinner, he invests attention in the task at hand. To do so successfully one must learn to balance the opportunities for action with the skills one possesses.

To alleviate this burden he invented a private activity that provides just enough challenges for him not to be completely bored during a dull lecture, but is so automated that it leaves enough attention free so that if something interesting is being said, it will register in his awareness. What he does is this: Whenever a speaker begins to get tedious, he starts to tap his right thumb once, then the third finger of the right hand, then the index, then the fourth finger, then the third finger again, then the little finger of the right hand. Then he moves to the left hand and taps the little finger, the middle finger, the fourth finger, the index, and the middle finger again, and ends with the thumb of the left hand. Then the right hand reverses the sequence of fingering, followed by the reverse of the left hand’s sequence. It turns out that by introducing full and half stops at regular intervals, there are 888 combinations one can move through without repeating the same pattern. By interspersing pauses among the taps at regular intervals, the pattern acquires an almost musical harmony, and in fact it is easily represented on a musical staff.


pages: 405 words: 130,840

The Happiness Hypothesis: Finding Modern Truth in Ancient Wisdom by Jonathan Haidt

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crack epidemic, delayed gratification, feminist movement, Ignaz Semmelweis: hand washing, invisible hand, job satisfaction, Lao Tzu, meta analysis, meta-analysis, Peter Singer: altruism, placebo effect, prisoner's dilemma, Ralph Waldo Emerson, stem cell, Steven Pinker, telemarketer, the scientific method, ultimatum game, Walter Mischel

It m u s t have broken her heart, and one day she ignored the rules and went in. S h e was c a u g h t a n d sternly reprimanded. My father recovered with no paralysis, but this i m a g e has always stayed with m e : a small boy alone in a room, gazing at his m o t h e r through a p a n e of glass. My father had the bad luck to be born at the confluence point of three big ideas. The first was germ theory, proposed in the 1840s by Ignaz Semmelweis and incorporated into hospitals and homes with gradually increasing ferocity over the next century. When they began to collect statistics from orphanages and foundling homes in the 1920s, pediatricians came to fear germs above all else. As far back as records went, they showed that most children dropped off at foundling homes died within one year. In 1915, a New York physician, Henry Chapin, reported to the American Pediatric Society that out of the ten foundling homes he had examined, in all but one of them all the children had died before their second birthday.3 As pediatricians came to grips with the deadly effects of institutions on young children, they reacted in a logical way by launching a crusade against germs.

In some split-brain patients, or in others who have suffered damage to the corpus callosum, the right hemisphere seems to be actively fighting with the left hemisphere in a condition known as alien hand syndrome. In these cases, one hand, usually the left, acts of its own accord and seems to have its own agenda. T h e alien hand may pick up a ringing phone, but then refuse to pass the p h o n e to the other hand or bring it up to an ear. The hand rejects choices the person has just made, for example, by putting back on the rack a shirt that the other hand has just picked out. It grabs the wrist of the other hand and tries to stop it from executing the person's conscious plans. Sometimes, the alien hand actually reaches for the person's own neck and tries to strangle him.13 T h e s e dramatic splits of the mind are c a u s e d by rare splits of the brain.

Hindu homes in Bhubaneswar have the same concentric structure as the temples: Leave your shoes at the door, socialize in the outer r o o m s , but never go into the kitchen or the room or area where offerings are m a d e to deities. T h e s e two areas are maintained as zones of the highest purity. Even the human body has peaks and valleys, the head and the right hand being pure, the left hand and the feet being polluted. I had to take extraordinary care to keep my feet from touching anyone and to avoid handing s o m e t h i n g to another person with my left hand. As I moved around Bhubaneswar, I felt like a square in Spaceland as I tried to navigate a three-dimensional world with only the dimmest perception of its third dimension. T h e interviews I conducted helped me to see a little better. My goal was to find out whether purity and pollution were really just about keeping biological "necessities" separate from divinity, or whether these practices had a deeper relationship to virtue and morality.


pages: 309 words: 114,984

The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age by Robert Wachter

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Affordable Care Act / Obamacare, AI winter, Airbnb, Atul Gawande, Captain Sullenberger Hudson, Checklist Manifesto, Clayton Christensen, collapse of Lehman Brothers, computer age, crowdsourcing, deskilling, en.wikipedia.org, Erik Brynjolfsson, everywhere but in the productivity statistics, Firefox, Frank Levy and Richard Murnane: The New Division of Labor, Google Glasses, Ignaz Semmelweis: hand washing, Internet of things, job satisfaction, Joseph Schumpeter, knowledge worker, medical malpractice, medical residency, Menlo Park, minimum viable product, natural language processing, Network effects, Nicholas Carr, obamacare, pattern recognition, personalized medicine, pets.com, Productivity paradox, Ralph Nader, RAND corporation, Second Machine Age, self-driving car, Silicon Valley, Silicon Valley startup, six sigma, Skype, Snapchat, software as a service, Steve Jobs, Steven Levy, the payments system, The Wisdom of Crowds, Toyota Production System, Uber for X, Watson beat the top human players on Jeopardy!, Yogi Berra

Part One The Note Chapter 3 The iPatient Some patients … recover their health simply through their contentment with the goodness of the physician. —Hippocrates, Precepts You’ve probably played that parlor game in which you fantasize about what it would be like to have a drink with one of the great figures in history. Perhaps you’d choose Shakespeare, or Churchill, or Einstein. They all sound great to me. But as a doctor and a student of health policy, I would sooner choose Ignaz Semmelweis, the nineteenth-century Hungarian physician whose pioneering work on antisepsis led him to be committed to an asylum for heresy; Sir William Osler, who articulated many of the key principles of medical diagnosis and treatment; or Avedis Donabedian, whose insights transformed our understanding of healthcare quality. Or a man named Arnold “Bud” Relman. Relman, who died in 2014 at the age of 91, spent his early career at Boston University, where he conducted pioneering research into the causes and treatment of kidney disease.

One arm of this movement highlights the role of patients and their families in protecting themselves, such as having patients ask their doctors and nurses whether they have washed their hands. While many (including myself) are skeptical about how effective this is and whether it places an inappropriate burden on patients and their families, there are clearly times when patients or their loved ones are highly aware of their treatment plans and can participate meaningfully in catching errors. In the midst of doing the bar-code scans, Levitt decided to ask her young patient about this strange dose of Septra. Pablo was used to taking unusual medications, and on top of that, he remembered his mom’s parting words about the meds he’d be given for his colonoscopy prep. So Pablo told Levitt that the Septra dose seemed okay. Reassured, the nurse handed the half-filled cup of pills to her patient and he began to swallow them, some a handful at a time. Levitt remembers thinking to herself, “What a good kid, what a trouper.”

The nurse had already gathered some history before Sinsky entered the room to see her first patient, an elderly man with white hair and a pot belly; every Christmas, he plays a department store Santa. He was wearing a Harley-Davidson T-shirt that said “Motorcycles: Ride Free, Live Free.” On the wall of the small room was a series of colorful posters, one showing the four food groups and another instructing people to wash their hands. A third showed a child’s drawing of a bunch of flowers with the caption, “Don’t regret growing old. It is a privilege denied to many.” Sinsky sat knee-to-knee with her patient. Her laptop was open on her desk, but she was working hard to maintain eye contact. After gathering some of the history, she activated her computer’s dictation system. Before she started, though, she turned to the patient.


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Clean Code: A Handbook of Agile Software Craftsmanship by Robert C. Martin

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continuous integration, database schema, domain-specific language, en.wikipedia.org, Eratosthenes, finite state, Ignaz Semmelweis: hand washing, iterative process, place-making, web application, WebSocket

It’s your job to defend the code with equal passion. To drive this point home, what if you were a doctor and had a patient who demanded that you stop all the silly hand-washing in preparation for surgery because it was taking too much time?2 Clearly the patient is the boss; and yet the doctor should absolutely refuse to comply. Why? Because the doctor knows more than the patient about the risks of disease and infection. It would be unprofessional (never mind criminal) for the doctor to comply with the patient. 2. When hand-washing was first recommended to physicians by Ignaz Semmelweis in 1847, it was rejected on the basis that doctors were too busy and wouldn’t have time to wash their hands between patient visits. So too it is unprofessional for programmers to bend to the will of managers who don’t understand the risks of making messes.

You can instrument your code and force it to run in different orderings by adding calls to methods like Object.wait(), Object.sleep(), Object.yield() and Object.priority(). Each of these methods can affect the order of execution, thereby increasing the odds of detecting a flaw. It’s better when broken code fails as early and as often as possible. There are two options for code instrumentation: • Hand-coded • Automated Hand-Coded You can insert calls to wait(), sleep(), yield(), and priority() in your code by hand. It might be just the thing to do when you’re testing a particularly thorny piece of code. Here is an example of doing just that: public synchronized String nextUrlOrNull() { if(hasNext()) { String url = urlGenerator.next(); Thread.yield(); // inserted for testing. updateHasNext(); return url; } return null; } The inserted call to yield() will change the execution pathways taken by the code and possibly cause the code to fail where it did not fail before.

This exposes the fundamental dichotomy between objects and data structures: Procedural code (code using data structures) makes it easy to add new functions without changing the existing data structures. OO code, on the other hand, makes it easy to add new classes without changing existing functions. The complement is also true: Procedural code makes it hard to add new data structures because all the functions must change. OO code makes it hard to add new functions because all the classes must change. So, the things that are hard for OO are easy for procedures, and the things that are hard for procedures are easy for OO! In any complex system there are going to be times when we want to add new data types rather than new functions. For these cases objects and OO are most appropriate. On the other hand, there will also be times when we’ll want to add new functions as opposed to data types. In that case procedural code and data structures will be more appropriate.


pages: 651 words: 180,162

Antifragile: Things That Gain From Disorder by Nassim Nicholas Taleb

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Air France Flight 447, Andrei Shleifer, banking crisis, Benoit Mandelbrot, Berlin Wall, Black Swan, credit crunch, Daniel Kahneman / Amos Tversky, David Ricardo: comparative advantage, discrete time, double entry bookkeeping, Emanuel Derman, epigenetics, financial independence, Flash crash, Gary Taubes, Gini coefficient, Henri Poincaré, high net worth, Ignaz Semmelweis: hand washing, informal economy, invention of the wheel, invisible hand, Isaac Newton, James Hargreaves, Jane Jacobs, joint-stock company, joint-stock limited liability company, Joseph Schumpeter, knowledge economy, Lao Tzu, Long Term Capital Management, loss aversion, Louis Pasteur, mandelbrot fractal, meta analysis, meta-analysis, microbiome, moral hazard, mouse model, Norbert Wiener, pattern recognition, placebo effect, Ponzi scheme, principal–agent problem, purchasing power parity, quantitative trading / quantitative finance, Ralph Nader, random walk, Ray Kurzweil, rent control, Republic of Letters, Ronald Reagan, Rory Sutherland, Silicon Valley, six sigma, spinning jenny, statistical model, Steve Jobs, Steven Pinker, Stewart Brand, stochastic process, stochastic volatility, The Great Moderation, The Wealth of Nations by Adam Smith, Thomas Malthus, too big to fail, transaction costs, urban planning, Yogi Berra, Zipf's Law

Thank you, modernity: it was “scientific progress,” the birth of the clinic and its substitution for home remedies, that caused death rates to shoot up, mostly from what was then called “hospital fever”—Leibniz had called these hospitals seminaria mortis, seedbeds of death. The evidence of increase in death rates is about as strong as they come, since all the victims were now gathered in one place: people were dying in these institutions who would have survived outside them. The famously mistreated Austro-Hungarian doctor Ignaz Semmelweis had observed that more women died giving birth in hospitals than giving birth on the street. He called the establishment doctors a bunch of criminals—which they were: the doctors who kept killing patients could not accept his facts or act on them since he “had no theory” for his observations. Semmelweis entered a state of depression, helpless to stop what he saw as murders, disgusted at the attitude of the establishment.

The reader can get a hint of the central problem we face with top-down tampering with political systems (or similar complex systems), the subject of Book II. The fragilista mistakes the economy for a washing machine that needs monthly maintenance, or misconstrues the properties of your body for those of a compact disc player. Adam Smith himself made the analogy of the economy as a watch or a clock that once set in motion continues on its own. But I am certain that he did not quite think of matters in these terms, that he looked at the economy in terms of organisms but lacked a framework to express it. For Smith understood the opacity of complex systems as well as the interdependencies, since he developed the notion of the “invisible hand.” Click here for a larger image of this table. But alas, unlike Adam Smith, Plato did not quite get it. Promoting the well-known metaphor of the ship of state, he likens a state to a naval vessel, which, of course, requires the monitoring of a captain.

Many things such as society, economic activities and markets, and cultural behavior are apparently man-made but grow on their own to reach some kind of self-organization. They may not be strictly biological, but they resemble the biological in that, in a way, they multiply and replicate—think of rumors, ideas, technologies, and businesses. They are closer to the cat than to the washing machine but tend to be mistaken for washing machines. Accordingly we can generalize our distinction beyond the biological-nonbiological. More effective is the distinction between noncomplex and complex systems. Artificial, man-made mechanical and engineering contraptions with simple responses are complicated, but not “complex,” as they don’t have interdependencies. You push a button, say, a light switch, and get an exact response, with no possible ambiguity in the consequences, even in Russia.


Atlas Obscura: An Explorer's Guide to the World's Hidden Wonders by Joshua Foer, Dylan Thuras, Ella Morton

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anti-communist, Berlin Wall, British Empire, Buckminster Fuller, centre right, colonial rule, Colonization of Mars, cosmic microwave background, cuban missile crisis, dark matter, double helix, East Village, Exxon Valdez, Fall of the Berlin Wall, Frank Gehry, germ theory of disease, Golden Gate Park, Google Earth, Haight Ashbury, horn antenna, Ignaz Semmelweis: hand washing, index card, Jacques de Vaucanson, Kowloon Walled City, Louis Pasteur, Mahatma Gandhi, mutually assured destruction, phenotype, Pluto: dwarf planet, Ronald Reagan, Search for Extraterrestrial Intelligence, trade route, transatlantic slave trade, transcontinental railway, Tunguska event, urban sprawl, Vesna Vulović, wikimedia commons, working poor

The crater field now features a meteor museum, souvenir shop, and hotel offering a buffet breakfast and sauna. Kaali Küla, Pihtla vald, Saaremaa. 58.303309 22.70604 A 360-foot-wide basin created by a blazing meteorite. HUNGARY Semmelweis Medical Museum BUDAPEST The Semmelweis Medical Museum contains some fascinating objects: a wax anatomical model with her intestines splayed open, an early X-ray machine, and a shrunken head, all housed in the very building in which Dr. Ignaz Semmelweis was born. However, the most interesting element of the museum is the story of Semmelweis himself. In the 1840s, Semmelweis, a Hungarian physician, was working in a Budapest maternity ward. At the time, a third of new mothers were dying from puerperal sepsis, a bacterial form of septicemia. Semmelweis was horrified by the deaths of these women, but the cause eluded him. He began keeping extensive notes on the hospital and found a surprising correlation: When there were fewer medical students around, there were fewer deaths.

In 1847, the death of a fellow doctor and friend, Jakob Kolletschka, finally provided the link he was looking for. Kolletschka perished after accidentally cutting his finger during a postmortem examination. His autopsy showed a similar pathology to the women with puerperal sepsis, leading Semmelweis to conclude that it was the doctors themselves who were causing the deaths of the mothers. Semmelweis implemented a strict hand-washing policy in his clinic, and the death rate quickly fell from 18 percent to 2.2 percent. But even Semmelweis himself couldn’t explain exactly why his method worked. It would be decades before Louis Pasteur confirmed the germ theory of disease. Without this underlying explanation, Semmelweis’s discovery was largely rejected as a “mania.” Later in life, in part due to the lack of success he had in spreading his theories, Semmelweis fell into a deep depression, writing bitter letters to prominent European obstetricians in which he accused them of being ignorant murderers.

A hall devoted to Egyptian bread-making includes ancient and modern ovens, a machine for washing wheat, a model of a bakery, and display cases exhibiting traditional pita breads and slices of Egypt’s delectably flaky layered pastry, feteer meshaltet. In the natural history section, walk among rows of pinned birds, insects, and butterflies before greeting the taxidermy horses, cows, leopards, and lion. (If the lion is lying on the floor, that’s normal—its legs aren’t too sturdy these days.) Round out your visit with a tour of the dioramas, which depict scenes from an Egyptian wedding, market, orchard, and a “potato- and bean-drying facility.” Much of the sprawling, decrepit museum is officially closed—“for renovation,” supposedly—but hand a tip to the staff and you may find they open a few forbidden doors for you.


Red Rabbit by Tom Clancy, Scott Brick

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anti-communist, battle of ideas, diversified portfolio, Ignaz Semmelweis: hand washing, information retrieval, union organizing, urban renewal

When Zaitzev's identity as a Russian citizen had been confirmed, a call had been made to the Soviet Embassy, where it was speedily established that the man in question was a KGB officer. That generated interest in the rezidentura, just across the street from the hotel where he'd ostensibly died, and more telephone calls were made. Before five in the morning, Professor Zoltan Biro was awakened in his bed by the AVH. Biro was professor of pathology at the Ignaz Semmelweis Medical College. Named for one of the fathers of the germ theory that had transformed the science of medicine in the nineteenth century, it remained a good one, even attracting students from West Germany, none of whom would attend the postmortem examinations ordered by the country's Belügyminisztérium, which would also be attended by the physician-in-residence at the Soviet Embassy. The first done would be the adult male.

The colonel was as good as his word, passing through the control point three minutes later. By that time, Zaitzev had returned the cipher book to central storage and slipped the message form, plus the translation, into a brown envelope, which he handed to the colonel. "Has anyone seen this?" Rozhdestvenskiy asked. "Certainly not, comrade," Zaitzev replied. "Very well." Colonel Rozhdestvenskiy walked away without another word. For his part, Zaitzev left his work desk and headed off to the cafeteria for lunch. The food was the best reason to work at The Centre. What he could not leave behind as he stopped at the lavatory to wash his hands was the message sequence. Yuriy Andropov wanted to kill the Pope, and the rezident in Rome didn't like the idea. Zaitzev wasn't supposed to have any opinions. He was just part of the communications system.

"Hey, I have a meeting scheduled at the CPSU Central Committee building." "Anything I ought to know about?" "Like I said, you can read it in the Times. They fax you the Early Bird out of Washington, don't they?" "Yeah, it eventually trickles down here." "Then, day after tomorrow, you can read it," Prince advised, standing to take his leave. "Tell Ernie." "I'll do that," Foley said, extending his hand. Then he decided he'd walk Prince to the elevator. On the way back, he'd hit the men's room to wash his hands. His next stop after that was the Ambassador's office. "Hi, Ed. Meet with that Prince guy?" Foley nodded his head. "Just cut him loose." "Did he nibble at your hook?" "Nope. Just spat it right back at me." Fuller smiled crookedly. "What did I tell you? There used to be some patriotic reporters back when I was your age, but they've mostly grown out of it over the last few years."


pages: 1,631 words: 468,342

Home Comforts: The Art and Science of Keeping House by Cheryl Mendelson

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biofilm, Broken windows theory, clean water, deskilling, Ignaz Semmelweis: hand washing, Indoor air pollution, indoor plumbing, Jacquard loom, Jacquard loom, Own Your Own Home, sensible shoes, spice trade, Telecommunications Act of 1996, telemarketer

This is accomplished in four ways: frequent washing of hands; frequent and thorough surface cleaning followed, in appropriate circumstances, by a judicious use of disinfectants; the use of noncontaminated and noncontaminating tools and materials in cleaning; and keeping things dry. WASHING HANDS IS CRUCIAL Aseptic techniques were introduced in medicine in the nineteenth century, when Dr. Ignaz Semmelweis, a Hungarian obstetrician, noticed that the washing of hands in obstetrical units greatly reduced the incidence of puerperal fever (postpartum infection of the uterus). Even today, contaminated hands continue to be a major source of hospital infections, and the washing of hands continues to be the major defense against the spread of infection in hospitals. The same is true in your home. Washing Hands The Importance of Washing Your Hands. Our hands are probably the most important means by which nonairborne and nonwaterborne pathogens in our homes are spread to surfaces and other people. Frequent hand washing is one of the most important means we have of defending against pathogens in the home.

For the most part, the kitchen sink is not for washing your face or hands. So many homes lack a laundry tub these days that it is tempting to hand-wash laundry in the kitchen sink, but this is not a good idea either. If you have no laundry tub or sink, use a portable plastic tub and empty it into the toilet. My Italian grandmother was extremely rigid about this. You were permitted to do nothing in the kitchen sink but wash foods and dishes. No matter how many extra steps it cost you, you had to go up to the bathroom or down to the cellar to wash your hands. The dog’s dish had to be washed in the cellar, his water dish filled there. You could not empty a flower vase in the kitchen sink or even cut and arrange flowers there. My own procedure on washing my hands is to wash them outside the kitchen before I begin cooking.

Traditional dishwashing rules are so ingrained in me that I could far more easily walk off and leave all the dishes unwashed than bring myself to wash glasses after skillets or mix washed and unwashed items on one side of the sink. About Hand-Washing Dishes. No matter how high-tech and efficient your dishwasher may be, you need to know how to wash dishes by hand. When you’re cooking and have soiled bowls, pots, or utensils that you need to use again immediately, you can’t wait to run the machine; you must also know how to handwash all the things that cannot go into the machine. When the dishwasher is broken or too full, you have to hand-wash everything. And sometimes you want to hand-wash things because they seem too few to run the machine for and you do not want them to sit in the machine until it fills. If you do it properly, handwashing produces safe and bright dishes. Instructions appear below for washing by hand all the soiled dishes, glasses, flatware, serving dishes, pots, pans, and utensils created by an entire dinner.