Crazy Is A Numbers Game

Ignaz Semmelweis was a Hungarian doctor in the 19th century at the start of the golden age of the physician scientist. 

This was a time when doctors were no longer thinking of illness as an imbalance caused by bad air or evil spirits. They looked instead to anatomy. Autopsies became more common, and doctors got interested in numbers and collecting data.

The young Dr. Semmelweis was no exception. He started a new job in the maternity clinic at the General Hospital in Vienna, where he began collecting some data of his own. Semmelweis wanted to figure out why so many women in maternity wards were dying from a fever commonly known as childbed fever.

To assess this, he studied two maternity wards in the hospital. One was staffed by all male doctors and medical students, and the other was staffed by female midwives. 

He began counting the number of deaths on each ward and discovered that women in the clinic staffed by doctors and medical students died at a rate nearly five times higher than women in the midwives' clinic.

The big question now was to figure out why.

Semmelweis went through the differences between the two wards meticulously and started ruling out ideas.

It didn’t take long to work out a huge difference between the two wards. 

In the midwives' clinic, women gave birth on their sides but in the doctors' clinic, women gave birth on their backs. So he had women in the doctors' clinic give birth on their sides. 

The result had no effect.

Semmelweis observed a pattern, each time a patient died from childbed fever, a priest would solemnly proceed through the doctors' clinic, passing the beds of the women while accompanied by an attendant who rang a bell. Semmelweis hypothesised that the presence of the priest and the sound of the bell instilled such terror in the women post-delivery that they developed a fever, fell ill, and died (He was really clutching at straws here in my opinion). So Semmelweis had the priest change his route and ditch the bell. 

Shock, the result had no effect.

By now, Semmelweis was becoming increasingly frustrated. He took a leave from his hospital duties and travelled to Venice. He hoped the break would clear his head.

When Semmelweis got back to the hospital, he was met with some sad but important news. One of his colleagues, a pathologist, had fallen ill and died. It was a common occurrence. There was nothing new about the way he died. He pricked his finger while doing an autopsy on someone who had died from childbed fever and then he got very sick himself and died.

This was a lead for Semmelweis to follow. He studied the pathologist's symptoms and realised the pathologist died from the same thing as the woman he had autopsied. This was a revelation. Childbed fever wasn't something only women in childbirth got sick from. It was something other people in the hospital could get sick from as well.

But the original question Semmelweis' was looking to find hadn’t been answered: "Why were more women dying from childbed fever in the doctors' clinic than in the midwives' clinic?"

The big difference between the doctors' ward and the midwives' ward is that the doctors were doing autopsies and the midwives weren't.

Semmelweis suggested that tiny bits of dead bodies, which he called 'cadaverous particles,' lingered on the students' hands while they worked on the bodies. He believed that when these students helped deliver babies, they passed these particles into the women's bodies. This, he thought, could be what made the women get sick and die.

Semmelweis implemented a new rule for his medical team, they were to clean their hands and instruments not only with soap but also with a chlorine solution. Today, we recognise chlorine as the best disinfectant, but back then, Semmelweis didn't know about germs. He chose chlorine primarily because he believed it would effectively eliminate any odours from the cadaverous particles he theorised were causing the infections.

The result did have an effect this time.

When he imposed this, the rate of childbed fever fell dramatically.

What Semmelweis uncovered is a principle that remains vital in public health today. 

You would expect this to be nationally rolled out as a standard for hospitals. Yet, the response was far from celebratory.

The theory implied that doctors themselves were inadvertently responsible for spreading childbed fever, a suggestion that provoked outrage among his peers.

Semmelweis was not very tactful once he discovered this revelation. He openly criticised those who doubted him and made some influential enemies in the process.

The doctors gave up the chlorine hand-washing and Semmelweis lost his job.

This is more than a chapter in medical history, it's a stark reminder of the delicate interplay between innovation, acceptance, and the human ego. It's a story of how a simple solution to a complex problem was dismissed, only to be embraced years later as a fundamental truth. 

In today’s world, it’s pretty manky to walk out of the bathroom without washing your hands. 

Manky definition (Scottish slang): “often used to describe something as dirty, unpleasant, or in a state of disrepair.”

Semmelweis wasn’t crazy. He just didn’t have the numbers.

My point here is getting an initial crowd (numbers) behind you when challenging a status quo is vital to the success of the idea and I see the same happening in Bitcoin but unlike Semmelweis, Bitcoin has the numbers. If enough people believe the same, it suddenly becomes not so crazy.

I write this on the 2nd of January 2024 before the expected spot ETF approval in the US on the 10th of January where it could be on the precipice of taking a significant step into the world of acceptance, dramatically increasing the numbers of people behind it. Whether this will happen on this day or not, your guess is as good as mine but I’m starting to feel a little less crazy as the days go on.

This is a guest blog. Views expressed are the author’s own and do not necessarily represent the views of Bitcoin Collective.