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|The Semmelweis Solution|
It has been well over a decade since I first began to think about this topic, the nature of innovation and how to nurture it, and more than five years since I happened upon Semmelweis and decided to use his story as a way to explain my ideas. I always meant to come back to him. Since I still haven't found the time, I invite anyone who reads this to help complete it. Just copy and paste it into a word processor and when you're done email me the results.
Al Silverman 5/28/07
Most of the problems faced by humanity have already been solved. The trick is finding those solutions and putting them to work. So I have built an Innovation Machine. This machine finds the best ideas coming from anyone anywhere and turns them into real world solutions.
I call my invention the Semmelweis Machine - in honor of Dr. Ignaz Semmelweis. Semmelweis is the classic example of innovation punished. This is from the online Encyclopaedia Britannica:
"Semmelweis, Ignaz Philipp
Born July 1, 1818, Buda, Hungary, Austrian Empire - Died August 13, 1865, Vienna, Austria
Semmelweis German-Hungarian physician who discovered the cause of puerperal ("childbed") fever and introduced antisepsis into medical practice. Educated at the universities of Pest and Vienna, Semmelweis received his doctor's degree from Vienna in 1844 and was appointed assistant at the obstetric clinic in Vienna. He soon became involved in the problem of puerperal infection, the scourge of maternity hospitals throughout Europe.
Although most women delivered at home, those who had to seek hospitalization because of poverty, illegitimacy, or obstetrical complications faced mortality rates ranging as high as 25-30 percent. Some thought that the infection was induced by overcrowding, poor ventilation, the onset of lactation, or miasma. Semmelweis proceeded to investigate its cause over the strong objections of his chief, who, like other continental physicians, had reconciled himself to the idea that the disease was unpreventable.
Semmelweis observed that, among women in the first division of the clinic, the death rate from childbed fever was two or three times as high as among those in the second division, although the two divisions were identical with the exception that students were taught in the first and midwives in the second. He put forward the thesis that perhaps the students carried something to the patients they examined during labour.
The death of a friend from a wound infection incurred during the examination of a woman who died of puerperal infection and the similarity of the findings in the two cases gave support to his reasoning. He concluded that students who came directly from the dissecting room to the maternity ward carried the infection from mothers who had died of the disease to healthy mothers. He ordered the students to wash their hands in a solution of chlorinated lime before each examination....Under these procedures, the mortality rates in the first division dropped from 18.27 to 1.27 percent, and in March and August of 1848 no woman died in childbirth in his division."
To summarize: In 1844 there were two maternity wards in a Vienna Hospital - one staffed by doctors and doctoral students, the other by midwives. In the first, 20-30% of the women died of puerperal fever after giving birth, while only 2% of women died who were delivered by midwives or by no one in particular, on the streets of Vienna.
As part of their training, student doctors dissected women who had just died of puerperal fever. They then rushed off to the obstetric ward, to kill some more. These doctors were so busy they couldn't stop to wash their hands, but just wiped them on their aprons. In fact, running around in a dirty bloody apron was seen as a badge of honor. It showed how very busy and important these men were. So when Semmelweis told the doctors to wash their hands and put on clean aprons, naturally they protested.
Though Semmelweis didn't scientifically establish the cause of puerperal fever, he found a way to prevent it. In one month he cut the death rate for mothers in this ward from roughly 19 per cent of all women delivering, to fewer than 2 per cent.
Did his superior, Dr. Klein, immediately see the importance of Semmelweis' discovery? Did he ensure the procedure was followed throughout the hospital? Did he quickly submit articles to the most prestigious medical journals of his day, thus saving the lives of myriad women? Dream on.
This is from another Internet source,
"Angered by favorable reports concerning the new methods that indirectly represented an indictment of his own beliefs and actions, Klein refused to reappoint Semmelweis in March 1849."
Semmelweis was young, impudent, impatient, and came from backward uncultured Hungary, not sophisticated Vienna. When Klein and the local medical establishment kicked him out of Vienna, he went back home.
"Despite the unfavorable circumstances, he managed to receive an honorary appointment and took charge of the maternity ward of Pest's St.-Rochus Hospital in May 1851, remaining there until 1857. When he came to this hospital an epidemic of puerperal fever had broken out in the birth clinic. Semmelweis, at his own request, took charge of the department, where his prophylactic measures soon reduced mortality to a mere 0.85 percent. At his time, mortality in Prague and Vienna was still between 10 and 15 percent.
In 1861 Semmelweis finally published his momentous discovery in book form Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers. The work was written in German and discussed, at length, the historical circumstances surrounding his discovery of the cause and prevention of puerperal fever. A number of unfavorable foreign reviews of the book prompted Semmelweis to lash out against his critics in a series of open letters written in 1861-1862, which did little to advance his ideas. At a conference of German physicians and natural scientists, most of the speakers rejected his doctrine."
Finally, this again from the Encyclopaedia Britannica:
"The years of controversy gradually undermined his spirit. In 1865 he suffered a breakdown and was taken to a mental hospital, where he died. Ironically, his illness and death were caused by the infection of a wound on his right hand, apparently the result of an operation he had performed before being taken ill. He died of the same disease against which he had struggled all his professional life.
"Semmelweis' doctrine was subsequently accepted by medical science. His influence on the development of knowledge and control of infection was hailed by Joseph Lister, the father of modern antisepsis: "I think with the greatest admiration of him and his achievement and it fills me with joy that at last he is given the respect due to him."
A search for `Semmelweis' on the Internet search engine Google finds 14,300,000 hits. Budapest has a Semmelweis University. There is also a "Semmelweis Reflex". Here are two definitions:
"The automatic rejection of the obvious, without thought, inspection, or experiment." - Robert Anton Wilson
"Mob behavior found among primates and larval hominids on undeveloped planets, in which a discovery of important scientific fact is punished rather than rewarded. Named after Dr. Ignaz Semmelweis, ... physician who discovered the cause of puerperal fever, a now-obsolete disease which, in Semmelweis's primitive era, yearly killed a vast number of women in childbirth. Semmelweis was fired from his hospital, expelled from his medical society, denounced and ridiculed widely, reduced to abject poverty and finally died in a madhouse." - Timothy Leary in The Game of Life
On the Internet you will find Semmelweis has become a handy symbol for just about anyone who feels their own particular insights have been unjustly overlooked. This includes a site espousing Creationism (?).
Facts surrounding his life and death vary widely. For my purposes I intend on saving Dr. Semmelweis from his fate and giving him a long, happy and prosperous life, despite himself.
The Innovation Machine
An innovation is simply a new way of doing something, hopefully one which works better than the old. That's what we're aiming for, not just different, but better.
The first problem innovators face is simply finding someone to talk to. They need people to bounce ideas off of who are as passionate about an idea as they themselves are, and knowledgeable enough to understand it.
Where can one find such people? On the Internet. For better or worse, out of six billion people one can always find someone who is thinking almost exactly what you are thinking, no matter how far out or crazy those thoughts may be.
The number six billion, the aggregate human population of Earth, may not be strictly accurate. I'm sure someone somewhere can't find an Internet connection, no matter how hard they try.
If the Innovation Machine had existed in 1847, Semmelweis might have typed: "I am a doctor of obstetrics at the Vienna Hospital for research. I have discovered the cause of puerperal fever. Doctors and students autopsy cadavers and then go directly to the obstetrics ward and deliver children. Their aprons are filthy with blood from the dissections, and for the most part they don't even wash their hands. They must be carrying something to the patients whom they examine during labour.
I have instituted a practice whereby all doctors and students must wash their hands in a solution of chlorinated lime before each examination. The month during which I began this practice, the death rate on the ward from childbed fever was reduced from 19% to under 2%. I'm sure I have found the cause of this terrible affliction of mothers, and the way to prevent it.
Ignaz Philipp Semmelweis M.D."
Dr. Semmelweis hits enter. His email flies into cyberspace.
Because people with brilliant ideas don't necessarily communicate them well (Semmelweis himself was a lousy writer), the email passes first into a document summarizing program, after which it is translated into English, Japanese, French, Russian, Spanish, Arabic..., from whatever language Semmelweis writes in. If Semmelweis is a bad speller (spell check), blind and arthritic (voice transcription programs), or to overcome any other barrier which stands between the doctor and saving the lives of those women, we have a solution.
Thousands of Internet forums exist. People join for many reasons: to put forth ideas, espouse causes, blow off steam, commiserate, get questions answered... They are immense repositories of shared wisdom along with being enormous wastes of time.
For our forum a computer program initially brings participants together on the basis of emails. Thus in 1847 Dr. Semmelweis finds himself part of the "Puerperal Fever Forum". Most likely everyone in this forum wrote emails containing some of these words: `puerperal childbed fever solution idea hand washing spread doctors doctoral students research dissection cadaver maternity chlorinated lime ward midwives obstetrics cause autopsy cadaver aprons filthy blood carrying transfer labour prevent'.
I say "Most likely" because artificial intelligence programs can make weird connections. I once interviewed for a job with a company whose software advises shoppers on items to buy, based on prior Internet browsing. For one customer, given an incongruous list of associations, something along the line of lawn tractors, onions, men's socks, and kiwi fruit - the program immediately displayed a cigar humidor. This, it turns out, was exactly what the man was looking for.
Employing its complex algorithms, the Innovation Machine matches Dr. Semmelweis with Oliver Wendell Holmes, a physician from the United States - not the Supreme Court Justice, but his father.
This isn't a difficult connection to make, considering that in 1843 the New England Journal of Medicine and Surgery published an article by Holmes called "The Contagiousness of Puerperal Fever." Holmes came to the same conclusions as Semmelweis, only three years earlier. Thereafter he found himself in hot water with his own medical establishment.
Now two men work together on the problem of puerperal fever. This emboldens them, giving them confidence. Two? No, even back in 1847, 100's of individuals, even 1000's, having watched the agony of dying mothers, their babies orphaned shortly after birth, must have desperately sought a cure for puerperal fever.
It's not just the opposition of superiors like Dr. Klein which hinders innovative thinkers. Many problems Semmelweis encountered were of his own making. He didn't express himself well and clashed with superiors, often for no good reason. But with so many people working together, he could focus on a procedure for eradicating the disease, leaving the rest to others.
Recipe for Solutions
A solution is not a general idea. It is not a rant or rave. It is a recipe, a step by step procedure for solving a specific problem, and must include relatively inexpensive methods for testing the solution. Ideas are the raw material, solutions the finished products.
Here is my recipe for solutions:
A. Brainstorm, throwing out ideas.
B. Design general solution.
C Break tasks down into individual steps.
D. Break steps into smaller steps until they can be broken down no further.
E. Solve steps in parallel, seeking the best possible solution at every turn.
Using this procedure, the Puerperal Fever Forum of 1847 quickly ends the scourge of puerperal fever! And what of Dr. Semmelweis? Instead of dying in 1865 in a mental institution, distracted embittered man, let's have him die at home in 1904, surrounded by friends and family, beloved, fulfilled, honored - but not, I must add, honored for ending the scourge of puerperal fever. That honor would have gone to others.
This is from an article published in Microbiology Today, November 2001, by Milton Wainwright - Professor of Microbiology at University of Sheffield, England:
"The Manchester-based physician Charles White, who as early as the late 1700s, showed that the occurrence of childbed fever could be drastically cut down by isolating victims and insisting on cleanliness. By 1795, Alexander Gordon, of Aberdeen, had come to the radical conclusion that, like many other doctors, he had accidentally spread the disease and had caused the death of many women in his care."
The article is called "Childbed fever - the Semmelweis Myth", and may be found by doing a Google search on "Milton Wainwright" and `Semmelweis'.
The worst problems faced by humanity have already been solved. Many were solved long ago. The trick is simply finding the right solutions and putting them to work.
The Semmelweis Machine gives creative individuals a place to work and tools to work with. It employs four groups of technologies:
1. The Internet, search engines, sorting programs, heuristics.
2. Huge data bases, cheap data storage, data mining, archiving and compaction programs.
3. Digital signatures, encryption programs.
4. Moderated forums, logic and fact verification programs, BPM, solution and process management software.
All these technologies are widely used today. What's important is how we assemble them.
Ideas come in via email. Like ideas are grouped into forum topics - people working on the same type of problem, people offering the same type of solution, etc.
Existing programs can be easily modified for this purpose. After all, if Google can search three billion web pages and come up with an ordered list within milliseconds, it can certainly do the same with far fewer emails.
Summarization programs cut out the chaff, simplify ideas and put them into standard format. Translation programs translate so language is not a problem. Transcription programs even transcribe spoken words for people who cannot type. Going in the other direction, programs read idea summaries to the blind. Spelling is corrected - whatever is necessary to make an idea/solution more easily understandable.
Our goal is to devise succinct plans to accomplish specific tasks in the best possible manner. The solution space is spare as possible. Everything extraneous or irrelevant is eliminated, but all emails must be archived exactly as sent, for an indeterminate period of time.
This is necessary because ideas can be stolen easily on the Internet. With all original emails time stamped and viewable, there can be no dispute as to who came up with an idea first. This method insures a greater degree of protection than any method short of obtaining a patent, a process so costly and time consuming it inordinately favors the litigious and wealthy.
Very large forums already exist, Yahoo's for example. The cost of data storage has come down drastically while the technology keeps on improving, putting larger and larger amounts of data on smaller and smaller media. Compaction and archiving programs further condense this data.
Digital signatures and encryption programs guarantee the integrity of email, both in transit and after archiving. This proves when an email was sent and received and by whom. Companies that supply digital signatures with encryption include VeriSign, BelSign, and Thawte.
Because a step may already have been worked out, our program searches for like steps in pre-existing solutions. Topics are self-organizing. They may operate like other forums, the usual back and forth sharing of ideas, or they can use BPM tools provided by the forum. BPM (Business Process Management ) has existed for decades. Semmelweis spreads the advantages of these systems to anyone with a problem that needs solving.
Logic and Fact Verification Engines are critical components. Lies can spread so easily over the Internet, the perception exists that information there cannot be trusted. People make outlandish claims without proof. They employ spurious logic to prove their points. But then, we have no simple way to check the validity of statements we read in newspapers or hear on radio and TV, or from another person. In fact it's actually much easier to verify truth or falsehood on the Internet. One has the Internet right there for research.
For instance, if a salesman tells me the dishwasher he's trying to sell me is "rated number one in the world", there is no way I can copy and paste his words directly into Google. But give me two minutes on the Internet and I'd know if he were lying. Heuristic programs would do this immensely quicker and far more accurately.
Likewise, both on the Internet and in the world at large, individuals give all sorts of reasons why their product is the best, their position is correct, their way is right. They play on emotions, coerce, and harangue. They string disparate facts together, then declare their point made. Logic and fact verification programs would sort this out quickly.
|Note of 5/14/07 The following section is especially sketchy. Anyone who wants to take a shot at improving it, please do. Thanks, Al|
Semmelweis is an open institution. Data is protected, but all of it is viewable by everyone. No one owns it. No one controls it solely for their own benefit. It can provide solutions at any level, large or small, public or private, locally, nationally, internationally.
In the world of computer programming, `recursion' pertains to a function which can call itself. The Semmelweis Machine functions recursively. When solving a problem, if you run into another problem that needs solving, just apply Semmelweis. It is heuristic, self-learning. At every turn take the best available solution. If a better solution turns up later, use that.
The Semmelweis Machine promotes a pure distributed meritocracy. It is not a forum for debate. It's not `I scratch your back, you scratch mine'. One doesn't accomplish things by politicking, force of personality, or because I smile nicely, so that you like me.
No two eyes can see what thousands can. A thousand perspectives, a thousand minds, a thousand intellects will better solve the problems humanity faces.
Decisions made by committee are often inferior to those made by individuals. What I am proposing here is different from either decision by committee or decision by individual. It is decision by community, with community defined by interest, knowledge, and ability.
What if the President of the United States were to announce she/he would be using the Semmelweis Machine as input for US policy? All the individuals who seriously study a given topic would gather into loose ongoing coalitions, based on shared perspective and interests. Within these groups individuals would hash out what's going on and what should be done about it.
There's still a chance independent thinkers would be shut out, but less of one. Winning solutions would have a better chance of being spotted. And ideas couldn't be stolen, certainly not the case today in academics, business, or politics.
Aggressive individuals would not rise to the top just because they are aggressive. If Jane Doe of Akron, OH correctly points out that a crisis is brewing in the far northwest corner of Brazil, her reputation would rise, even if she were not capable of rising from a hospital bed. The proof is there and time stamped. If Joe Smith, a complete nobody from central Idaho, figures out best policy concerning soybean production on the high plains, then use it.
All this takes place in Real Time. Real Time is an immensely important concept. Much is lost by Powers-That-Be because information travels up to them via hierarchical chains of command where experts jockey for position. But if one is constantly jockeying for position, one can't be out in the world, where things really happen. This dynamic rewards aggressive self-advertisement, not knowledge. It also moves agonizingly slowly for the world today.
How many advisors directly inform the President on an issue, especially in times of emergency? Just one or two on some policy issues? Suppose something happens in south central Brazil, a seemingly minor occurrence which nonetheless has enormous significance and demands immediate attention. If one person notices and broadcasts it over Semmelweis, solutions would immediately emerge from the Brazil forums, from within the community of all individuals most knowledgeable on the subject. That's the power of Real Time. Instead of just one or two experts, one has thousands, watching the situation constantly, able to react immediately.
Now substitute `Al-Quada' for `Brazil', and instead of 1847, roll the Semmelweis Machine back to 9-11-2001. The information on 9-11 was there, just like the information on puerperal fever. The right solution could not be found in time.
When I speak of `limiting factors', I never tire telling the story of Dr. Stephen W. Hawking, astrophysicist and world's foremost theorist on black holes, those odd features of our universe. Dr. Hawking also suffers from Amyotrophic Lateral Sclerosis (ALS), or Lou Gerhig's disease, a degenerative disease of the nervous system for which no cure has been found.
Since Dr. Hawking has a very slow developing form of ALS, he's been able to live with it most of his adult life. All his important work has been done since first diagnosed at age 21. Since 1974 he's been unable to feed himself or get in and out of bed. Until 1985 he was able to speak in a slurred manner - after that, not at all.
This is from Dr. Hawking's web site, http://www.hawking.org.uk/,
"However, a computer expert in California, called Walt Woltosz, heard of my plight. He sent me a computer program he had written, called Equalizer. This allowed me to select words from a series of menus on the screen, by pressing a switch in my hand. The program could also be controlled by a switch, operated by head or eye movement. When I have built up what I want to say, I can send it to a speech synthesizer.
"Using this system, I have written a book, and dozens of scientific papers. I have also given many scientific and popular talks. They have all been well received. I think that is in a large part due to the quality of the speech synthesiser."
Stephen Hawking has had a debilitating disease for over 30 years, yet is able to communicate with peers, write books and articles, and give lectures. Despite daunting physical handicaps, he actively participates in the world, adding considerably to our store of knowledge.
The implications of this are enormous. Before modern technology, an individual had to physically move to a specific location to accomplish any task related to a given project. If you could not travel, you could not contribute.
This applied not only to purely physical tasks, but also for mental tasks where no movement was really necessary. Age, disability, finances, myriad reasons not directly related to ones ability to actually accomplish the task itself, eliminated one from participation.
These barriers no longer exist, except in our minds. How many Semmelweises are out there, waiting to change our world for the better? To find out, we need only give them a chance.
Addendum of 11-10-2014.
I apologize for my awkward presentation of this material. The tool I want to create is the one we need to create this article itself. The process allows you to make the article better. Please do, if you can. Just copy it into your word processor and send me your version.
I was introduced to the Internet in 1988. My ideas are logical extensions of that introduction, plus simple observations based on the evolution of computer hardware and software since that time.
My description of the Innovation Machine is far more complex than need be. Here is a much simpler version.
To find best possible solutions to all the world's problems,
1. Ask, "How do we do this?"
2. Let anyone in the world answer.
3. Pick the best answer.
Given todays tools such a solution is within our grasp. All we need do is build it.
About Alan Silverman (me).
I graduated in 1986 with a degree in computer science from the State University College of New York at New Paltz.
After graduation I worked as an application programmer for a HMO management company. In January 1988 I went to work at IBM in support of their mainframe operating systems, troubleshooting critical problems involving I/O, device support, data storage and electronic networks. In 1999 I retired from IBM. Now I own Computing Solutions, a technology consulting company based in Stone Ridge, NY.
© 2003 by Author. All Rights Reserved. Revised 11/10/2014 11:44 AM
Permission granted to redistribute this article in its entirety with credit to author.
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