The World’s First Atlas

Today’s Google Doodle is a particular treat for a map lover like me: it commemorates the publication in 1570 of the world’s first atlas, the Theatrum Orbis Terrarum (Theatre of the World) by Flemish cartographer Abraham Ortelius.

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As Forbes explains, Ortelius’ work was an unusual concept at the time: an expertly-crafted book of similarly-sized maps neatly organized by geography. Continue reading

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The Hungarian Doctor Who Pioneered Handwashing

Handwashing is easy to take for granted. It is one of the earliest and most basic forms of etiquette and hygiene we that we learn, not to mention a major pillar of our individual and collective health.

But like so many other “givens” in modern medicine and public health, hand washing was not always so accepted, even among health professionals. In fact, it practically came down to one person to discover and advocate the importance of washing one’s hands: NPR tells the story of Hungarian medical underdog Ignaz Semmelweis and his semi-successful attempts to improve the lives of millions through this deceptively simple practice.

Semmelweis was a man of his time, according to Justin Lessler, an assistant professor at Johns Hopkins School of Public Health.

It was a time Lessler describes as “the start of the golden age of the physician scientist,” when physicians were expected to have scientific training.

So doctors like Semmelweis 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. When he showed up for his new job in the maternity clinic at the General Hospital in Vienna, he started collecting some data of his own. Semmelweis wanted to figure out why so many women in maternity wards were dying frompuerperal fever — commonly known as childbed fever.

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. And he counted the number of deaths on each ward.

When Semmelweis crunched the numbers, he 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.

But why?

Like any rational, scientifically-minded individual, Semmelweis carefully assessed the data and sought out some empirical basis for this pattern.

“What Semmelweis had discovered is something that still holds true today: Hand-washing is one of the most important tools in public health. It can keep kids from getting the flu, prevent the spread of disease and keep infections at bay.

Semmelweis kept trying to convince doctors in other parts of Europe to wash with chlorine, but no one would listen to him.

Even today, convincing health care providers to take hand-washing seriously is a challenge. Hundreds of thousands of hospital patients get infections each year, infections that can be deadly and hard to treat. The Centers for Disease Control and Prevention says hand hygiene is one of the most important ways to prevent these infections.

Over the years, Semmelweis got angrier and eventually even strange. There’s been speculation he developed a mental condition brought on by possibly syphilis or even Alzheimer’s. And in 1865, when he was only 47 years old, Ignaz Semmelweis was committed to a mental asylum.

The sad end to the story is that Semmelweis was probably beaten in the asylum and eventually died of sepsis, a potentially fatal complication of an infection in the bloodstream — basically, it’s the same disease Semmelweis fought so hard to prevent in those women who died from childbed fever.”

An ignoble and cruelly ironic end to a man whose findings are now the bedrock of public health and sanitation worldwide. Semmelweis was ridiculed, marginalized, and ultimately forgotten because his observations conflicted with the established scientific and medical opinions of the time; indeed, many doctors took offense at the idea that they should wash their hands — at the cost of their patients’ lives.

It was only two decades after his sad death that Semmelweis’s recommendations gained widespread acceptance: Louis Pasteur’s confirmation of the germ theory of disease, followed by Joseph Lister’s use of hygienic methods during surgery both validated the Hungarian doctor, who lacked the scientific means to explain his findings.

But given his dedication to the well being of patients, I would like to imagine Semmelweis would be pleased to see his ideas become conventional wisdom. He might also be amused that his name is used for the eponymous “Semmelweis reflex” or “Semmelweis effect”, which describes a tendency for new evidence or knowledge to be viscerally rejected because it contradicts established norms, beliefs, or paradigms.

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The Anniversary of Separate But Equal

On this day in 1896, the U.S. Supreme Court ruled in the landmark case Plessy v. Ferguson that racial segregation in public transportation was constitutional under the “separate but equal” doctrine.

The effects were immediate: already significant disparities in funding for segregated schools widened, flying in the face of the vague doctrine. States that had successfully integrated blacks quickly adopted legislation that reversed the progress made during Reconstruction. These segregation laws would eventually become known as  the Jim Crow system. Continue reading

What Worries the World

The wave of populism sweeping across the world — particularly, but not exclusively, in the West — is largely product of widespread discontent among the masses. But the causes of anxiety and cynicism vary from country to country, with each society facing its own unique challenges or trajectories.

A recent poll of 25 countries conducted by Ipsos MORI, a leading market research group based in the U.K., uncovered the main issue that worries each nation and whether they think things are going on the right track. Here are the results, courtesy of The Economist: Continue reading

Torture Doesn’t Work

As recounted in Scientific Americanas early as 1631, with the publication of Cautio Criminalis by Jesuit scholar Friedrich Spee, it was discovered that torturing criminal suspects did not work. Spee came to this conclusion in the most salient way possible:

The Duke of Brunswick in Germany invited two Jesuit scholars to oversee the Inquisition’s use of torture to extract information from accused witches. “The Inquisitors are doing their duty. They are arresting only people who have been implicated by the confession of other witches,” the Jesuits reported. The duke was skeptical. Suspecting that people will say anything to stop the pain, he invited the Jesuits to join him at the local dungeon to witness a woman being stretched on a rack. “Now, woman, you are a confessed witch,” he began. “I suspect these two men of being warlocks. What do you say? Another turn of the rack, executioners.” The Jesuits couldn’t believe what they heard next. “No, no!” the woman groaned. “You are quite right. I have often seen them at the Sabbat. They can turn themselves into goats, wolves and other animals…. Several witches have had children by them. One woman even had eight children whom these men fathered. The children had heads like toads and legs like spiders.” Turning to the flabbergasted Jesuits, the duke inquired, “Shall I put you to the torture until you confess?”

Having been put in the shoes of the many innocent people maimed and executed solely on the desperate “confessions” of the tortured, Spee was roused into writing the book that helped put an end to centuries of torture as standard law enforcement practice. Hence why all Western countries — including the U.S. via its Eighth Amendment against “cruel and unusual punishment” — recognizing torture as having neither a moral nor practical place in their society. Continue reading

Khassan Baiev

d091d0b0d0b8d0b5d0b22c_d0a5d0b0d181d0b0d0bd_d096d183d0bdd0b8d0b4d0bed0b2d0b8d187Some years ago, as an  undergrad at FIU, I had chance meeting with one of the greatest heroes I’ve ever known, a man I hadn’t even heard of until that day. It has stayed with me to this day as an enduring reminder of the many unsung and unknown heroes around us who go about their lives without praise, notice, or popular knowledge.

Khassan Baiev is a Russian-born doctor, now living in the U.S., who risked his life to indiscriminately help those in need in the midst of a bloody warzone. As a sickly and frail Chechen youth growing up in the Soviet Union, he spent years building up his mind and body, eventually becoming both a pro athlete and a surgeon (at around fifty years old, I recall him looking more fit than some people my age). He held strongly to the ideals of humanism, altruism, and the Hippocratic oath. As a Muslim and non-Russian, he faced discrimination along the way, but ultimately made a promising career in Moscow.

In 1994, when Chechnya attempted to break from the Russian Federation, the response was horrific. The Russian Army leveled almost every building in the capital, Grozny, and was virtually indiscriminate about the places it bombed and shelled. Perhaps 200,000 were killed in the course of the conflict, and many more psychologically and physically disabled. Dr. Baiev left the safety of distant Russian capital and went where he was needed; he was perhaps the only surgeon in the entire region. At great risk to his life, he adhered to his duty as a doctor and treated everyone and anyone he could, including Chechen militants and Russian soldiers. He explained how his Hippocratic oath, as a doctor, adhered him to helping whoever needed it, regardless of their allegiances.

It was enough dealing with hundreds of patients in the middle of a war zone, but given the circumstances, Dr. Baiev was soon forced to make due with few resources. When his hospital in Grozny was destroyed by Russian shelling, he moved his operations to an abandoned clinic in his hometown of Alkan Kala, restoring it with the help of locals and his own funds. Anesthesia was handmade; running water, electricity, and gas were typically unavailable. Wounds had to be dressed with sour cream or egg yolks. Baiev relied on household tools for his procedures, including a power drill for brain surgery and a hacksaw for amputations; he did 67 amputations and eight brain procedures in the span of just three days. He and his nurses, some of whom were killed, even donated their own blood for patients. This went on for six years of almost constant warfare.

Given the overwhelming demand for his services, Baiev would go days without sleeping, taking in an average of 40 to 50 patients. He never asked questions of those in need — he simply did his job and moved on to the next patient. He and the village elders kept the peace between the soldiers on both sides, who were sometimes in the same hospital, giving them equal medical treatment. But his willingness to help anyone put him on bad terms with both sides of the war, each of whom regarded him as a traitor. Bounties and arrests were put on his head. He was kidnapped several times and almost killed several more. He remained to do his job anyway, and only after an official warrant for his arrest did he reluctantly leave to America for the sake of his family.

He has returned to Chechnya several times since the war, even organizing a group dedicated to providing affordable medical care and to raising awareness of the brutality of the conflict. He had all his procedures recorded as evidence of Russian atrocities, which the Russian government denied (allegedly going so far as to kill some of his patients as a cover up). I saw some of the horrific footage myself; I still can’t imagine how someone could take all that trauma daily for several years.

Unfortunately, there is still much for him to do, as rates of birth defects, psychological trauma, and cancer remain high from the effects of the war. As I speak he still goes to his native republic to help despite occasional threats on his life.

I subsequently purchased his book, The Oath: A Surgeon Under Fire, and had the honor of having him autograph it. When I saw him up close, I was struck by how large and strong he looked; the man was in damn good shape. Yet he had a really somber and weathered look to him, and I could feel that presence as well. He had a firm handshake and a force of personality, but at the same time maintained a quiet and humble demeanor, fitting for a man who risked certain death for simply doing his job without any want of attention or money. He is exactly the kind of man I hope to be, and exactly the sort of person who stays with you years later, inspiring you to be the best damn person you can be.

The Sedition Act of 1918

On this day in 1918, the Sedition Act was passed by Congress forbidding Americans from using “disloyal, profane, scurrilous, or abusive language” about the U.S. government, flag, or armed forces during the ongoing First World War. It also allowed the Postmaster General to refuse to deliver any mail that, in his discretion, fit this description.

This was actually the second act of its name and kind, with the first being passed early in the history of the republic, in 1798 (though it expired in 1801). Those convicted under the 1918 act generally received prison sentences of five to 20 years. Continue reading

The Kalliu Relay System

One of the earliest and most effective mass communications system ever developed was the “kalliu” relay system of the Neo Assyrian Empire in the Middle East. The Assyrians formed one of history’s first empires in the 10th millennium B.C.E., perfecting many strategies and institutional of imperial rule that set the standard for other empires. Chief among these was their mass relay system, which allowed the empire to span 540,000 square miles and last over 300 years.

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Rather than have one trusted envoy to deliver a message through a direct route, Assyrian rulers relied on multiple riders to stop at purpose-built stations where they would pass the message to another rider who was ready with a fresh mount. The stations were carefully positioned at regular intervals along the imperial highway system. Mules were used for their sturdiness and speed in rough terrain and climates. The system was maintained by the military and used only by the state: about 150 officials known as “Great Ones” held a copy of the Assyrian royal seal — depicting the king fighting a lion — which they stamped on messages to identify their authority, since it was recognized throughout the empire. Only letters with this seal could be mailed.

Because messages did not require one rider who would need to rest, the kalliu system offered unprecedented communication speed at the time. One estimate suggests that a message traversing 430 miles through rough terrain would take less than five days. Little wonder that later empires like the Persians adopted this technique for their massive territory. Even the United States used it as the basis for the famed Pony Express in the 19th century. Indeed, the use of a series of anonymous messages along different relay systems remain the basis of modern postal systems worldwide — to think it all began with an Iron Age Mesopotamian state nearly 3,000 years ago.

Americans Have Less Free Time Than Medieval Peasants

It probably goes without saying that we Americans have a lot more going for us nowadays than our ancestors did several centuries ago: public health and sanitation, plentiful food and water (for the most part), democracy and free press (of a sort). But this article from Business Insider points out one big area in which we resoundingly (and perhaps surprisingly) lose out: vacation time. Continue reading