Project: Impossible — The Savior of Mothers

Dr. Ignaz Semmelweis

My 26th book will be Project: Impossible, an exploration of how people achieved goals any reasonable person would have thought impossible. This week, the story of the Doctor's Plague.

Childbed Fever

The advent of hospitals and the establishment of obstetrics as a medical discipline had an unanticipated side effect: a dramatic increase in cases of puerperal fever, commonly known as childbed fever.

It was a horrific disease. Death rates for all women giving birth in hospitals ranged from 20-25%. From time to time, there were epidemics of the disease, with death rates approaching 100%. Famous victims included the mother and two wives of Henry VIII and famous feminist and mother of the author of Frankenstein, Mary Wollstonecraft. (Today, puerperal fever is known to be a collection of several different diseases, including endometriosis, routinely treated with antibiotics, though it still occasionally results in death.)

The advent of pathological anatomy as a medical practice correlated strongly with the increase in cases of puerperal fever, though this link did not become clear until much later.

Childbed fever deaths spiked at the Vienna hospital, where pathological anatomy was performed, but not at the Dublin hospital, which did not practice it.

Paging Dr. Semmelweis

As the 19th century opened, the crown jewel, the largest hospital in the world, the center of medical practice in 18th Century Europe was the Allgemeines Krankenhaus der Stadt Wien, the Vienna General Hospital. Ignaz Semmelweis, newly admitted to the practice of obstetrics, spurred by the recent death of his mother, became obsessed with childbed fever.

The obstetrics department had two clinics: the First Clinic, staffed by doctors, and the Second Clinic, staffed by midwives.  Women often pleaded to be admitted to the Second Clinic rather than submit themselves to the care of doctors. Their fear was well founded, as there was a dramatic difference in mortality rates between the two clinics.

The First Clinic, staffed by doctors, had a death rate from childbed fever as high as 16%, but the Second Clinic, staffed by midwives, had a corresponding rate as low as 2%.

The most common theory was that the disease was simply a general miasma, just one of those things. It was nobody’s fault. Especially not the doctors.

An unhappy accident pointed Semmelweis to the answer, when his friend and mentor Professor Jakob Kolletschka died suddenly. The symptoms and progress of his disease were identical to childbed fever. It turned out that Kolletschka’s finger had been nicked by a student with the same knife that was being used in the autopsy. Somehow, contact with the corpse during the autopsy had led to the disease.

And it was in the performance of autopsies that the doctors of the First Clinic differed from the midwives of the Second Clinic.

Cadaver Particles

Ignorant of microscopes, microbes, and the germ theory of disease, Semmelweis could only observe one fact: that there was a connection of some sort between the cadaver and the death of Kolletschka, and by extension, between the cadavers used in pathology to the deaths of the childbed fever victims. What the agency of infection was, Semmelweis did not know and had at the time no way of finding out. He referred to them as “cadaver particles,” although he could not see them, measure them, or learn much about them directly.

But that didn’t mean he couldn’t come up with a treatment. What distinguished cadavers was the putrid smell, and what got rid of the putrid smell was a solution of chloride. In May 1847, Semmelweis embarked on a clinical experiment by placing a dilute concentration of chlorine at the entrance to the obstetrics ward and insisting that everyone who would touch a patient washed in it.

Today, of course, cleanliness for physicians is a matter of routine, but at the time, this was a radical break with traditional practice. Most Europeans at the time felt that a few baths a year were sufficient, and doctors were no exception. In fact, the blood-stained frock was a sign that a physician was hard working and professional. If doctors scrubbed themselves, who would know how hard they worked?

Against the criticism, however, the statistics spoke loudly and clearly. Semmelweis began his handwashing process in May, and by June the drop in puerperal fever was dramatic. First Clinic death rates fell to Second Clinic levels.

Change in death rates from childbed fever following the introduction of handwashing.

You’d expect that to be conclusive, but that turned out not to be the case.

The Semmelweis Reflex

Elsewhere in this blog, I’ve written about the Semmelweis Reflex, originally defined as “the automatic rejection of the obvious, without thought, inspection, or experiment.” As I've argued, what triggers the Semmelweis Reflex, however, isn't new knowledge per se,  but the implied criticism of previous behavior that results.

To accept the Semmelweis approach, doctors had to also accept the idea that they themselves had been responsible for the deaths of thousands of women. Who wants to think of himself or herself as a killer, however inadvertent? It’s not surprising that there is a human tendency to reject or challenge scientific or other factual information that portrays us in a negative light.

You don’t have to look far to find contemporary illustrations, from tobacco executives aghast someone dared accuse them of making a deadly product to the notorious Ford Motor Company indifference to safety in designing the Ford Pinto. The people involved weren’t trying to be unethical or immoral; they were in the grips of denial triggered by the Semmelweis Reflex. This denial was strong enough to make them ignore or trivialize evidence that in retrospect appears conclusive.

There was a dramatic reaction against Semmelweis and his theory by the medical establishment, both in Vienna and elsewhere. Puerperal fever is now known as the “Doctor’s Plague,” because it was a case in which medical treatment made things worse — a lot worse. Semmelweis himself was terribly shocked and depressed to realize that it was his own actions that had resulted in the deaths of many women. And if Semmelweis was shocked, one can only imagine the reaction of other healers to being told that they were in practice, if not in intent, killers.

 Semmelweis continued to make things worse by attacking those who criticized his work. He accused his fellow physicians of murder and worse, and his own behavior became increasingly erratic. Showing increasing signs of mental illness and breakdown, his wife committed him to an asylum in 1857, where he died under mysterious circumstances.

Rembrandt, The Anatomy Lesson

Managing the Impossible Project: Inertia and Friction

Semmelweis succeeded in his “impossible project” to determine the basic cause and treatment of childbed fever, but failed to win widespread support for his ideas at the time. It would not be until the latter part of the 19th Century that the germ theory of disease became widely accepted.

If we consider Semmelweis’s project to be identifying the cause and treatment of childbed fever, he was a remarkable success. As noted, he was much less effective in gaining widespread acceptance for his ideas.

The natural human resistance to new ideas and the role of persuasion and influence management in achieving change are a constant source of frustration — and sometimes despair — for leaders of all stripes. It may help to extend our scientific metaphor and describe the obstacles in light of physics: people and organization, no less than other objects in the real world, are subject to inertia and friction.

Whatever the etiology of the Semmelweis Reflex, the idea of resistance to change is well established in management literature, and it’s just inertia under another name. A body at rest tends to stay at rest until acted upon by an outside force. The good news is that if you can just get the motion started, inertia changes from your enemy to your friend and helps sustain the motion.

Friction, of course, is one of those “outside forces” that hamper inertia. Moving parts have friction, and friction results in the degradation of useful energy. In the human sphere, we’ve all witnessed the results of friction in every human encounter. In mechanics, one way to lessen the effects of friction is through lubrication. The discipline of emotional intelligence, good manners, politeness, and office politics all work to lessen the friction in organizational interaction. It’s just as much a part of the job as the technical work, and leaders ignore it at their peril.

Project: Impossible — Lindbergh Wins the Orteig Prize

My 26th book will be Project: Impossible, an exploration of how people achieved goals any reasonable person would have thought impossible. Here’s a summary of some of the cases covered in the book.

Charles Lindbergh's Flight

What’s impossible about Lindbergh’s famous flight is not that he made it from New York to Paris. That was going to happen within a few weeks anyway. No, what’s impossible is that the underfunded and unknown Lindbergh jumped ahead of highly qualified and lavishly funded competitors.

The Orteig Prize

Crossing the Atlantic by air wasn’t new. The Curtiss NC-4 flying boat did it in 19 days back in 1919, hopping in 50-mile jumps between pre-positioned ships. The following month, British aviators Alcock and Brown flew nonstop from Newfoundland to Ireland. A month after that, the British airship R-34, carrying a crew of 31, made the first lighter-than-air round-trip crossing.

In 1919, French-born New York hotelier Raymond Orteig decided to offer a $25,000 prize the first aviators to fly non-stop from New York to Paris, in either direction.

The first serious attempt at the prize came in 1926, when Frenchman René Fonck crashed on takeoff, killing two. Admiral Richard E. Byrd, famous polar explorer, announced his entry in late 1926. Clarence Chamberlin, practicing for the attempt, set a world endurance record by circling New York City for over 50 hours. From the other side of the Atlantic, Nungesser and Coli readied their Levasseur biplane L'Oiseau Blanc (The White Bird).

By early May 1927, the Chamberlain and Byrd groups were ensconced at adjoining airfields on Long Island, and Nungesser and Coli were getting ready in Paris.

Anyone who thought they’d come in and beat that field was surely a fool.

The Flying Fool

Charles Lindbergh had many nicknames, but the one he despised was given him by the New York Sun: “The Flying Fool.”

He responded, “I take no foolish risks and study out everything I do in the air. I don’t think I am a flying fool.” It is, however, not difficult to understand how the Sun — and others — could have reached that conclusion. Most entries were multi-engine aircraft; Lindbergh flew a single-engine. All the other entrants planned for a crew of at least two to handle the 30+ hour flight. Lindbergh was the only solo entry. Finally, all the other entrants did extensive test flying. Total test flying time for the Spirit of St. Louis amounted to a paltry five and a half hours!

Then there was his safety record. He had only been a pilot for four years, and was famous for only one thing — the most emergency parachute bailouts. In 1924, he collided in mid-air with another Army flying cadet. In his first job post-graduation, he bailed out a second time while serving as test pilot. As an airmail pilot on the St. Louis-Chicago route in 1926, Lindbergh bailed out of not one but two DH-4s when he became lost in storms and ran out of fuel.

The Spirit of Charles Lindbergh

It took ego to enter the race. “Why shouldn’t I fly from New York to Paris?” he wrote in his autobiography. He raised funds from the St. Louis Chamber of Commerce, but had trouble finding a plane. Finally, a small San Diego company, Ryan, offered to build one for him. The Ryan NYP (New York to Paris) had no radio, no parachute, no gas gauges, and no navigation lights. Lindbergh even replaced the leather pilot’s seat with a wicker chair. It was built in record time, only two months.

Two days before Lindbergh was scheduled to leave San Diego for New York, Nungesser and Coli took off from Paris. All the other competitors stopped and waited to see if the Frenchmen would succeed — except for Lindbergh, who set off immediately for New York, setting a speed record en route.

When he reached New York, he learned for the first time that L'Oiseau Blanc had vanished. Charles Lindbergh was back in the race.

The Spirit of Long Island

A lawsuit delayed the Chamberlin group, and Byrd’s America crashed during a practice flight. All the teams were hampered by bad weather, which began to clear on May 19, a few days after Lindbergh finally arrived in New York. Unfortunately, paved runways weren’t yet common in aviation. The field was muddy — too muddy to allow a heavily-laden plane to take off.

But on the morning of May 20, 1927, at 7:52 AM, Charles Lindbergh loaded his plane with four sandwiches, two canteens of water, and 451 gallons of gasoline, and took off. The Spirit of St. Louis barely managed to clear the telephone wires at the end of the runway.

Thirty-three and a half hours later, Charles Lindbergh and the Spirit of St. Louis landed safely in Paris.

Managing the Impossible Project: The Role of Risk

The difference between a possible project and an impossible project is the constraints, the factors that restrict the options available to the leader and team. If the constraints are different, the options are different.

All the teams competing for the Orteig Prize consisted of talented, experienced aviators, engineers, and designers. What distinguishes Lindbergh is the nature and level of risk he was willing to assume.

The technical equation for risk is R = P x I; that is, the price of a risk is the probability of it happening times the impact if it does happen. If there’s a ten percent chance of a $1,000 negative event, the value of the risk is $100, meaning that if you can get rid of the risk for less than $100, it’s a good investment.

What if it costs more than $100 to get rid of the risk? Well, it may still be a good investment depending on other factors. What’s the value of getting into the history books? What’s the value of being acclaimed the world’s best pilot? The price of a risk and the value of a risk aren't necessarily the same thing.

Accepting an elevated level of risk doesn’t automatically make you a “flying fool.” Sometimes it’s exactly what allows you and your team to achieve the impossible.

Project: Impossible — Easter Island

Moai

 My 26th book will be Project: Impossible, an exploration of how people achieved goals any reasonable person would have thought impossible. This week, the strange statues of Easter Island.

The European Discovery

On Easter Sunday 1722, a Dutch West India Company commanded by Jacob Roggeveen, seventeen days out of Chile, sighted a low, flat island, which he named after the day of his discovery: Easter Island.

Easter Island a windy place, flat and treeless. At the time of Roggeveen’s visit, he judged the population to be between 2,000 and 3,000 people. The poverty and barrenness of the island stood in remarkable contrast to what makes Easter Island famous: the monolithic rock carvings known as moai, the giant head-statues that dominate the landscape. The tallest of the moai towers a remarkable 33 feet in height; the heaviest weighs 86 tons.

About half the statues that have been discovered are still in the main quarry where they were all created. Many are only partially completed, as if the workers suddenly left their jobs, never to return. One thing, however, was abundantly clear: the sculpting, transporting, and installing of these statues was a remarkable feat — and clearly, one utterly beyond the capabilities and resources of the poor islanders.

Theories

Of the various theories on the creation, transportation, and erection of the moai of Easter Island, the most fanciful was advanced by Erich von Däniken, that they were designed and built by extraterrestrial visitors. Von Däniken was not alone in marveling about the Easter Island statues. Tribal folklore on Easter Island itself claimed that mana, or divine power, allowed the moai to walk from the quarry to their assigned locations.

A more serious theory was advanced by explorer Thor Heyerdahl, who actually moved a 10-ton moai using a sledge drawn by 180 islanders. Scaling up, it would have required approximately 1,500 people to move the largest moai. Anthropologist William Mulloy developed a complex engineering technique using huge trees for support, but later studies suggested that the necks of the moai couldn’t absorb the excessive stress the method would create.  Czechoslovakian scholar Pavel Pavel and Wyoming archeologist Charles Love attempted to move moai in a semi-upright position, but caused noticeable damage.

Moving the moai was difficult enough, but then came the problem of setting them upright on their ahu platforms. In 1994, archeologist Claudio Cristino could barely re-erect an 88-ton moai using a modern crane!

Of course, ancient civilizations (most famously the Egyptians) moved massive stones — all you need is lots of thick long ropes (traditionally made from tree bark in Polynesia) and lots of large trees. You also need a large labor force, and that also requires a generous amount of surplus food.

But on Easter Island, there are hardly any trees worthy of the name. Worse, the island is unable to support a large population.

Well, today, in any event.

A display of Easter Island moai atop an ahu platform. The ahu are an engineering feat in themselves.

How It Was Done (and Why It Shouldn't Have Been)

Although today Easter Island is relatively barren, botanical surveys have revealed that at the time of human settlement the island was heavily forested, with the dominant tree similar to the Chilean wine palm.
Chilean wine palms are prized for their nuts, for a sweet sap that can be fermented into wine or turned into honey, for fronds capable of being turned into a variety of useful products, and, of course, for the wood of their immense trunks. The trees were extremely important to human civilization on the island — and, of course, they were essential to the transport of the moai.

The imposing and majestic moai were built at the unwitting cost of the civilization that created them, triggering an ecological disaster. By the arrival of famous British explorer Captain James Cook in 1774, the islanders were, in his words, “small, lean, timid, and miserable.” The destruction was so complete that in the end, the people of Easter Island turned to the largest remaining source of protein — each other.

Map of Easter Island Showing Location of Moai

Managing the Impossible Project: The Consequences of Success

Every leader has to face the consequences of potential failure, but it’s important not to overlook the consequences of success as well. Too much focus on getting today’s job done can compromise — sometimes fatally — your future capabilities as well.

Even if you can do the impossible, it’s not necessarily always a good idea.

Project: Impossible — Julius Caesar at the Siege of Alesia, 52 BCE

Gaius Julius Caesar

My 26th book will be Project: Impossible, an exploration of how people achieved goals any reasonable person would have thought impossible. Here’s a summary of some of the cases covered in the book.

The Rise of Vercengetorix

Until the rise of Vercengetorix, Gaius Julius Caesar had been able to fight the tribes of Gaul one at a time. But in 52 BCE, they united under a single leader: Vercingetorix, chieftain of the Arverni tribe.

Caesar’s military and political situation at the time was deteriorating badly. Caesar’s political enemies, known as the boni, threatened him in Rome, and this new uprising compromised his plans for Gaul.

Vercingetorix conducted one of the first known uses of a scorched earth policy, destroying crops to keep them from falling into the hands of the Romans. He also dopted a hit and run strategy. In addition, he raised an army many times larger than the Romans who opposed him — by some counts, as large as 500,000.

Caesar, distracted with events in Rome, was in the settled Roman province of Cisalpine Gaul when Vercingetorix opened his campaign, but quickly crossed the Alps with eight understrength legions to find the scorched earth policy beginning to bite. Although Vercingetorix had burned twenty settlements, he had spared one, the fortress town of Avaricum, thought to be impregnable. In a 27-day siege, plagued by poor supplies and surrounded by hostile Gauls, Caesar took the town — and the food.

Vercingetorix, in response, captured a food convoy bound for Caesar. Still determined to avoid a decisive battle until the odds favored him, he retreated his cavalry into the fortress town of Alesia.

Vercingetorix had every reason to believe that his situation was still advantageous. His forces outnumbered Caesar’s. He had the advantage of high ground. Most importantly, the defending forces inside Alesia were only a small part of the Gallic forces. Soon, Caesar would not only have to contend with the forces inside Alesia, but also the remainder of the army of united Gaul — a relief army of between 125,000 and 250,000. Caesar would shortly find himself trapped in a doughnut, with enemies both inside and outside.

Caesar’s response was to launch one of the most ambitious and astounding feats in the history of military engineering.

The Impossible Project

First, Caesar’s men built a circumvallation, an eleven-mile long fortification of earth piled thirteen feet high, enclosing the entire town. Behind the earthen rampart his soldiers dug two ditches, each about fifteen feet wide. If that wasn’t enough, Caesar’s men built 23 fortlets, one every 80 feet, along the entire route — and did it in only three weeks!

Of course, Caesar also had the Gallic relief forces to worry about, so now he had to do it all over again. The Roman forces built a contravallation, an external set of defenses similar to the circumvallation, but this one extending for thirteen miles!

This immense engineering feat took thirty days, slowed by the need for Caesar’s men to collect supplies to feed the army. But it was all done before the huge relief army arrived.

A reconstruction of Caesar's fortifications around Alesia

The Battle of Alesia

After skirmishing and small battles, the main attack began at midnight, with Vercingetorix’s men crossing the treacherous fortifications Caesar’s soldiers had built. Caesar’s legates Marc Antony and Gaius Trebonius (later one of Caesar’s assassins) were able to repulse the attacks from both sides.

Meanwhile, the leaders of the relief army scouted Caesar’s fortifications and found a weak spot, a Roman camp to the northwest that had not been included in the contravallation because of the hilly terrain. Two legions (around 8,000 soldiers) occupied the camp, and the Gauls sent an attacking force of nearly 60,000 against it, starting with diversionary attacks before the major assault began. Vercingetorix, seeing some of the preparations, launched an attack on the inner lines.

Vercingetorix Surrenders to Caesar

Caesar himself waded into the thick of the battle, and the Romans carried the day. The next day, Vercingetorix surrendered. His men were sold into slavery.

Managing the Impossible Project: Maximizing Resource Quality

The performance of the Roman legionary is legendary, and it’s not surprising that 30,000 Romans could defeat a force arguably ten times as large. But even a cursory reading of Roman military history will make it abundantly clear that not all Roman generals enjoyed equal success.

Of course, Caesar’s military and engineering genius had a lot to do with his success, but it’s the superior performance of his legions, even by already high Roman standards, that is the key to understanding Alesia. The staggering magnitude of the earth-moving alone is a testament to backbreaking, unromantic work. It’s one thing to convince soldiers to fight; it’s another thing to convince them to dig.

If there is a mismatch between what you want people to do and what they actually are doing, you can either modify the process or modify the people. Modifying the process may mean improving the tools and equipment, or it may involve changing methodologies. Modifying the people can involve motivation, or changing the rewards and punishments for performance.

When people are well trained, motivated, and led effectively, they can achieve results that would otherwise be impossible.

Wrong is Right (Red Herrings, Part 25)

The 25th and final installment of Red Herrings (a subset of Fallacies) ends with the red herring known as “two wrongs make a right.” There’s actually one more red herring in the Wikipedia list, previously covered in my series on cognitive biases: the Texas sharpshooter fallacy. Next week, something completely different. Or maybe not.

Two Wrongs Make a Right

Given the reality that no side is completely innocent of all wrongdoing, the “two wrongs make a right” argument crops up with surprising frequency. When Side A is accused of some misdeed, the response all too often becomes “Side B is even worse!” But the sins of Side B, no matter how true or how severe, don’t excuse Side A.

The fundamental test of any red herring fallacy is that the truth or falsehood of the counterclaim is irrelevant to the merit of the primary claim. Whether a different group is as bad or worse changes nothing. Two wrongs, as we all know (or should know), don’t make a right.

But that doesn’t stop people from trying.

Drawing Straws (Red Herrings Part 24)

Part 24 of Red Herrings covers still more responses to arguments that distract from the argument rather than address it directly. This week, the straw man.

Straw Man

The Economist reports Mitt Romney’s stump speech about President Obama, in which Romney says,

Just a couple of weeks ago in Kansas, President Obama lectured us about Teddy Roosevelt’s philosophy of government. But he failed to mention the important difference between Teddy Roosevelt and Barack Obama. Roosevelt believed that government should level the playing field to create equal opportunities. President Obama believes that government should create equal outcomes.

Of course, Mitt Romney is lying. As the article goes on to say, “Barack Obama doesn't ‘believe that government should create equal outcomes’ any more than Mitt Romney believes that 1% of Americans should have all the wealth while the rest get nothing, or that companies should fire all their American workers and send their jobs to China because Americans are overpaid and lazy.” Instead, Romney is attempting to reframe a discussion on income inequality in a way that is more advantageous to his own arguments.

This is an example of the Straw Man fallacy. Instead of arguing with what a person actually says or believes, the responder creates a distorted version of that argument and attacks that, instead.

Straw man arguments take the following form:

1. Person A holds position X.

2. Person B disregards certain key points of X and instead presents the superficially similar position Y. Position Y is distorted from position X in varying ways, including:

a. A direct misrepresentation of the opponent's position. 

b. Quoting an opponent's words out of context — i.e. choosing quotations that misrepresent the opponent's actual intentions.

c. Presenting someone who defends a position poorly as the main defender, then refuting that person's arguments — thus giving the appearance that every upholder of that position (and thus the position itself) has been defeated. 

d. Inventing a fictitious persona with actions or beliefs which are then criticized, implying that the person represents a group of whom the speaker is critical. 

e. Oversimplifying an opponent's argument, then attacking this oversimplified version.

3. Person B attacks position Y, concluding that X is false/incorrect/flawed.

There may well be honest and legitimate reasons to attack Position X, but attacking Position Y instead is always dishonest.

Hume’s Guillotine (Red Herrings Part 23)

Part 23 of Red Herrings covers still more responses to arguments that distract from the argument rather than address it directly. This week, the is-ought problem.

Is-Ought Problem

The “is-ought problem” is also known as Hume’s Law or Hume’s Guillotine, first articulated by Scottish philosopher David Hume in his 1739 work A Treatise of Human Nature.

In every system of morality, which I have hitherto met with, I have always remarked, that the author proceeds for some time in the ordinary ways of reasoning, and establishes the being of a God, or makes observations concerning human affairs; when all of a sudden I am surprised to find, that instead of the usual copulations of propositions, is, and is not, I meet with no proposition that is not connected with an ought, or an ought not. This change is imperceptible; but is however, of the last consequence. For as this ought, or ought not, expresses some new relation or affirmation, 'tis necessary that it should be observed and explained; and at the same time that a reason should be given; for what seems altogether inconceivable, how this new relation can be a deduction from others, which are entirely different from it.

As in the case of many logical fallacies, it’s not necessarily the case that “is” precludes “ought,” but rather that “is” doesn’t constitute a sufficient proof by itself. To reach a conclusion of “ought” requires additional argument.

The problem is easier in goal-setting than in morality. For example, if you want to win a race, then you ought to run quickly. However, whether you ought to want to win in the first place is a different question.