Health Care ParadigmsPregnancy and Chiropractic

The Strange, Sad Story of Ignatz Semmelveiss

The story of Ignatz Semmelveiss is one that everyone should know.  It is a cautionary tale about the danger of clinging to old paradigms when the evidence is clear that it is time to shift.

The year is 1846, and childbed fever is “the scourge of Europe”.  Women are dying in childbirth is epidemic proportions, and no one knows why.  Though most women at the time gave birth at home, those who had to resort to hospital birth braved mortality rates of 25-30%.  As to the cause of childbed fever, the medical paradigm of the time had some unusual explanations.  Since there was no awareness of microorganisms or infectious disease, puerperal sepsis, or childbed fever as it was known, was attributed to such ambiguous causes as crowdedness, poor ventilation, beginning lactation, and changes in the weather.

Enter Ignaz Semmelveiss.  In July 1846, as the US-Mexican war was in its early stages, Semmelveiss became the house officer of the First Obstetrical Clinic of the university’s teaching institution, The Vienna General Hospital (Wien Allgemeines Krankenhaus).  His most urgent problem to solve was the high maternal and neonatal mortality rates due to puerperal fever, over 13%.

Semmelveiss, through a series of observations and conclusions, arrived at a radical theory and a radical notion: he proposed that perhaps the doctors should wash their hands in between their work with the rotting cadavers in the morgue and their manual examination of the pregnant patients.  This may not seem radical to you or I today, but you must appreciate the mentality of the scientific community “Pre-Pasteur”; before the discovery of microorganisms.  The staff refused to follow Semmelveiss’ advice until he literally forced them to.  When he finally achieved the begrudging compliance of his staff, childbed fever in the First Clinic of Vienna was virtually wiped out.  Cured.

Now, you may think that this was a moment of great celebration in Vienna, a city where 8,000 women a year died from childbed fever.  But you would be wrong.  Even after Semmelveiss published and proved his cure, the medical community refused to accept it and refused to adopt his protocols.  To do so would be to acknowledge that the thousands of women who were dying in childbirth from puerperal fever were being “killed” by their own doctors.  In fact, Semmelveiss’ reward for his discovery was that he was summarily fired from his position, forced to leave the country, and ultimately was committed to an insane asylum where he was beaten to death.

As Dave Barry says, I am not making this up.

Even more tragically, the Semmelveiss discovery was not fully adopted for decades.  In 1920, 40% of the women who died in childbirth in the U.S. died of puerperal fever.  That is an astonishing 63 years after the infection had been cured!

If you have heard the story of Ignatz Semmelveiss, you may be familiar with the above information.  But I’ll bet you haven’t heard the next part.

You see, there was a Second Clinic of Vienna.   Semmelveiss was not in charge of the Second Clinic.  However, they did have one interesting attribute: they had virtually no puerperal fever.  It was this fact that initiated Semmelveiss’ thought process that led him to his antiseptic procedures.  What was different about the Second Clinic?  It was not run by doctors-  it was run by midwives.  And the reason the Second Clinic had no childbed fever was not that the midwives washed their hands, it was that the midwives did no vaginal examinations at all!

Why, when Semmelveiss discovered that the Second Clinic had successfully avoided the epidemic of childbed fever, did he not simply seek to reproduce their methods exactly?  Why did he go so far out of his way to solve the problem in such an elaborate manner?  That is a question whose answer probably has more to do with the status of women and midwives in 19th Century Europe than anything else.  It is an unfortunate oversight, because time has borne out (no pun intended) the fact that, for the vast majority of births, the kind of “hands off” supportive care given by midwives produces superior outcomes for mother and baby than the universal utilization of medicine and surgeons to normal healthy births.

The lesson in the sad story of Ignatz Semmelveiss is that there can be tremendous resistance to the most obvious, simple, and proven ideas, particularly when those ideas challenge the authority of a powerful institution.  It is our responsibility to use our minds, listen to our instincts, and trust our bodies.  We can honor the memory of Semmelveiss by remaining open to new ideas, trusting what clearly works, and maintaining a healthy skepticism toward established institutions which exert universal resistance to new developments and the empowerment of the human spirit.

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