Jonathan's Blog


I CHALLENGE YOU TO CHALLENGE YOU!

In the eighteenth century, the chances of a birth ending in the mother’s death-from infection, hemorrhage, convulsions, or dehydration-landed between 1 and 1.5 percent.

This may not sound high, but since the typical mother gave birth to between five and eight children, her lifetime chance of dying in childbirth ran as high as one in eight. Put another way, if a mother in George Washington’s time had eight female friends, she wasn’t shocked if one of the expectant mothers died during childbirth. No wonder eighteenth-century women often referred to bringing a new life into the world as “the Dreaded apparition,” “the greatest of earthly miseries,” or “that evil hour I look forward to with dread.”

This morbid maternity situation didn’t improve until a young doctor in Vienna, Austria, challenged medicine’s conventional thinking on hygiene and the childbirth process. That doctor was Ignaz Semmelweis, who was born in Hungary in 1818, the fifth child of a prosperous German shopkeeper. Just before he turned twenty, Ignaz traveled to Vienna to study law, but once in school, he was more attracted to medicine. He threw himself into his studies over the next seven years, completing his dissertation in 1844 and becoming a doctor. He applied for a position with the Vienna General Hospital, site of the world’s largest maternity clinic, so he could learn from professor Johann Klein, a leading authority on puerperal fever, or what was known as “childbirth fever” in those days. Though most women were still giving birth in their homes, more women were seeking medical attention for their “problem pregnancies.” The problem, it turned out, was keeping mom and baby alive after the delivery. Mortality rates were ten, even twenty times higher inside the maternity ward than at home. Attending physicians scratched their heads and blamed the high death rates on crowded conditions or poor ventilation.

Within a year of arriving at Vienna General Hospital, Dr. Jakob Kolletschka, a close friend of Dr. Semmelweis, was performing an autopsy when he sliced his finger with a scalpel. An infection developed, and within days, Dr. Kolletschka died of symptoms resembling puerperal fever. Dr. Semmelweis was beside himself. Why would his good friend die of puerperal fever, in a maternity clinic nonetheless? That didn’t make sense in a hospital with an international reputation for delivering babies, so Dr. Semmelweis began an investigation.

The First Clinic, where physicians attended to upper class mothers, had a dubious record: 13 percent of women or babies did not survive childbirth. Next-door, at the Second Clinic, a second-class facility, where midwives delivered the babies, the mortality rate was 2 percent. What Dr. Semmelweis noticed was that doctors left the dissection room and walked right into the delivery room, their hands practically dripping with the blood of cadavers.

On a hunch and nothing more-Dr Joseph Lister of Scotland wouldn’t discover how to kill germs with heat and antiseptics for another eighteen years-Dr. Semmelweis established a new policy: from now on, doctors had to wash their hands in chlorinated water after working on cadavers. Within a month, the mortality rate from puerperal fever dropped from 13 to 2 percent. What an amazing discovery! Or was it a coincidence?

When word of Dr. Semmelweis’s breakthrough made the rounds, he found himself caught in a political vise. His German boss, Dr Klein, felt that he was being shown up by a young upstart-a Hungarian, no less!-so he blackballed him by blocking his promotion. The medical mainstream viewed Dr. Semmelweis as an outsider. Downcast, the young doctor moved to Budapest, Hungary, where he accepted a position at a far more primitive hospital. Once again, he instituted a policy that doctors had to wash their hands in a chlorinated solution before delivering babies. The maternity clinic saw its mortality rate plunge to 1 percent. This time, Dr. Semmelweis wrote a book about his discovery.

Upon its release in 1861, the medical establishment circled their wagons and shot the messenger. Dr. Semmelweis fired back by writing several critical letters, which burned his bridges in the powerful Viennese medical community. Bitter about the lack of recognition and dogged in his determination that he was right, Dr. Semmelweis suffered a nervous breakdown. His family committed him to a private asylum in Vienna. He died within two weeks under mysterious circumstances at the age of forty-seven. It’s generally believed that Dr. Semmelweis passed away after becoming violent with asylum personnel, who beat him savagely. But the story persists-and here comes the interesting part-that he cut his finger and died of the same puerperal infection that had killed his friend Kolletschka and thousands of young mothers and their children during childbirth. Now, that’s irony on the scale of a Greek tragedy.

Dr. Semmelweis was ahead of his time, but his pioneering work led to advances in hygiene, from which we all benefit today. These days, we take it as a matter of routine that our dentists and family physicians wash their hands before treating us. (Page 91-93 of The Great Physician’s RX for Women’s Health.)

I would like to encourage you to be open-minded. We don’t have it all figured out. To settle down on any issue as if every detail has been investigated and every insight has been gained is foolish. I challenge you to challenge you!