Two parallel clinics. One fatal. One not.
The women begged, cajoled, manipulated to be admitted to the second clinic for childbirth. Some who couldn’t get what they wanted opted for street births.
They were safer that way.
The place: Vienna.
The time: the 1840s.
The fatal clinic: the first — not the second — in a local Viennese maternity hospital.
The hero: Ignaz Semmelweis.
Except, he never knew he was a hero.
Like Chiune Sugihara, who was shunned by his Japanese government for saving Jews during the Holocaust, Semmelweis was shunned by his Viennese colleagues, demoted and stigmatized as a crank, although his intuition and instincts eventually led to the saving of countless lives.
Including, quite literally, your life and my life and the lives of every single person near and dear to you.
Semmelweis never knew.
So much for standing up to the intellectual powers that be.
So much for unsettling “settled science.”
So much for uncredentialed underlings knowing more than their superiors, the “experts.” (Reminds me of Abba Eban’s definition of an expert: somebody who knows everything — but nothing else.)
Semmelweis’ story is told by Siddhartha Mukherjee, who has unsettled my prejudice that beauty in writing is to be found only in the humanities, never in science.
There is a reason Mukherjee has won the Pulitzer Prize and topped the bestseller list. He has turned science writing into a thing of beauty.
Riveting. Humanizing. Scientific page-turners.
Here is but one of the stories that Mukherjee tells in his riveting, gorgeously written, The Song of the Cell: An Exploration of Medicine and the New Human (Scribner, 2023). What follows is almost entirely quotation:
Ignaz Semmelweis worked as an assistant in a Viennese maternity hospital in the late 1840s. The clinic was divided into two wards: the first clinic and the second clinic. Childbirth, in the nineteenth century, was almost as much life threatening as it was life giving. Infections — puerperal fever, or, more colloquially, “childbed fever” — caused postpartum death rates that ranged from 5% to 10% for mothers.
Semmelweis noted a peculiar pattern: compared with the second clinic, the first clinic had a significantly higher rate of maternal mortality from childbed fever. News of this discrepancy, spread via gossip and rumor throughout Vienna, was an open secret.
Pregnant women would beg, cajole, or manipulate their way to be admitted to the second clinic. Some women, wisely, even opted for so-called street births — outside the clinic — reasoning that the first clinic was a far more dangerous place to have a baby than the street.
A hospital clinic, dangerous?
What protected those who delivered outside the clinic from the destructive influences inside the first clinic? How could it be that two women, with the same condition, entered through two doors of the same hospital, yet one emerged with a healthy newborn and one was dispatched to the morgue?
Semmelweis made a mental list of possible differences between the two clinics. There seemed to be none.
There were no differences in women’s ages, in ventilation, in length of labor, in the position or number of beds.
What difference could there be?
One fine day in 1847, one of Semmelweis’ colleagues cut himself with a scalpel while performing an autopsy. He was soon febrile and septic, and Semmelweis noticed that his symptoms mirrored those of the women with childbed fever.
Here, then was a potential answer: the first clinic was run by surgeons and medical students who shuttled casually between the pathology department and the maternity ward — from performing cadaver dissections and autopsies straight to delivering babies. In contrast, the second clinic was run by midwives, who had no contact with cadavers and never performed autopsies.
Were the surgeons and medical students transferring something to the women, whom they routinely examined without gloves?
“Cadaverous material,” Semmelweis called the transferred “something.”
Semmelweis — remember, he is a mere assistant to the experts — insisted that the surgeons and students wash their hands with chlorine and water before entering the maternity wards.
Lo and behold. The morality rate in the first clinic declined by 90%!
Semmelweis’ superiors did not believe in germ theory and Semmelweis himself could not pinpoint the decisive factor — fluid, blood, a particle?
Bottom line: Semmelweis was harassed and ridiculed. The idea that childbed fever was a “doctor’s plague” — iatrogenic — did not sit well with the professors in Vienna. They packed off Semmelweis to the backwaters of Budapest. He died in an asylum, a broken man, in 1865.
• • •
Of course, it was germs, it was disease, that the doctors transferred from the pathology department to the maternity clinic.
This is what scares me about climate change being regarded as “settled science.” No doubt, much of climate science is settled, just as, no doubt, Semmelweis’ colleagues knew a lot of medicine that also was “settled.” But Semmelweis was ridiculed; his questioning was dismissed — and the women continued to die.
Today, the political ridicule of those who pose questions about climate change, or even simply say that as non-scientists they cannot comment on it, create an atmosphere similar to that faced by Semmelweis in the Viennese hospital.
Such an atmosphere stifles discovery — perhaps, the very discovery that could conquer climate change, just as Semmelweis was onto a discovery that has saved lives on a global scale.
We all benefit from science. It advances when its paradigms are shifted (apologies to Thomas Kuhn), when its settled assumptions are unsettled.
Climate science should be no different.
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