What was killing all those women during childbirth?

If you were a woman going into labor in mid-nineteenth-century Vienna, you might have thought yourself lucky to be living in one of the world’s great medical centers. And you might have thought yourself particularly lucky to be giving birth at the Vienna General Hospital, where highly trained doctors would care for you at no charge. Little might you know that you would be walking into a death trap.


How come? And what turned this around? This is, as you’ll see, a story about women, doctors, and, most of all, power. If there was ever doubt about how power dynamics are everywhere, this should help end it.


I don’t know anything about his bedside manner, but no doctor was more dedicated to saving women’s lives, no doctor worked more heroically to do so, and no doctor suffered more tragically for his efforts than Ignaz Semmelweis, who died in Vienna in 1865 at the age of 47, literally driven mad by the efforts to suppress his work. Today he is honored worldwide, with statues of him and hospitals named for him everywhere, from Teheran to Vienna itself, where every attempt had been made to destroy him.

Here he is at 42, prematurely aged by battles he would win only after he was dead:



Let me oversimplify a long and painful story. At the Vienna General Hospital, there were actually two clinics. Clinic One had a high maternal death rate; Clinic Two’s maternal death rate was much lower. And many women knew about this! They often chose to give birth on the street rather than be assigned to Clinic One.

Although Semmelweis was an obstetrician, he thought like an epidemiologist. He analyzed the maternal death rates and came to a powerful, inarguable conclusion. Clinic One offered the services of doctors; Clinic Two offered the services of midwives. Ah!, you say, midwives are better than doctors. No. the difference was that doctors very often delivered babies after dissecting cadavers. Midwives didn’t dissect cadavers.

So, theorized Semmelweis, something about the cadavers was contaminating the women giving birth. Because, you see, the doctors never washed their hands.

Semmelweis instituted a policy of handwashing in Clinic One and maternal mortality immediately fell by 90%. Down to the level of the Clinic Two with the midwives.


So far logic, evidence, and good sense reign, and women’s lives are saved.


But!


As will be no surprise to many of our regular readers, the doctors of Vienna interpreted Dr. Semmelweis’s handwashing policy as...a power move!! “What! This little pissant wants to make us wash our hands like f**king servants!?! Screw him!!” They saw this attempt to save women’s lives as an attempt to disempower them, to humiliate them. And Semmelweis was dismissed from the hospital, harassed by the entire medical community in Vienna, and ultimately forced to move to Budapest.


Again the same thing. He got spectacular results when he was able to implement his methods. And he got vicious attacks from his fellow doctors.

It wasn’t just that he was making them wash their hands, poor babies. He was challenging their understanding of disease itself. His evidence meant nothing. Their fear of loss of power meant everything.

Semmelweis kept fighting back with increasingly vociferous polemics. The medical establishment fought back by destroying his career and his mental health.

In 1865, according to the best accounts, Semmelweis was lured to a Viennese insane asylum. He “...surmised what was happening and tried to leave. He was severely beaten by several guards, secured in a straitjacket, and confined to a darkened cell. Apart from the straitjacket, treatments at the mental institution included dousing with cold water and administering castor oil, a laxative. He died after two weeks, on August 13, 1865, aged 47, from a gangrenous wound, due to an infection on his right hand which might have been caused by the struggle. The autopsy gave the cause of death as pyemia—blood poisoning.”

This leads us to—forces us to—acknowledge that whatever can be played out in the realm of power will be done so. The medical establishment didn’t just want to be right. They wanted to kneel on Semmelweis’s neck until the life was crushed out of him.

Sadly for Semmelweis, the germ theory of disease hadn’t developed by 1865. Not in time to rescue him from his tragic end. Sadly for the doctors who crushed him, around the time of Semmelweis’s death Pasteur was just laying the theoretical foundation for the germ theory of disease that would later go on to thoroughly vindicate Semmelweis’s life work.


Let’s be fair. Power always comes up because our sense of our empowerment is always feeling—or on the verge of feeling—threatened. Just watch a tech tycoon called to testify before Congress. Why do they always seem like such clueless jerks? It’s because as powerful as they are, they are all too aware of Congress’s power, and it scares them. And it puts them in a terrible bind. They can’t cave in. And they can’t bluster and threaten: that would just be poking the bear, like any amateur power move. So they dance and dodge, ultimately acting as though, Oh, you poor know-nothing Congressperson, you can’t possibly understand all of this. It’s the best power move they can come up with.

That’s what we see in life, whenever we see people maneuvering in the social sphere: people making the best power move they can come up with.

My life work? It’s all about shutting down the whole dance. How about NO power moves? How about none of this endless and insane and almost-impossible-to-stop dynamic of I disempower you and you re-empower yourself and I re-empower myself, and on and on until something or someone is destroyed, like a Semmelweis or a marriage or, God forbid, the whole wide world.

Semmelweis wasn’t trying to save the world. Just women giving birth. I’m not trying to save the world either. Just marriages racing as fast as they can down the tubes. It’s all in Why Couples Fight. Fortunately, a much, much easier read than Semmelweis’s major work, The Etiology, Concept and Prophylaxis of Childbed Fever.

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