Three days after I gave birth to my youngest child TD, I developed the worst fever I’ve ever had in my life. My teeth chattered so badly I thought my jaw would break and I simultaneously sweat through my bedding and shooks with chills. I had developed Puerperal Fever, colloquially known as “Childbed Fever.” When my temperature hit 104F, I called my obstetrician who remarked that Puerperal Fever is very rare, but wrote me a prescription for some antibiotics. A day or two later, I was better.
Puerperal Fever is caused by the bacteria Streptococcus pyogenes entering the bloodstream through tears in the uterine and vagina lining that occur during childbirth. This causes sepsis, a dangerous infection of the blood. In the eighteenth and nineteenth centuries, Puerperal Fever was one of the most common causes of death in the days following childbirth. Puerperal Fever killed 10.5% of women in the mid-1800s. In 1847, a hospital in Vienna made one simple change that decreased that mortality rate to 2.1%.
It required the doctors to check their egos and wash their hands.
In the 19th century, germ theory was in its infancy and our understanding of how the disease was transmitted was very poor. Viennese physician Ignaz Semmelweis, often considered the father of physician-scientists, made the interesting observation that women who delivered with a male doctor or student attending were five times more likely to die than women who delivered with a female midwife. He contrasted the behaviors of the different providers. Midwives delivered women in different positions. Male physicians often had priests that walked through the clinic ringing a bell, and Semmelweis hypothesized that the bell was scaring women to death. He carefully and systematically changed his practice, but found that none of these differences were impacting the physician’s high mortality rate. Then in 1847, his friend Jakob Kolletschka was performing an autopsy of a deceased mother, accidentally inoculated himself with some of the dead woman’s blood, and died of fever. This led to Semmelweis’s Theory of Cadaverous Poisoning and his hypothesis that doctors and medical students were transmitting some type of poison between women on their hands. He instituted a strict policy of handwashing and limited the number of invasive pelvic exams, which reduced mortality by nearly 90%. The key difference between the physicians’ and midwives’ wards had been cleanliness.
While Semmelweis’s findings have become a classic case study in disease transmission, his work did not earn him any popularity among his peers. He was terminated from his position in 1849 and his 1862 publication “An Open Letter to all Professors of Obstetrics” was regarded as nothing short of scandalous. It was completely unfathomable to physicians who had been trained to cure and enjoyed tremendous status in society that they could be the primary source of maternal death following childbirth. His pleas were rejected by his peers. Even though his work ultimately gave rise to Koch’s postulates, Semmelweis died in disgrace in a mental institution of the very thing he had struggled to save mothers from – a blood infection.
But, Semmelweis did something we all could use a healthy dose of. He spoke truth to power and fought to protect his patients. He used data to inform practice, rather than conceding to ego.
Earlier today, Vice President Mike Pence toured the Mayo Clinic to learn about their efforts to develop novel treatments for COVID-19. Everyone around him appears to be wearing a mask, but Pence allegedly refused to wear one. He’s seen talking to a patient and bumping elbows with an internationally renowned physician-scientist.
It’s not surprising. President Trump has set the tone of the administration and made very clear that masks are bad optics, stating:
“I just don’t want to wear one myself,” the president said. “It’s a recommendation. They recommend it. I’m feeling good. I just don’t want to somehow sitting in the Oval Office behind that beautiful Resolute desk, the great Resolute desk.”
“I think wearing a face mask as I greet presidents, prime ministers, dictators, kings, queens, I don’t see it for myself. I just don’t. Maybe I will change my mind. But this will pass. Hopefully, this will pass quickly,” Trump said.
The problem is, optics don’t save lives. Data saves lives. Trump and Pence have made it very clear that they need to be protected from us, the proletariat, but they care little for whether they transmit the virus to us. They’ve asked us to stay at home, to social distance, and to struggle through unprecedented economic hardship but they lack the simple courtesy it takes to wear a mask and contain your spittle. They’re no better than Semmelweis’s colleagues who refused to examine their own ego and consider that they could be a source of infection. When our nation collapses under the idiocy of this administration, perhaps we can all just eat cake.
What is completely unfathomable is that the Mayo Clinic let them get away with it. No one stood up to our man-child of a vice president and told him he could not put others at risk. The clinicians at the Mayo Clinic treat some of our nation’s sickest patients, including the severely immune-compromised, and they let Pence prance around unchecked. In my own university’s hospital, patients are being hospitalized without their families. Without someone they love to hold their hand while they suffer. They are dying alone in the name of protecting others from COVID-19 and I have watched my colleagues weep at having to tell patients they may die in our hospital alone, without being able to see their loved ones because we can’t risk spreading an infection we don’t entirely understand.
But Mike Pence has carte blanche to behave as he wishes. Ponder that bitter little pill.
This, my lovely readers, is likely to be the Puerperal Fever of our generation. We have decades of experience and data on how to slow the spread of infection, and our own ego and hubris is going to be our great undoing.
Every apocalypse movie starts with someone ignoring a scientist. Maybe the real apocalypse starts when scientists start ignoring themselves.