Tag: public health

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Lessons from Puerperal Fever: Trust in Science Matters

The COVID-19 pandemic and its aftermath eroded public trust in public health policies and institutional medicine. In their place, shamans, discredited pseudo-experts, and individuals without medical credentials have gained prominence, amplified by the reach of social media. Robert Kennedy Jr., a prominent anti-vaccine advocate, is positioned as a potential candidate for Cabinet Secretary of Health. History provides stark warnings about the dangers of rejecting sound scientific principles and the profound impact this can have on a nation’s health.

Puerperal fever, or childbed fever, was one of the leading causes of maternal death in the 18th and 19th centuries, claiming the lives of women shortly after childbirth. The tragedy of its widespread occurrence lies in the fact that the solution—basic hygiene—was discovered yet resisted by the medical establishment and society for decades. Two pivotal figures, Ignaz Semmelweis and Oliver Wendell Holmes, made significant contributions to combating this deadly condition, yet both faced resistance from a system unwilling to change.

Ignaz Semmelweis: The Savior of Mothers

In the mid-19th century, Ignaz Semmelweis was a Hungarian physician working at the Vienna General Hospital, which had two maternity clinics. He noticed a striking discrepancy: one clinic, staffed by physicians and medical students, had a much higher mortality rate from puerperal fever than the other, which was staffed by midwives.

Semmelweis hypothesized that physicians, who often conducted autopsies before delivering babies, were transferring infectious material to patients. In 1847, he introduced the practice of handwashing with chlorinated lime, which dramatically reduced mortality rates—from nearly 18% to less than 1%.

Despite his compelling results, Semmelweis faced intense opposition. The medical community, entrenched in tradition and resistant to criticism, dismissed his findings. Many doctors were insulted by the implication that their practices were contributing to patient deaths. In addition Hungary’s struggle for independence and its opposition to Habsburg rule in the mid-19th century created a sociopolitical backdrop that indirectly hindered the adoption of the hygienic practices advocated by Ignaz Semmelweis. Several factors contributed to this dynamic:

1. Political Turmoil and Distrust

  • The Hungarian Revolution of 1848–49 against Habsburg domination and the subsequent suppression by Austrian forces created widespread political instability. In such an environment, scientific advancements were often overshadowed by nationalistic and political concerns.
  • Semmelweis, though Hungarian, worked in Vienna under the Habsburg monarchy. This affiliation may have complicated the acceptance of his ideas in Hungary, where anything associated with Habsburg rule was met with skepticism.

2. Resource Constraints

  • The aftermath of the revolution left Hungary economically weakened and socially disorganized. Hospitals and medical institutions, already limited in resources, struggled to implement new practices that required infrastructure and consistent training, such as handwashing with chlorinated lime.

 Semmelweis’s inability to articulate his findings diplomatically, coupled with his increasingly combative demeanor, further alienated him from his peers. Tragically, he was institutionalized and died in 1865, long before his hand washing protocols gained acceptance.

Oliver Wendell Holmes: A Parallel in the United States

Around the same time, American physician Oliver Wendell Holmes was independently addressing puerperal fever. In 1843, he published “The Contagiousness of Puerperal Fever,” in which he argued that the disease was infectious and could be transmitted by physicians and nurses. Holmes emphasized the importance of hygiene and the need for strict protocols to prevent the spread of infection.

Holmes’s work was met with similar resistance. Many physicians rejected the idea that they could be responsible for spreading disease. Some accused him of undermining the reputation of the medical profession. Nevertheless, Holmes persisted, advocating for systemic changes that eventually influenced medical practices in the United States.

The Tragic Cost of Resistance

The refusal to accept Semmelweis’s and Holmes’s findings delayed the adoption of antiseptic techniques, leading to countless preventable deaths. Their experiences highlight a recurring theme in medical history: progress is often hindered by the reluctance of entrenched systems to embrace new ideas, especially when those ideas challenge the status quo.

Lessons for Modern Health Leadership

The story of puerperal fever, Semmelweis and Holmes  is a stark reminder of the cost of ignoring science. Today’s health crises—whether pandemics, chronic disease management, or antibiotic resistance—demand informed, expert leadership. When science is sidelined, history tells us lives are lost.

The U.S. must learn from the mistakes of the past and ensure that those tasked with safeguarding public health possess the qualifications and humility to respect evidence, embrace change, and prioritize the well-being of the population over personal or political agendas. Let’s not allow history to repeat itself.

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The Art and Science of Barriers

“Good Fences make good neighbors” is a memorable and salient line from Robert Frost’s poem, “Mending Walls.”  While the context of its meaning is a plea for the importance of privacy, it is a useful phrase for the COVID-19 pandemic as we all try social distancing as our physical defense and protective barrier from the Coronavirus. Six feet away from one another and swathed with a nose and face covering mask seems to be the barrier du jour. It has been that throughout life we must deal with barriers that represent either obstacles, as in the poetic verse of Robert Frost, or provide succor to our existence. In our current COVID-19 world, our imposed barrier, a protective mask, will be critical to manage our “new normal” prior to a transformative drug or vaccine. In essence, we need a science driven mask that is effective, comfortable and re-wearable.

Biologic barriers are present from conception. Surrounded by the amniotic membrane, we are protected from most pathogens. Upon its rupture and our ride down the birth canal we start the self versus society struggle.  Hepatitis B, polio, rotavirus, diphtheria, tetanus and pneumococcal vaccinations are our initial immune barrier. Child proofing mechanical barriers (plug locks, stair locks, edge protectors) are present during our formative years. Car seats and later seat belts protect us from motor vehicle morbidity. Science has driven these medical protections and public health measures have orchestrated their distribution to the public and their acceptances as standards of care.

Societal barriers have protected humans for eons from human aggression, accidents and microbes. The Caves of Lascaux  protected Paleolithic man, The Great Wall of China retarded invasion by the Mongols. The Roman emperor Hadrian built his namesake “wall” in Northern England to keep out the “barbarians.” Ramparts and moats around European castles in the Middle Ages slowed the devastation wrought by the Vikings. In our lifetime we put up with anti-terrorist barriers at TSA checkpoints at all U.S. airports. Physical barriers and screening techniques have been shown over time to decrease disease and death from outside threats to our well-being.

Our protection from COVID-19 now demands a barrier to our nasopharynx. We are now safely surrounded by our homes’ four walls and limited “world” contact through our UPS and Amazon delivery services. In order to integrate into society we need extra protection from the virus. A mask or “facial condom” could provide us with the protection and turn human interaction into an acceptable risk. We are now familiar with the N95, surgical, and home-made masks. We have YouTube videos of media celebrities constructing masks. Now,  “mask science” is the next logical step to assure that our efforts are working to prevent Covid-19 transmission. What we really need is some evidence based guidelines developed from a controlled study.

 The geometry is well known: N95 keeps out 95% of particles that are as small as 0.3 microns; droplets containing COVID-19 are 50 microns or less. Droplet spread is 6 feet, more if sneezing or aerosol transmission is involved from the contact. What we don’t know is what materials and layering are most effective against virus spread when used in a real world scenario.

Compliance and comfort are inextricably linked. When I donned a mask in the OR, my face felt like I was in the microclimate of Miami during the summer and my eyeglasses fogged up like winter in London. We have designers and aerosol engineers that can overcome “wearability” issues that could lead to improved compliance. We have industry and universities that have the capability of testing combinations of fabric under simulated and actual environmental conditions.  Distribution capabilities are available to send masks to every household in the United States utilizing the Postal Service.

Americans have internalized the use of seatbelts and TSA screenings in my lifetime. Introducing and complying with  a “new fence” is easier when the alternative may be a painful respiratory death. Wearing a fashionable, comfortable and effective face mask should become the “new normal.”  The design, efficacy and distribution is simply just one more barrier for science to overcome.