The_Invention_of_Surgery

physicians themselves. Childbirth had only ever been commandeered by
midwives, but obstetrics arose as a specialty, challenging the supremacy of
midwifery. Nobility and the upper classes began choosing to have
physicians (rather than midwives) deliver their babies in Europe and
throughout the Continent. But the ultimate shock was this: women (and
their babies) were much more likely to die if delivery was handled by a
doctor.
A confounding duality therefore existed throughout the 19th century,
wherein women were (directly or indirectly) pressured to deliver with a
physician obstetrician in a hospital, in spite of the fact that the known risk
of dying was many times higher than delivery with a midwife. What was
the cause of death? Puerperal fever, also known as childbed fever.
Typically, it would strike a woman in the hours after delivering, and would
start as a lower abdominal pain, with a striking tenderness and swelling of
the vaginal tissues. A foul discharge of pus would follow, and within
hours, a gaseous distention of the belly and a spiking fever would develop.
Most patients would rapidly progress toward shock, with shallow
breathing, delirium, and profuse sweating in the hours before death. There
was simply no effective treatment for a patient suffering from puerperal
fever, and there was no explanation. Why—and how—were doctors
making matters worse?
Infections were a complete mystery to every generation of physicians,
from Hippocrates to court physicians to every emperor and king in Europe
in the 19th century. Epidemics had occurred in waves, including the
plague, typhoid, yellow fever, malaria, and cholera, but lacking proper
science to analyze the means of transmission, and having no way to
visualize the culprits, contagions were as scary and insoluble as the
demons in a Botticelli or Michelangelo painting. Most theorists pondered
the “foul air” associated with an infection, wondering if there was
something noxious in the atmosphere (in Italian, bad air is “malaria”). The
miasma theory of infection posited that bad air was indeed to blame, and
therefore, when puerperal fever was ravaging through a maternity unit,
physicians concluded that some phantom agent was responsible. It simply
wasn’t in the minds of men to conclude that small germs, bacteria, or
viruses, were to blame.