HARVARD SQUARE COMMENTARY

December 24, 2007
From a Writer's Notebook: Some Thought on Childbirth in Stables

John R. Guthrie


Giving birth, always fraught with risk, is certainly all the more so should one give birth in a stable as tradition holds that Mary did some 2,000 years ago. Stables are not hospitable places for either human mothers or infants. They are hospitable for such commonplace germs as the Streptococcus group (think toxic shock) as well as more exotic and more lethal ones: Clostridium tetani, for instance, which causes tetanus; Cattle quite commonly carry this organism and have developed resistance to it. The now notorious Bacillus anthracis is found all too commonly in livestock, particularly swine. Camels are similarly inclined toward lethal organisms.

Advances have been made through the centuries which would greatly increase the risk of the maternal/infant survival should they be so unfortunate as for the infant to arrive in a dung-strewn stable. Sir Alexander Fleming, whose fortuitous realization that the mold, Penicillium notatum, that contaminated his bacterial culture, inhibited the bacteria’s growth, is probably the best known example of such pioneers. His fame only slightly exceeds that of Joseph Lister, whose carbolic acid sprayed by a pump operated by a primitive, erratically firing internal combustion engine known tellingly as a “donkey engine,” introduced antiseptic surgery and led to modern sterile techniques.  Yet these pioneers, giants though they were, stood on the shoulders of many others, many of them obscure.

My favorite example among the latter is Ignaz Phillip Semmelweis. Born in Hungary and educated at the University of Pest, he received a teaching post at the University of Vienna hospital in the Empress Maria Theresa’s Austria in 1844.

In certain sections of the maternity wards, the death rate for young, healthy women who delivered there was as high as one out of every three. “Miasmas…the stress of lactation…acts of God,” and the misognynistic assertion that maternal deaths were caused by, “immoral behavior in that (the mothers) enjoyed the act of procreation." Semmelweis, however, noted that the death rates in the wards where midwives were trained was but ~2 percent. Childbed fever was also rare when women gave birth at home.

The medical students, he noted, came directly from the dissecting lab where they worked on cadavers, cadavers that were often in an advanced state of putridity. They then went directly to the maternity wards to participate, along with their professors, in the pelvic examinations and other care of the newly delivered mothers. No Latex® glove niceties in those days!

In what was actually a classical piece of scientific detective work, Semmelweis perceived cause and effect, and insisted that hand washing stations with a chlorine solution be set up at the exit of the anatomy lab. The drop in the maternal death rate was 90%! Other refinements, such as washing the instruments and the bed linens resulted in further reductions in maternal death.

The reaction of Vienna’s medical establishment was swift and sure. The hospital director, who felt his leadership had been criticized by this Jewish upstart, was furious. In addition, the senior attendings were livid to be told that their healing touch was actually the touch of death. Semmelweis was hounded into obscurity. He became distraught and depressed to such a degree as to require hospitalization in the section of the hospital reserved for the “mentally and morally infirm.”

Semmelweis died in obscurity in 1865, the sad, isolated, and tragic death of a broken and impoverished man.  Hew as 47. As a final irony, the cause of his death was the same as that which killed the women in the lying in hospitals (and his physician friend). He scratched his finger during surgery shortly before admission to the mental ward, developed an overwhelming infection, and died.

There are several conclusions possible here, including: that if you are going to do death-defying acts such as give birth in a stable, as did Mary, or buck the establishment, as did Ignaz Phillip Semmelweis (or that other Jewish upstart who was born in that stable that night 2,000 years ago) divine protection would be most helpful.

One may conclude that because someone, or their ideas or behavior are different, that does not mean that they are necessarily bad or dangerous. There is a corollary to this; having heretical theories that buck the establishment does not mean that one must be correct. Semmelweis’s rejection has been used as justification by a variety of crack pot theorists up until the present day. One of the most indecent acts of the Intelligent Design crowd, for instance, is their attempt to co-opt Semmelweis into their cause.

Still, forbearance and tolerance of variants of thought and deed represent the best of both our political and our religious traditions, and scientific methodology, over time, is the best source of verity available. The surgeon Semmelweis, who died, broken and ruined by those who should have revered him most, left the stepping stones that Pasteur, Lister, and others ascended. And the infant who lay in that manger in the stable in Bethlehem those millennia ago, only to be broken on the cross by the establishment of that day, left teachings and examples, many of which are still a lamp unto our feet and a light unto our path.


Dr. John R. Guthrie practiced family medicine in the Smokey Mountain foothills of Appalachia for years. As an adolescent he was a U.S. Marine infantry rifleman and later served as a physician in the U.S. Navy Reserve. He lives in Southern California and is a writer and social activist.


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