“Every day he heard the heart-rending pleas of women assigned to his care begging to be discharged because they believed these doctors to be the harbingers of death. Fortunately, Dr. Semmelweis was smart enough to listen to his patients.” – PBS Newshour
“Wash your hands.”
Common sense, right? Ever since doctors such as Pasteur, Lister, and Koch published work regarding the Germ Theory of disease, we know that there are microorganisms that exist in the world that can make us very sick, or even kill us, but we can’t see them. Sanitation fights these germs and makes our world healthier and more hospitable.
If you’ve ever seen a medical team scrub before a surgery, you know they’re not playing around. Lives are at stake.
But what did people do before we understood this simple fact?
They didn’t wash their hands. They would operate on one person, walk down the hall, and immediately begin operating on another person.
This became an epidemic in the mid-1800s in Europe with something called Puerperal Fever. In Vienna there were two maternity clinics. One had a maternity clinic run by midwives, where the death rate for mothers giving birth was about 5 in 1,000.
The other maternity clinic was in a teaching hospital, Vienna General, and women giving birth were attended to by medical professionals in training and their teachers, who were experienced doctors. It had a rate of Puerperal Fever about three times higher, about 15%.
Enter Ignaz Semmelweis.
Ignaz Semmelweis made a discovery that saved countless women’s lives.
Semmelweis was a Jewish-born Hungarian in Vienna who became chief resident of Obstetrics at Vienna General Hospital in 1946. He was puzzled by the discrepancy. He also witnessed a good friend die after cutting his hand on a scalpel while dissecting a cadaver. While dying, he exhibited the same pathology as the women dying from Puerperal Fever:
“raging fevers, putrid pus emanating from the birth canal, painful abscesses in the abdomen and chest, and an irreversible descent into an absolute hell of sepsis and death — all within 24 hours of the baby’s birth.”
Semmelweis became obsessed with finding a cure. He eventually linked the disease to his attending physicians. They would be teaching anatomy or performing an autopsy, usually with their student physicians, and then they would leave right away to meet a woman in labor and help her deliver her baby.
No hand washing.
We know today that the cause of all this strife was Group A hemolytic streptococcus. But back then, doctors didn’t know about germs.
Even without the requisite knowledge of germ theory, Semmelweis demanded that his doctors wash their hands using a chlorinated lime solution until their hands no longer smelled of dead bodies.
And overnight, the death rate fell to mirror that of the other clinic.
You would think that the doctors would praise Semmelweis for his discovery, but instead, they were outraged.
Many were completely offended that someone would suggest that they were the cause of these deaths.
Some were incensed that someone would have the audacity to claim that their hands were dirty at all—after all, they were gentlemen. Their hands couldn’t be dirty.
Because of this, Semmelweis was laughed at, despite his demonstrable success in saving thousands of women’s lives.
After being denied the ability to influence the greater medical establishment in Vienna for political and cultural reasons in 1848, he left Vienna. He ended up becoming the head obstetrician in Pest (modern-day Hungary). There he replicated his results and nearly eliminated Puerperal Fever entirely. By now, he was having physicians not only wash their hands, but sterilize their instruments as well. This lead to a further drop in the death rate.
He ended up in a mental institution, though, for what we would now know to be a combination of severe depression and possibly early-onset Alzheimer’s syndrome. Two weeks later, he was beaten to death by guards.
A man who should have been a medical hero met a sad, tragic end.
What does Semmelweis’s story have to do with circumcision?
Semmelweis’s demise at the hands of his peers is a perfect example of “belief perseverance”. This is the idea that people will cling to their previously-held beliefs in the face of contradictory evidence. This is especially likely if the new information means that they will lose significantly from shift in knowledge.
With American physicians, a perfect example of belief perseverance would be the continuation of the practice of Routine Infant Circumcision.
There is overwhelming evidence from global sources that routine circumcision is:
- A violation of commonly accepted ethical standards
- Unhealthy
- Unhygienic
- The cause of many painful side effects
- Completely unnecessary (the vast majority [99.6%] of all boys will never require a circumcision)
Despite this, many doctors in America still recommend circumcision to their patients. If they don’t recommend it, they at least take a “neutral” stance on it. They often don’t dissuade their patients from choosing to cut their sons for cultural reasons or uninformed “medical” reasons. The justifications still touted by the CDC and the AAP have been disproven or discredited, but many doctors either don’t know or (assumably) don’t care.
Many doctors also still recommend that infants and toddlers have their prepuce (foreskin) retracted for daily cleaning. This is bad medical advice, and even the AAP says not to do this. The foreskin is designed to be tightly attached to the glans well into childhood, and forcing it to retract causes scarring, infection and pain. Doctors who recommend retracting to clean do not recognize the problems caused by premature and forceful retraction as an example of iatrogenic (doctor-caused) injury.
Perhaps, like Semmelweis’s colleagues, they are offended to hear that their recommendations and actions are causing the foreskin to be “problematic” rather than any inherent problem.
Why would doctors do this?
First of all, they might continue to push it because they don’t know the correct information regarding circumcisions, or the benefits of being left intact. They were taught one way, and as one medical professional (anonymous, for professional reasons) put it, “the only thing I was taught in medical school about the foreskin was how to remove it.”
Secondly, he or she might benefit from it financially. Circumcision is big business. One circumcision costs between a few hundred and a few thousand dollars, depending on the location and the insurance plan. If you could get a few hundred dollars for a few minutes work, would you discourage it, or would you look the other way?
Lastly, doctors might be silent on the issue because of the implications of backlash. If the medical industry admitted that circumcisions were unnecessary, and that they were wrong for performing them, there would be many lawsuits and countless reparation payments. Every man who felt harmed by his circumcision would speak up. Every mom coerced into signing a consent form when she felt conflicted would speak up. That’s a lot of liability.
Nurses Speak Up
Little Images works closely with many medical professionals, including many nurses. Many have shared stories of times where they felt that the doctor they were working with had given bad advice, or purposefully told a parent to do one thing despite best practices stating otherwise. Many felt that speaking up would have cost them their reputation as nurses, if not their jobs. After all, questioning a doctor’s authority is a major taboo in hospitals.
However, several nurses have agreed to share their stories anonymously with us for this blog post. For every story below, there are many, many others that have been told in confidence or asked not to share publicly.
And we’ve been hearing stories like these for years. This is not an isolated issue.
“I had a doc ask once about circ’ing the baby while he was finishing stitching up the c-section. Mom seemed hesitant, so he said, ‘Oh, don’t worry, he won’t feel a thing. But hopefully I’m in a good mood tomorrow morning, or he’ll end up with a nickname like “Stumpy ****.”’ I was mortified.”
“Last week I was in L&D when a mom came in pushing. Her son was born not too long later. The doctor had been in the room just long enough for the baby to actually deliver, and, no lie, about 30 seconds after he took his first breath, the doc asked, ‘So, is baby **** going to be circumcised?’”
“I had a midwife who tried to convince a parent who didn’t want to circumcise her son to actually do it anyways because her son’s bris was ‘so beautiful.’”
“Once I challenged a midwife regarding circumcision. I brought up that some men are upset that they were circumcised as babies. Her response was ‘Yeah, but don’t you think that’s kind of stupid?'”
“We had a beautiful delivery for an Asian Indian couple and the resident looked at the doc and said, ‘Don’t we need to ask them about circ?’ The doc replied, ‘Nah, you learn who does it usually. But you can ask anyway.'” [NOTE: this implies racial stereotyping on the doctor’s part.”]
“I had one pediatrician who, when I said I would never circumcise after he returned from caring for a post-circ baby who was hemorrhaging in the ER, said he would always recommend circ, especially to ‘people of color because they tend not to wash themselves very well.’ I was disgusted. A complaint was filed, but nothing was done.”
“I often need to tell the doc after c-sections that I don’t feel comfortable having mom sign the consent because she can barely keep her eyes open, and that perhaps she can sign once she can comprehend what you’re saying to them. The reactions I get vary from being told to get consent anyways to shrugging and waiting until the next day to get it.”
“I was in a C-Section and the doc was stitching up mama and asked about circ. She snickered and said ‘Oh, you mean mutilating my baby? Yes, sign me up!’ Then the doc said out loud, ‘I wonder if any of these kids will sue me someday.’ Then when he came over to see the baby on the warmer, he looked at me and went, ‘Oh man, we’ll have to use the big bell on this one!’ and looked for a response, but he got a scowl instead.I almost quit my job that night.”
“I have had a heart-to-heart with a resident that I truly admire. I asked him why they do it at all (since they never see the results of their procedure) and he said ‘because it’s a surgeon’s skill.’ I asked him to please leave as much foreskin as possible since he seemed to have an understanding that it has a purpose, and he said that there was a high incidence of parents being ‘unsatisfied’ with the cosmetic look regardless of what they were told about the importance of room to grow… so the boys would end up needing revision surgeries later.”
“…So they cut more than they know they should. When I spoke to him about my own sons’ experiences (they had complications from theirs, and I don’t remember consciously giving consent), he seemed very empathetic and apologized that the OB who did it did not obtain informed consent. He didn’t consider meatal stenosis as a long term complication until I mentioned it, either [note: this occurs in up to 20% of circumcised males and almost zero intact males]. I really pray I planted some seeds with him.”
Do you have a similar story to tell? Share with us below in the comment section.
You are not alone.
- FGM in Kurdistan: Different culture, same reasons as MGM - July 8, 2019
- FGM and MGM: Are they similar? - December 27, 2018
- Why are men born with a foreskin? - December 9, 2018
Dan Bollinger says
Terrific essay! I liked the mid-point segue!