The willful determination by medical professionals to lie about the incidence of these infections explains in large measure why the average person seldom if ever hears a word about the resulting deaths.
How could physicians keep such a shattering story so quiet? The answer is by means of a determined, carefully orchestrated, and self-protective "conspiracy of silence" on the part of the medical profession, including the conscious decision to tell outright lies under oath. pediatrician Catherine McKegney’s 1988 paper on the impact of neglect and abuse during medical training reveals the underlying compulsions that cause physicians to conceal medical errors. Nonetheless, the society continues to demonstrate a willingness to grant physicians the benefit of what has to be viewed as a growing list of serious doubts about the quality of clinical performance.
In the November/December 1996 issue of Health magazine, Katherine Griffin published an article, entitled "They Should Have Washed Their Hands," that underscores the deep entrenchment of the dominant medical mind-set. Griffin states: "More Americans die from hospital infections every year than from car wrecks and homicides combined. Many of these tragedies could be avoided--if only nurses and doctors would clean up their act. ...After heart disease, stroke and cancer, hospital-acquired infections are the nation’s next biggest cause of death." Griffin quotes William Jarvis, chief of investigation and prevention for the CDC’s Hospital Infections Program, as saying: "The proportion (of hospital-acquired infections) that leads to death is probably increasing." Griffin goes on as follows:
"Study after study has concluded that hospital workers are shockingly lax about keeping their hands clean. Hand washing has been the first line of defense against hospital infections since 1847, when an Austrian doctor named Ignaz Semmelweis first made doctors aware that they were infecting their own patients. When he bucked convention by getting doctors to wash up after dissecting cadavers, the change cut maternity ward deaths by more than 90 percent. Hospital workers today are supposed to wash their hands vigorously for two minutes before starting each shift and then for ten to fifteen seconds before every contact with a patient, even if they’re going to put on surgical gloves. By now you’d think the practice would have become second nature. But it hasn’t."
"Experts in infection control coax, cajole, threaten and plead," railed a recent editorial in the New England Journal of Medicine, "and still their colleagues neglect to wash their hands." In a comprehensive review of 37 studies on hand washing, epidemiologist Elaine Larson of the Georgetown University School of Nursing found that "doctors and nurses typically washed their hands only 40 percent of the time. That figure held true even in intensive care units, with their mix of highly vulnerable patients and virulent bugs. And in some of these studies the health care workers knew they were being watched. ...This isn’t rocket science...it’s a basic concept we teach kids. But somehow people don’t really believe that dirty hands can be a vehicle for infection."
Faced with absurdities such as these, it is reasonable to pose this question: What are the specific causes underlying such a consistently horrendous performance by physicians who have dedicated themselves to the care of patients, and who have solemnly sworn the Oath of Hippocrates: "This above all, I shall do no harm to my patients?"
The first cause of such conduct is the mechanistic and dualistic mind-set that continues to be the dominant paradigm in conventional American medicine. The persistent patterns of neglectful physician behavior--"not having the mind focused on the matter"--that are resulting in deaths on so dramatic a scale ought to be a telling indication that this flawed mind-set of physicians remains unchanged in any significant way as a new century unfolds. The ability to fully accept germ theory and to translate that acceptance into legitimate and effective clinical action requires an intellectual commitment to think in organismic terms, and to overcome the mechanistic and dualistic modes of thought that have been ingrained during conventional medical education. There are now no signs in evidence of a radical shift of this kind in the deep-seated patterns of belief and behavior that continue to dominate in American medicine today. On the contrary, the scale on which nosocomial infections are now occurring in the United States constitutes significant evidence that the mind-set deficiencies that exist for physicians practicing conventional medicine have changed little during the past one hundred and fifty years. In 1843--nearly twenty years before Ignaz Semmelweis challenged his European colleagues about their aesceptic practices, and sixteen years before Darwin published his "Origin of Species" -- Oliver Wendell Holmes, Sr., then a thirty-two year old physician on the faculty of the Harvard University School of Medicine, published his paper on "The Contagiousness of Puerperal Fever" in The New England Quarterly Journal of Medicine, the precursor of today’s New England Journal of Medicine. (The word "puerperal" is another "secret language" sentinel, and is derived from two Latin words: puer, meaning "child"; and parere, meaning "to bear," hence "childbearing" fever). In response to this paper, Hugh Lenox Hodge’s 1852 textbook on Obstetrics explicitly counseled physicians to ignore Holmes’ writings, and to:
"Divest your minds of the overpowering dread that you can ever become...the minister of evil; that you can ever convey, in any possible manner, a horrible virus, so destructive in its effects, and so mysterious in its operations as that attributed to puerperal fever."
At the time, Hodge was a professor of Obstetrics and Gynecology at the prestigious University of Pennsylvania. With an arrogance indistinguishable from that of the Inquisitors who ridiculed the facts that Galileo had observed through his telescopes, the haughty adversaries of hand-washing by obstetricians were demonstrating that, in nineteenth century Boston and Philadelphia, the authority of the established medical guild would hold sway over the absolute correctness of brute facts observed through medical microscopes, as well as over the judgments of doctors like Semmelweis and Holmes about what would best protect the lives of female patients during childbirth. The free medical barony of the mid-nineteenth century asserted that authority would prevail over experience; that beliefs would be taken as more persuasive than scientific demonstration; and that any physician colleague who dared to rebel against the orthodox beliefs, methods or established practices of academic medicine would be hounded out of the professorship and be banished from the medical guild on grounds of treason. Strict compliance with medical orthodoxy would be required of all licensed physicians, no matter what the murderous consequences might be for childbearing women. Professor Holmes subsequently had this to say about the attitudes of his medical colleagues: "throw out wine...and the vapors which produce the miracle of anaesthesia, and I firmly believe that if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind--and all the worse for the fishes."
In his opinion in the infamous case involving orthopedic surgeon John Nork California Superior Court Judge B. Abbott Goldberg took note of the fact that Hodge’s Department of Obstetrics at Pennsylvania Hospital "had a somewhat unfortunate experience with puerperal fever and after being closed for some time [the Department of Obstetrics] was finally abandoned in 1854." Judge Goldberg commented further on these events, as follows:
"The medical profession rose up in arms against Dr. [Oliver Wendell] Holmes [Sr.]. He [Holmes] ignited a controversy that would rage for years. ...[His article] held that the disease [puerperal fever] was related to the personal uncleanliness of the attending obstetricians. ...Dr. Holmes replied to his critics only rarely. But he did say once: 'I am too much in earnest for either humility or vanity, but I do entreat those who hold the keys of life and death to listen to me for this once. ...I beg to be heard in behalf of those...whose lives are at stake, until some stronger voice shall plead for them.'"
Although Harvard’s Holmes was absolutely right about the origins of puerperal fever, and the University of Pennsylvania’s Hodge was absolutely wrong, a major problem at the time was that many of Holmes’s colleagues at Harvard did not believe in germ theory. In fact, many profoundly resented and totally rejected the notion that they could be infecting their own patients. At the time that Hodge’s textbook containing an attack on Holmes was published in the United States, Semmelweis, the European obstetrician, made a breakthrough discovery about the causes of puerperal fever. Following is a brief description of this young physician’s conclusions about whether or not the germs infecting and killing their obstetric patients in large numbers were being spread by doctors:
"In the middle of the nineteenth century, a young Hungarian-born obstetrician by the name of Ignaz Phillip Semmelweis was delivering babies in a famous Viennese hospital. Women coming to give birth here were sent to one of the hospital’s two sections--the First Clinic, where obstetricians prevailed and medical students received training; or the Second Clinic, staffed entirely by midwives. Noticing that women were literally begging to be admitted to the Second Clinic, Semmelweis began to look carefully at the autopsy records from the two sections. ...What he discovered was that the death rate from puerperal [childbed] fever for women in the doctor’s wards was more than four times higher than for women under the midwives’ jurisdiction. Semmelweis, like the other doctors of his time, had no idea that germs could cause disease. ...But in a moment of inspiration he decreed that the medical students handling deliveries on his ward should wash their hands in a chlorine solution after dissecting corpses, and after each examination of a woman in the ward. ...The results were outstanding. Before the hand washing, one out of every eight women giving birth in the First Clinic had died of puerperal fever. But now the death rate dropped almost immediately to less than 1 in 100. What do you think the reaction was when Semmelweis published the records of this spectacular success? ...Orthodox obstetricians virtually declared war on the poor man, battering and insulting him at every opportunity. He was hounded from Vienna, and eventually driven insane by the relentless attacks. He died without ever knowing that his views would eventually triumph, and that thanks to his discoveries, puerperal fever would nearly disappear. Why were such spectacular results dismissed by the medical establishment of the day? ...[T]he finger was being pointed at obstetricians, who found it inconceivable that their own hands might be spreading the fatal infection. ...In the United States, …another prominent obstetrician, Dr. Charles D. Meigs, leapt into the fray, accusing Holmes of 'propagating a vile, demoralizing superstition.' It was impossible for doctor’s hands to spread disease, he declared, because doctors were gentlemen. Due to the refusal of the medical establishment to openly consider the evidence advanced by Semmelweis and Holmes, hundreds of thousands of women continued to die needlessly."
The prevailing mechanistic mind-set of nineteenth century American physicians militated against the recognition of microbes as infectious agents that could be spread about by the hands of medical doctors. Eventually, by the turn of the century, the brutal realities that were being observed consistently through the microscope and in the hospital morgue could no longer be entirely ignored and surgeons--often with profound reluctance--began wearing rubber gloves so as to protect their patients from infection.
In the United States, physicians have established absolute control over everything that occurs in the acute-care hospital setting that could be construed as either "medical" or "surgical." No one other than a licensed physician, with privileges to practice at the specific hospital, may legally make any medical or surgical decision involving the care or treatment of a patient within the walls of that hospital, period. Responsibility for the outcomes flowing from a hospital admission is therefore properly assigned to the physician or physicians attending each specific patient, whether those outcomes turn out to be for good or for ill. This responsibility must include any and every incidence of nosocomial infection, including every death resulting from these infections.
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