Thoughts on Hospitalism

A few people have commented on the similarity between puerperal fever, the cause of which was discovered by Ignaz Semmelweis, and hospitalism.

There are certain regions of overlap between the two examples. In both cases, a great deal of suffering and death was iatrogenic – that is, caused by doctors and their treatments. And in both cases, the problem was mostly resolved once the causes were generally understood. The differences are important, however: puerperal fever was considered a normal, if very serious, risk. Hospitalism deaths were always considered to be a morbid deviation from a healthy baseline. Of greater concern is nature of the relative causes: the high incidence of puerperal fever was the result of doctors not knowing about germ theory more than any particular thing they did; although midwives were far less likely to conduct internal investigations without pressing need, a large amount of direct physical contact is pretty inevitable. Hospitalism, in contrast, did not occur in anything approaching a ‘natural’ post-birth environment. It was caused entirely by the interventions of medical professionals. Thus, every attempt to improve things made them worse instead.

Failing to prevent harm, and actively inflicting harm, are distinctly separable.

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