Safer Births

Stéphane Tarnier had a problem he was trying to solve. Babies kept dying on his watch.

Paris in the 1870s was a hotbed of innovation, dragging the rest of Europe kicking and screaming into the modern era. This included a great deal of innovative medicine, leading to less acceptance of preventable deaths—and a greater understanding of what was preventable in the first place.

Tarnier was constantly turning over the problems of infant mortality in his head. As serendipity would have it, he happened upon something that would dramatically change the survival rates of premature babies all around the world.

While looking for a break from his activities, Tarnier found himself at the Jardin des Plantes, Paris' famed zoo and botanical garden. In a quiet corner of the zoo, a zookeeper tended to a peculiar contraption cradling rows of chicken eggs. It was an incubator, a simple yet ingenious device maintaining a steady, life-sustaining warmth.

This must have hit Tarnier like a thunderbolt. If something like this could nurture fragile eggs to hatch, producing healthier live chickens, could this also provide the same life-giving warmth to premature human infants?

Outrageous. Preposterous. Slow-roasting human babies was the stuff of “barbarism”, not medicine.

In spite of a lot of scoffing and skepticism, Tarnier persisted. His curiosity had gotten the better of him, and besides, he was pretty confident this would work. This was his life, after all. Tarnier was one of the most renowned gynecologists in the world, and he was passionate about saving premature lives.

By 1881, a modest heated wooden box with a glass lid proved the concept, and the results over time have been nothing short of stunning. Odds of survival for a premature baby improved by as much as 50% over the next few decades.

Tarnier wasn’t the first to come up with the idea of the incubator for human babies, but he was the first to successfully demonstrate this idea, and that changed the world.

Lots of life-saving innovations were in the air at the time. Ignaz Semmelweis was just out of medical school in 1846, working at a maternity ward in Vienna. Vienna was another hotbed of innovation during the 19th century, with profound ideas about philosophy, psychology, and physics swirled around some of the most revered art and music.

In this innovative environment, Semmelweis was frustrated. The maternity ward at Vienna General Hospital was divided into two sections—one staffed by male doctors and medical students, and the other staffed by female midwives. For some reason, the ward staffed by doctors and medical students had a significantly higher mortality rate than the midwives' ward. Far more mothers got puerperal fever and died.

Semmelweis was intrigued. Why could this be? He began to observe the differences in the two facilities.

The puzzle remained until one of his colleagues died of something suspiciously similar to puerperal fever—the same thing that led to the deaths of so many new mothers after childbirth. This colleague seems to have accidentally cut himself during an autopsy, and within a few days, his infection had led to his death.

After a lot of thinking and observing, Semmelweis concluded that doctors were contaminating the mothers and babies with “cadaverous particles” from autopsies. With the same hands that were handling corpses, the doctors were delivering babies, infecting mothers and potential infants alike.

“Wash your hands” seems like common sense today, but that’s only because of Semmelweis and people like him. After instituting a policy of using a chlorinated lime solution for handwashing before examining patients in the maternity ward, there was a dramatic decrease in puerperal fever and maternal deaths.

“No good deed goes unpunished” seems like an appropriately cynical mantra here: despite the clear success of his methods, Semmelweis's ideas were met with resistance and skepticism from the medical community. Frustrated by the lack of acceptance of his ideas, Semmelweis eventually suffered from severe depression and mental health issues. He was committed to an asylum in 1865, where he died just two weeks later, possibly from a gangrenous wound—an ironic fate for such a passionate opponent to infection.

Giving birth has always been a dangerous endeavor, both for the mother and the infant. Mortality rates during the Roman Empire were much higher for infants than during the Victorian era, but almost certainly much lower for mothers.

The effects of civilization often make a condition worse before they make it better, like with human lifespan during the industrial revolution (it went down before it went up). Eventually, the hope is that the trade-offs are worth it, and we come out the other side much better off than when we went in.

Today, modern mortality rates for infants are vastly lower around the world:

Instead of as many as one in three children dying before their first birthday in antiquity, we now have fewer than one in twenty. Vastly fewer women die in childbirth, and conditions are generally a great deal safer than they were a century ago.

Tarnier and Semmelweis remind us that groundbreaking change does not happen overnight. Instead, it’s often faced with great resistance and even mockery by those embedded in the current system. There’s often a light at the end of the tunnel, but that light sometimes doesn’t shine until the person who came up with the idea is long gone.

What are some other examples of medical innovations that dramatically improved lives, or decreased mortality rates? Go and watch a few episodes of The Knick if you want to be inspired, and come back with some answers!