In the 19th century, pregnant women who delivered in hospital wards attended by physicians and medical students contracted childbed fever at much higher rates than those in other wards attended by midwives. Associated with a high mortality rate, these postpartum infections were costly, without any idea as to the cause or cure.
In the 1850s, Hungarian physician Ignaz Semmelweis, MD, noticed this disparity between wards. Despite having no knowledge of germ theory, Dr. Semmelweis hypothesized that the difference was due to doctors moving between autopsies and childbirth without washing their hands, thereby spreading infections. To test this hypothesis, he introduced mandatory handwashing with chlorinated lime solution. The rates of childbed fever plummeted, confirming his theory.
Dr. Semmelweis, however, did not initially test alternative explanations, such as environmental factors or patient demographics. Despite publishing on how handwashing reduced postpartum infections, without testing other hypotheses, Dr. Semmelweis faced great skepticism from the medical community, which held biases toward existing theories like miasma, or bad air. Only decades later, with the advent of germ theory, did his handwashing hypothesis gain full acceptance.
Testing alternate hypotheses not only strengthens our conclusions but also equips us to address skepticism and deepen our understanding of the truth. Without doing so, even ideas rooted in evidence may struggle to stand up to scrutiny. In this issue of GT, contributors take assigned stances to explore whether certain procedures are ready for prime time. Such deliberations help us to consider all aspects of and viewpoints on glaucoma care and shed light on potential areas where further investigation is needed. We may believe fully in an evidence-backed approach, but without exploring the alternatives, that practice may be as difficult to accept as hand hygiene once was.
