The Doctors' Plague: Germs, Childbed Fever, and the Strange Story of Ignac Semmelweis (Great Discoveries)

This is a simple story, and today it is hard to imagine that there was a time that this could have happened. A girl in Vienna, Austria in the 1840s meets a dashing young college student. It is such a lovely relationship, but soon, she gives herself to him--- over and over and over. She becomes pregnant and the dashing student blames himself for his “dallying” with this girl. Of course, he takes no responsibility for this pregnancy. The girl’s mother died years ago, but her father has always been so understanding, he will have a solution. Instead, he flies into a rage. The girl stays with her friend Liesl, and she makes frequent trips to the Allgemeine Krankhausen, a huge hospital, the pride of Vienna. Since the 18th century fine hospitals had been built all over Europe, coupled with schools of medicine. Hospitals were a tremendous benefit for the lower classes, but affluent families continued to be treated in their own homes. The girl (author Nuland never gives her a name) scouts out the hospital in her many quiet visits. From Liesl she learns that there are two obstetric divisions—one run by doctors and the other by midwives. She should ask for the one run by midwives, Liesl advises. “Stay away from the prying hands of the medical students,” she says. The day comes when the girl’s water breaks and she and Liesl walk over a half mile to the Allgemeine Krankenhaus They are greeted by a friendly nurse, and she is assigned to the first division, the one run by doctors. No, she cannot go to the second division. This is where she is assigned. The girl is given her bed, and visited by nurses, doctors and medical students. The routine for the students is to visit the “Deadhouse”, where they can examine corpses of those patients who have recently died. Then the students come up to examine these young women, about to give birth. The girl has a long labor, but finally delivers a fine young boy, whom she names for her father. Surely, she thinks, “When I show my father the baby he will forgive me.” Shortly after the birth, however, the girl develops a high fever and her body begins to fill with gas. She vomits, and cannot take food. She becomes cold and clammy, then delirious. Finally, three days after the delivery, she dies. This is 1847, and the author has used this fictional story to lead us into the story of how doctors eventually discovered that they were the very causes of death of so many young women. Fully one out of every six women in this first division at Allgemeine Krankenhaus died of puerperal fever, or childbed fever. Every morning, young doctors would open up bodies of deceased women and find their uteruses inflamed and filled with pus. Then they would proceed directly to the first division and examine healthy young women about to give birth. In the second division, midwives examined the young women, but they did not visit the deadhouse. The mortality rate in second division was much lower. At that time no one knew about germs or infection. They thought that the sickness that swept over these women came from bad vapors or perhaps some mysterious aura. They thought there might be a connection between the changes in a woman’s body that allow her to give milk to her child, or a blockage of the amniotic fluid (lochia). Everything but the thought that it could be doctors with filthy fingers! When we read about doctors wading in bodily fluids, inflamed flesh, pus and a putrid stench, and then proceeding directly to examine healthy women, we can hardly imagine that anyone could have ever been that stupid. Along comes Ignác Semmelweis. Born in Hungary in 1818, Ignác starts out learning to become a lawyer, then changes to medicine. He studies at the University of Vienna one year, then changes to the University of Pest back in Hungary, then back to Vienna to finish and get his degree. Nuland has studied Semmelweis a great deal before writing this book. In 1847, as Semmelweis concluded that doctors and students were conveying the disease, he set up bowls of chloride solution at the entrance to the maternity ward and ordered students to wash their hands before entering the ward. Johann Klein, Semmelweis’ chief at the Vienna lying-in hospital, was an Austrian doctor who followed all the rules and was beholden to the royal apparatus, had been a stern teacher of young doctors and insisted on thorough autopsies and clinical observations of cadavers. He did everything in his power to suggest that puerperal fever, and all the deaths, were caused by the ventilation, the walls, anything but by his doctors. Semmelweis had a lot of characteristics that made him hard to get along with. He had a habit of really haranguing any students or doctors who failed to use the chloride solution upon entering the maternity ward. And he failed to put his theories about infection into print. He soon moved to the lying-in hospital in Pest, Hungary. There he found the same problem—doctors handling a cadaver filled with pus and stinking to high heaven, and then proceeding to operate on a theretofore uninfected patient. He nagged them about using the chloride. And still, they resisted. Back in Austria, someone wrote an article in the Vienna Medical Weekly, saying that one would expect that now (several years after Semmelweis had departed) this chloride-washing theory had been discredited. Semmelweis was not easy to get along with. He was impatient, impetuous, single-minded and blustery. He did not make friends easily. Yet, in 1856, at the age of 38, he married a beautiful young woman, daughter of a prosperous Hungarian merchant. Finally, in 1861 Semmelweis published his book, The Etiology, the concept and the prophylaxis of Childbed Fever. It was met with indifference and opposition by leading obstetricians, which set Semmelweis into a rage. Soon, Semmelweis’ behavior became more bizarre than usual, with strange sex habits, including openly consorting with a prostitute, and rambling speech. He was clearly suffering from some sort of dementia. He was committed to a hospital for the insane and died in August 1865. Four years later, scientists discovered microbes in chains, later to be called streptococci, and in 1879 Louis Pasteur connected Semmelweis’ work with the streptococci to pronounce that “it is the doctor and his staff that carry the microbe from a sick woman to a healthy woman.”

Dr. Nuland's book is a very readable, lucid account of the tragedy of Semmelweiss. Yet, although he offers some plausible insights as to Semmelweiss's self-defeating character flaws, Nuland seems to overlook the need to account for the Viennese doctors' psychological resistance to such clear-cut findings of doctor-caused deaths. Nuland implicitly makes a case that Semmelweiss, as a low-status minority in the Vienna hospital, was likely to have been discounted and patronized by many of these colleagues. As an ethnic "outsider," Semmelweiss may have angrily expected--and thus exacerbated--their prevailing negative response to his disturbing evidence. Still, the glaring statistics he presented--a much, much higher rate of "puerperal" deaths in the wing where the doctors had just arrived from autopsies--should have prompted immediate attention, had the doctors really cared. Professional arrogance, self-serving rationalizations (which, as in the military, can go to astonishing lengths), relative indifference to the (needless) deaths of so many--AND more than a bit of patronizing misogyny? Semmelweiss, not interested in the fine points of professional "diplomacy," was morally outraged to see the continuation of such senseless and tragic carnage. Embittered--and, evidently, turning to alcoholism--his increasingly erratic behavior was conveniently labeled as "mad" (and, as Nuland indicates, he was peremptorily beaten to death after a brief, enforced "commitment").I raise this point in light of our present-day, horrifying statistics of "iatrogenesis" ending in fatality: every year, several hundred thousand unnecessary hospital deaths--due to medical negligence or errors. Is there a clarion-call of emergency, an immediate effort to solve this terrible problem? Or, do most doctors, as in Semmelweiss's day, prevail in their complacency and indifference?

Mr. Nuland's book on the Semmelweis story and his efforts to find the cause of the Childbed-fever epidemic that had been sweeping though urban hospitals in the early 19th Century is concise, thorough, and well done. My interest was in Semmelweis's scientific approach as well as the impact his personality had on the results. Nuland shows that Semmelweis basically applied a trial and error approach to solving the problem, until he had a hypothesis about the cause of this scourge of pregnant women. Semmelweis did find the cause, but his personality exemplified by the difficulty he had in getting along with others in the hospital organization, inhibited the adoption of testing procedures that might have provided faster evidence that his hypothesis was correct; and organizational inertia -- the narrow mindedness of his superiors -- delayed acceptance of his conclusions. Nuland's approach to the historical record shows both the rationality and irrationality that can accompany scientific endeavors. Semmelweis made a clear and rational effort to save lives; but irrationalities resulting from his personality both delayed acceptance of his solution and had negative long-term effect on his life. Nuland captures all of this in a job well done.

This biography tells that medicine does not evolve from the top down, Semmelweiss came to understand the course of child bed fever by meticioulsly observing and building on his personal research and understanding.Now we tend to just look for another pill or shot before a clear picture develops. Communication is a second important part of healing as his story shows.

This is a great book about the doctor who's discovery of Puerperal fever cause, and the prevention of it. It was really sad to read about how his theory was misunderstood and mock, and that he went insane in the end.

fascinating