The Doctors' Plague: Germs, Childbed Fever, and the Strange Story of Ignac Semmelweis - Sherwin B. Nuland [epub]

"Riveting" (Houston Chronicle), "captivating" (Discover), and "compulsively readable" (San Francisco Chronicle).

Surgeon, scholar, best-selling author, Sherwin B. Nuland tells the strange story of Ignác Semmelweis with urgency and the insight gained from his own studies and clinical experience. Ignác Semmelweis is remembered for the now-commonplace notion that doctors must wash their hands before examining patients. In mid-nineteenth-century Vienna, however, this was a subversive idea. With deaths from childbed fever exploding, Semmelweis discovered that doctors themselves were spreading the disease. While his simple reforms worked immediately—childbed fever in Vienna all but disappeared—they brought down upon Semmelweis the wrath of the establishment, and led to his tragic end.

**

From Publishers Weekly

In 1847, one out of every six women who delivered a baby in the First Division at the Allgemeine Krankenhaus hospital in Vienna died of childbed fever, a situation mirrored at other medical facilities in Europe and the U.S. Bestselling author Nuland (How We Die), a clinical professor of surgery at Yale, details in lively descriptive writing just how Ignac Semmelweis, an assistant physician at Allgemeine Krankenhaus, uncovered the origin of this devastating epidemic. Although theories were advanced that attributed it to unhealthy conditions in the expectant mother's body, Semmelweis launched his own investigation. He traced the high mortality rate from this fever in the First Division to the medical doctors, who went straight from dissecting cadavers to delivering babies without washing their hands; they were, in fact, infecting their own patients. Semmelweis's doctrine was controversial in medical circles, Nuland explains, partly because the eccentric physician's self-destructive personality alienated possible supporters. Drawing on careful research, the author convincingly argues that, contrary to popular myth, Semmelweis was not a persecuted victim but, despite his brilliance, was his own worst enemy. He was committed to a public mental institution and, according to Nuland, probably suffered from Alzheimer's and died from beatings administered by hospital personnel. In this engrossing story, Nuland shows how Semmelweis's groundbreaking discovery of how childbed fever was transmitted was later validated by the work of Louis Pasteur and Joseph Lister. FYI: This volume is the first in Norton's Great Discoveries series, which highlights scientific achievement.
Copyright 2003 Reed Business Information, Inc.

From The New England Journal of Medicine

Many people have heard of Semmelweis, whose fame rests on having shown in the 1840s that deaths from puerperal fever (an infection following childbirth) at the Vienna Lying-in Hospital could be reduced by making doctors and medical students wash their hands in a disinfectant solution before entering the maternity ward. His observations were largely ignored during his lifetime and for many years after his death in 1865. Near the end of the 19th century, however, and especially after the publication of a hagiographic biography in 1909, Semmelweis's reputation was raised to the skies. I know of no one else in the history of medicine whose reputation rose from the extreme of oblivion to reverence as one of medicine's greatest heroes. After he had acquired heroic status, it was asserted that Semmelweis was the first to discover that puerperal fever was contagious, that his work had led to the abolition of puerperal fever, that his now famous treatise, The Etiology, the Concept, and the Prophylaxis of Childbed Fever (1861) (Figure), was one of the greatest medical works of the 19th century, and that lack of support by his colleagues in Vienna drove Semmelweis mad. Since the 1970s, however, a small band of Semmelweis scholars have shown that few of these assertions are correct and that the truth about Semmelweis is much more complex -- and certainly more interesting -- than the conventional picture. That Semmelweis made some brilliant observations in 1847 on the manner in which puerperal fever is transmitted is beyond doubt. But he was his own worst enemy. His dogmatism, arrogance, hostility, and unforgivable rudeness to colleagues who dared to question his views, combined with his failure to publish his findings for 14 years, damaged his reputation. Such revelations prompted Sherwin Nuland to publish a paper entitled "The Enigma of Semmelweis: An Interpretation" in 1979. This book is a welcome expansion of that paper, with important additional information. There is broad agreement within the small group of historians who have studied Semmelweis since the 1970s that he possessed a complex and difficult character and about how his reputation rose from oblivion to fame. There are still disputes about both the nature of the mental illness from which Semmelweis suffered in his last few years and the cause of his death. Nuland, who believes that Semmelweis died as a result of a brutal attack by the staff of the lunatic asylum to which he had been admitted a fortnight before his death, has produced new evidence that supports this theory. But Nuland's certainty that Semmelweis suffered from Alzheimer's disease is not shared by most historians. That he was mentally deranged, or insane, or mad (whichever term you prefer) in his last few years is beyond dispute; but retrospective diagnosis of a mental illness that occurred in the 19th century is so difficult that exactly what illness Semmelweis was affected by may never be known. Unfortunately, this book has no index, no footnotes or endnotes, and only a brief bibliographic note. There are many places where one longs to know the evidence for new data; and there is the problem of the first chapter, which presents a detailed account of a young girl who becomes pregnant, is admitted to the General Hospital of Vienna in 1847, and dies of puerperal fever. The chapter is fictional in style and contains colloquial speech. For instance, a medical student says to the girl, "Please pay attention, young miss!" and the girl says to a nurse, "Please don't tell me I could die having a baby. Oh, please, please, Nurse, I couldn't bear to think of it," to which the nurse replies, "Hush, hush. . . . You'll get yourself all worried and excited for no reason." Because no source is given, I can only assume that part or even the whole of the first chapter is historical fiction. If so, it is out of place in an otherwise admirable history of the life and work of Semmelweis. Irvine Loudon, D.M., F.R.C.G.P.