The Doctors’ Plague: Germs, Childbed Fever, and the Strange Story of Ignác Semmelweis
by Sherwin B. Nuland
Atlas Books/Norton, 191 pp., $21.95
The life of Ignác Semmelweis (1818– 1865) is a puzzle that admits no solution. Here was a man whose painstaking investigations, while he was still only in his twenties, led him to devise a means to control the devastating epidemic of childbed fever then sweeping Europe. Semmelweis saved the lives of countless women and their newborn children. He showed how a statistical approach to the problems of medicine could demolish popular but mystical theories of disease. His work prepared the way for Pasteur’s elucidation of germ theory. He turned obstetrics into a respectable science. And he revealed how professional eminence and authority could breed crass stupidity and bitter jealousy.
Yet this Hungarian émigré died in Vienna broken and alone, abandoned by his family and his colleagues in a Viennese lunatic asylum. It took forty years for him to be commemorated in Pest, his home city. The controversy circling his life continued into the 1960s, when his remains were exhumed, reexamined, and finally returned to his homeland. Even today, Semmelweis scholars are partisan. Was Semmelweis the author of his own destruction, the Fool of Pest, as he was called? Or was he the victim of a deliberate character assassination by a racist, anti-Semitic, anti-scientific, decadent, and murderous medical establishment reigning in nineteenth-century Austria?
Semmelweis was the fourth son of a successful Jewish grocer. His schooling, in both Hungarian and German, left him with a hatred of writing, which was to cost him dearly in later years. He began studying law but quickly switched to medicine, completing his degree in 1844 and becoming accredited in midwifery, or the delivery of newborn babies, the same year. At that time, Vienna’s Allgemeines Krankenhaus was the world’s largest and most famous hospital. It housed two obstetric clinics, the first for teaching medical students, the second for training midwives. By 1846, Semmelweis had been appointed assistant to the director of the First Obstetrical Clinic.
Childbed (or puerperal) fever is an acute illness that affects women during labor. It can be aggressively infectious. During a twenty-month epidemic beginning in 1821, for example, childbed fever killed one in six women admit-ted to Viennese hospitals in labor. No one knew the cause. A commonly believed theory blamed noxious airs; as a result there was much drilling of holes through hospital walls and doors in the desperate attempt to improve ventilation. Even in 1864 an expensive ventilation system was being installed in the Viennese maternity clinic. Air ducts were piped through ceilings; iron gratings were laid across corridors. All to no avail.
Semmelweis was quick to notice that the women’s mortality rate in the clinic for medical students was exactly three times that in the clinic for midwives. Between 1841 and 1846, he calculated that 1,989 women died in the company of medical students, out of 20,042 admissions—9.9 percent. The comparable figures for midwives were 691 deaths out of 17,791 hospital confinements—3.3 percent. Women entering the Allgemeines Krankenhaus were …