- The Doctors' Plague: Germs, Childbed Fever, and the Strange Story of Ignác Semmelweis
Sherwin B. Nuland deserves much credit for drawing attention to various topics in the practice and history of medicine. This latest book is certainly not his least significant contribution of this kind: it is a partly fictionalized account of childbed fever, a horrible disease that devastated eighteenth- and nineteenth-century maternity clinics. Against a background of nineteenth-century medical beliefs (especially those of the British), Nuland recounts Semmelweis's adoption of chlorine hand washings, his rejection by the medical establishment, and his tragic death in a Viennese insane asylum. Semmelweis's story is so moving and so filled with tragic irony that it cannot be other than engaging; surely it is among the most interesting episodes in the entire history of science.
The Doctors' Plague includes eight chapters, plus an afterword that recounts, among other things, Pasteur's depiction of the streptococci that, he concluded, caused childbed fever. There is also a five-page bibliographic essay. However, there is no table of contents, no index, no list of sources, and no footnotes or other means by which to identify the exact sources of Nuland's numerous quotations.
Despite nearly a century of scholarly interest and study, many aspects of Semmelweis's life and work remain controversial: What was his personal relation to his teachers in Vienna? How did his conclusions relate to Anglo-American opinions about childbed fever? Did his increasingly strident criticisms of contemporary obstetricians reflect mental instability and, perhaps, some organic pathology? How exactly did he die? Nuland reviews and answers all these questions, and whether or not one accepts his answers, they must be taken seriously. However, in this context I can address only what I see as the two chief defects in his account: he misconstrues (1) the conceptual relation between Semmelweis and his predecessors (including his teachers in Vienna), and (2) Semmelweis's role in the sea change that swept medicine during the middle decades of the century.
First, according to Nuland, Semmelweis's innovative claim that every case of childbed fever shares a single cause (namely, the resorption of decaying organic matter) somehow emerged by induction from research in pathological anatomy. However, Semmelweis himself wrote that his intense study of victims' remains was fruitless and left the disease a complete mystery. Moreover, all of his predecessors who were trained in pathology, including his teachers in Vienna, continued to believe in a plurality of unrelated causes. In his own later writings on childbed fever, Josef Skoda—who, according to Nuland, was "more active in promoting the [Semmelweis] Lehre than anyone else" (pp. 130-31)—continued to ascribe the disease to a plurality of causes. How exactly could the idea of a single necessary cause be induced from research in pathology? It couldn't, and it wasn't—at least not in the sense Nuland seems to have in mind.1 Of course, in one horribly ironic [End Page 898] sense, Semmelweis's discovery did stem from studying pathological anatomy: he eventually saw that medical personnel who cut up cadavers infected patients with decaying organic matter. In this sense (but in no other) the study of pathological anatomy proved appallingly enlightening.
Second, what was the relation between Semmelweis and his successors? Here the choice for the historian is simple: (a) perpetuate the myth that, after his death, Semmelweis was ignored and forgotten (Nuland: "his work was neglected and all but forgotten" [pp. 182-83]), or (b) take the trouble to look at the literature. Which alternative did Nuland choose? Shortly after claiming that, following his death in 1865, Semmelweis's name was "barely remembered" (p. 179), Nuland mentions the pivotal and widely cited research by the French scientists Léon Coze and Victor-Timothée Feltz—apparently overlooking the fact that Coze and Feltz's monumental book (1872) itself includes a favorable discussion of Semmelweis. Ten years...