Perspectives in Biology and Medicine

The germ theory of disease—the idea that microorganisms invisible to the naked eye can cause human ailments—revolutionized medical education and patient care. Pasteur, Lister, and Koch are often heralded as the architects of this theory. From the demonstration of microbes in the air by Pasteur to the introduction of aseptic techniques in surgery by Lister to identification of specific microbes by Koch, these great scientists revolutionized medicine and saved countless lives.

Not as widely appreciated, however, are the people who came before these men, people who carefully observed, diligently recorded, and repeatedly proposed this idea, only to be ridiculed and ostracized by their colleagues. One such person was Ignac Semmelweis, the physician whose life and crusade is expertly chronicled by Sherwin Nuland in The Doctor's Plague. The book begins with the story of a young woman, who comes to represent the countless women who lost their lives to childbed fever, the disease that consumed Semmelweis' undivided dedication and attention. The first chapter, set in the First Division of the Allgemeine Krankenhaus in Vienna, captures the agony and fear of this illness, as well as the pride and denial rampant in medicine during that period. As a nurse caring for "the girl" said, "But this is a great and famous hospital, the finest in all Europe. So you mustn't concern yourself with such things as death." It was 1847.

Nuland details Semmelweis's development from his bourgeois upbringing in Budapest to his attendance at the prestigious Vienna School of Medicine to his eventual training in obstetrics at the Allgemeine Krankenhaus. Semmelweis is described as an energetic and eager young man whose enthusiasm quickly turned to frustration and terror as the young mothers he took care of fell suddenly to the grasp of death only days after the birth of their children. The disease, known as childbed fever, became an epidemic throughout hospitals in Europe and America. Semmelweis was not the only physician who was troubled by this enigmatic disease. "Well-respected" and politically powerful academic obstetricians put forth a myriad of theories to explain this disease, from the suppression of post-delivery fluid to the vascular absorption of stagnant fecal material during pregnancy to the movement of maternal milk to the pelvic cavity. Numerous attempts were made to lower the mortality rates from childbed fever; not surprisingly, however, many of the attempts failed. Deaths—and the number of motherless infants—continued to mount.

Nuland cites two reasons behind the inability of the obstetricians to solve this mystery: they were quickly discouraged in the face of failed attempts at improvements and, even more, they lacked introspection. In these respects, Semmelweis distinguished himself from his colleagues. He became personally responsible for [End Page 616] the lives of these women and dedicated himself to reading journals, conducting autopsies, and correlating disease occurrence with activities within the First Division. Eventually, he concluded that it was the obstetricians and nurses themselves who were transferring disease particles from patient to patient and from cadaver to patient. Although this theory is easily accepted today, it was understandably considered conjectural at the time, since the existence of bacteria in human tissues was unknown.

Semmelweis instituted extensive hand-washing efforts throughout his facilities and, as he expected, mortality rates from childbed fever noticeably decreased. This progress was not hailed by the medical community. To most practitioners at the time, it was absurd to consider disease particles invisible to the eye as etiologies of illnesses and even more outrageous for someone to put forth the idea that obstetricians were killing their own patients. Instead, they disregarded the concept and "clung to [their old theories] as to an amulet." One cannot place the blame solely on his opponents, however. Nuland lists Semmelweis's shortcomings, shortcomings that sadly prevented the embrace of his idea. He failed to conduct well-designed experiments, declined to use microscopy to validate his ideas...