Product Description

Sherwin B. Nuland tells the strange story of Ignac Semmelweis with an urgency and insight gained from his own studies and clinical experience. Ignac 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, they also threatened the medical establishment and so undid the passionate but self-destructive Semmelweis that he failed to overturn the status quo, leaving it to later medical giants - Pasteur, Lister and Koch - to establish conclusively the germ theory of disease.

Product Details

• Amazon Sales Rank: #417631 in Books
• Published on: 2004-10-29
• Released on: 2004-11-07
• Original language: English
• Binding: Paperback
• 192 pages

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 Booklist
Nuland's second excellent book this year (after the superb memoir, Lost in America [BKL N 15 02]) focuses on a physician who, like Nuland in the midst of his career, suffered from severe psychological disease. Unlike Nuland, Ignac Semmelweis (1818-65) probably couldn't have recovered and, in any event, died under odd circumstances days after admission to a mental hospital. Nuland's thoughts about Semmelweis' illness and death are in the final chapter, and waiting for them is eminently worthwhile because of the riveting account of childbed, or puerperal, fever that comes first. Incidence of the bacterial disease attained massive proportions with the rise of the modern hospital and of giving birth there rather than at home, and enormous numbers of newborns as well as mothers perished. As the book's title suggests, dirty doctors (and medical students) spread the disease, for antisepsis and asepsis were unappreciated--indeed, unknown--until, after Semmelweis' death, Pasteur and Lister verified the existence and dangers of germs. A few physicians had figured out the how of puerperal fever before Semmelweis, but his fanaticism for cleanliness in practice at the general hospital in Vienna, the medical capital of Europe, demonstrated huge reductions in the disease. He failed to publish adequately, however, and establishment physicians, wedded to general theories of disease, pooh-poohed his practices, preventing their acceptance elsewhere. In the midst of the controversy, Semmelweis ran home to Pest, Hungary, a medical backwater, and into obscurity. This is one of the greatest stories in medical history, and perhaps no one has told it better than Nuland does. Ray Olson
Copyright © American Library Association. All rights reserved

Review
"The Doctors' Plague succeeds: in telling the story of childbed fever, Nuland has managed to rediscover a critical moment in the history of medicine, the anxieties of which, although somewhat attenuated, persist today." The New York Times Book Review "The story of how doctors used to spread childbed fever from woman to woman in lying-in hospitals is chilling enough; the story of how they persisted in doing so in the face of overwhelming evidence of their guilt is blood-curdling; and the story of the flawed hero who tried to persuade them otherwise but was let down by his own character flaws is tragic. A great read." Matt Ridley, author of Genome and The Red Queen

Customer Reviews

The Cry and the Covenant redux
Childbed fever (puerperal sepsis) was the scourge of pregnant women in the middle of the 19th century. Germs hadn't been discovered yet, and the idea of washing their hands between doing an autopsy and delivering a baby was anathema to physicians, who strongly resented the implication that they were in any way 'dirty,' or that they themselves were the cause of the deaths of between 20-50% of women under their care. Ignaz Semmelweis, an unknown Hungarian obstetrician, concluded that a procedure as simple as hand washing between patients could save nearly all of the women's lives.
He was reviled, sank into despair and depression, and died of self-inflicted puerperal bacteria days after being admitted to a madhouse.
Neuland's superb book updates a much older book on the same subject, The Cry and the Covenant. It documents beautifully an almost forgotten piece of medical history, as Semmelweis's discoveries were later eclipsed by Pasteur and Lister (who had the simple advantage of living after the discovery of the microscope). Don't miss it.

Politics, Personality, and Childbed Fever
Sherwin B. Nuland looks at the strange story of Ignac Semmelweis, the man who discovered the simple means of preventing childbed fever which saved countless lives. The tragedy of his life was that he never went on to elaborate on a form of germ theory that was backed up experimentation or cogent writings (although he did eventually publish a rambling account of his theories that did more harm than good to his reputation). The author is best at setting the scene of women dying in lying-in hospitals in all of its graphic and horrific detail, and in demonstrating the ways in which Semmelweis's own intractable personality and the conservative politics of the hospital's at the time worked against him. The truly great achievment of this man is put into its proper context within its historical time period in a brilliantly succint manner. A nice addition to the Great Discoveries series.

Almost Getting To the Germ Theory
Wash your hands to keep the germs away. Even though we aren't really very good at following this rule, and have to be reminded (with questionable results) during flu season, it seems so very obvious. It is hard to imagine the time when people did not know this, when their mommies did not instill it into them so that it was something like an instinct. And yet, even the best medical professionals of the mid-nineteenth century had to be convinced of it, and until they were convinced, they literally killed their patients because they were not washing their hands. _The Doctors' Plague: Germs, Childbed Fever, and the Strange Story of Ignác Semmelweis_ (Norton) by Sherwin B. Nuland tells the story of how doctors learned to wash their hands. It was a surprisingly difficult lesson for them to learn.

The problem, for those who could see it was a problem, manifested itself most dramatically in maternity wards. The world had not learned about germs yet, but the doctors did not lack for explanations of what is known as puerperal ("childbearing") fever. Unseen spirits were blamed, as well as miasma, a mysterious condition of stale or unhealthful air. For us, it is obvious what was happening, once we know that doctors doing autopsies were going directly to the bedsides of mothers about to deliver, without the use of rubber gloves or handwashing. But only the young Hungarian obstetrician Ignác Semmelweis could see it initially. Semmelweis could make a clear case for a "cadaver factor" being the cause of the death of so many women. His solution was simple: hands were to be scrubbed with disinfectant between patients. It worked, and Semmelweis had the figures to show it.

Unfortunately, Semmelweis turns out to be a deeply flawed hero for this book. He was abrupt, sarcastic, and bullying when he tried to get the doctors to clean up regularly, and he alienated many from his ideas by his abusive personality. He was not only a difficult person to get along with, he inexplicably refused to document his findings in writing and he performed only the most primitive of experiments for verification. He ignored those colleagues who had supported him by fleeing to Hungary when he felt neglected. When he finally did publish, it was in a big, impenetrable book that contained the sort of invective for his foes that he displayed personally. He came astonishingly close to playing a key role in the definition of the germ theory of disease, but simply because of his personality, he had no such influence. He has been pictured before as the upright physician fighting the establishment, and this is somewhat true; but the better picture, given here, is that his own flaws meant that he would not win such a fight. Eventually, he became more obsessed and unreasonable, and his wife had to trick him into confinement at a mental hospital. He seems to have perished there by a beating from the attendants. Nuland's fascinating story shows how an "obvious" medical solution had to be discovered and promulgated more successfully by others, and leaves unasked the question of what current "obvious" solutions we may be neglecting as we climb the crooked ladder of medical progress.