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The Doctors' Plague: Germs, Childbed Fever, and the Strange Story of Ignac Semmelweis (Great Discoveries) Paperback – November 17, 2004


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Product Details

  • Series: Great Discoveries
  • Paperback: 208 pages
  • Publisher: W. W. Norton & Company; Reprint edition (November 17, 2004)
  • Language: English
  • ISBN-10: 039332625X
  • ISBN-13: 978-0393326253
  • Product Dimensions: 8 x 5.4 x 0.5 inches
  • Shipping Weight: 5.6 ounces (View shipping rates and policies)
  • Average Customer Review: 4.6 out of 5 stars  See all reviews (29 customer reviews)
  • Amazon Best Sellers Rank: #202,925 in Books (See Top 100 in Books)

Editorial Reviews

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. --This text refers to an out of print or unavailable edition of this title.

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.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to an out of print or unavailable edition of this title.

More About the Author

Sherwin B. Nuland is Clinical Professor of Surgery at Yale University School of Medicine and a Fellow at Yale's Institute for Social and Policy Studies. He is the author of over ten books, including the National Book Award-winning, HOW WE DIE: Reflections on Life's Final Chapter, an inquiry into the causes and modes of death that spent 34 weeks on the New York Times best-seller list. In addition he is a contributor to leading publications including the New Yorker, the New Republic, and the New York Review of Books.

Customer Reviews

4.6 out of 5 stars
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The figures tell the tragic story.
E. Bukowsky
It's an interesting, infuriating and investigative story - one that is well written and well worth the reader's time.
Graceann Macleod
This is common in other specialties as well, and medical error continues unabated.
Jeff Sutherland

Most Helpful Customer Reviews

14 of 15 people found the following review helpful By Kelly L. Norman VINE VOICE on July 30, 2006
Format: Paperback
In a short, readable volume, Sherwin B. Nuland, M.D. has succeeded in telling the story of a brilliant man whose findings changed medical science completely, and might have helped those changes take place much earlier but for his inability to get along with his peers and elders.

True, the blame for childbed fever continuing at the Allgemeine Krankenhaus in Vienna where he worked and studied should not fall solely on Ignác Semmelweis' shoulders. Arrogance on the part of others, as well as politics and simple entrenched institutionalism put up barrier after barrier, ensuring that medical students would for years after continue delivering babies after handling cadavers (the practice which was the primary problem at that hospital, and probably countless others worldwide). Dr. Nuland explains this in a style friendly to lay readers but which pulls together interesting facts from history, the culture in which Semmelweis worked (including its attitude toward women and children), as well as the world of medicine. He also writes sensitively about a man who had the knowledge to save others nearly a half century before it is put to use, whose personal quirks and lack of respect for others played a part in the disregard of that knowledge.

Fascinating, enlightening, and highly recommended.
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12 of 15 people found the following review helpful By E. Bukowsky HALL OF FAMETOP 100 REVIEWERVINE VOICE on November 17, 2003
Format: Hardcover
Many years ago, I read a story about Ignac Semmelweis that made him out to be a demigod. According to the legend, Semmelweis was a martyr to the cause of saving women from unnecessary deaths due to puerperal or childbed fever. In the early and mid-nineteenth century, childbed fever was ubiquitous and very often fatal in Europe and America.
In his fascinating new book, "The Doctors' Plague," Sherwin P. Nuland traces the history of this tragic disease and he sheds some light on how and why the medical profession was helpless to prevent it for so many years.
Nuland goes back to the great physician Hippocrates, who, over two thousand years ago, described childbed fever with great accuracy. For all of his powers of observation, Hippocrates knew nothing about the causes of the disease or how to prevent it. For many years, physicians promulgated wild theories, blaming the new mother's milk, bad air, suppression of discharges, and other equally irrelevant factors for the large number of infections that killed new mothers in hospitals. The figures tell the tragic story. At the London General Lying-In Hospital, between 1833 and 1842, 587 women per thousand died of childbed fever. The mortality statistics were similar in hospitals throughout Europe and the United States.
Ignac Semmelweis was born in Hungary. As a practicing doctor of obstetrics, he was appalled by the large number of women dying in childbirth. Because he was a keenly observant doctor who kept careful records and because he had a sharp, logical mind, Semmelweis eventually concluded that childbed fever was somehow passed to women from their doctors, nurses, and dirty bed linens.
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9 of 11 people found the following review helpful By Peggy Vincent on June 13, 2004
Format: Hardcover
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.
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7 of 9 people found the following review helpful By Peggy Vincent on November 24, 2003
Format: Hardcover
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 and the acceptance of the Germ Theory). Don't miss it.
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