One of the great truths of science is that in seeking the answer to one question, the greatest discoveries are often made. It is of such a quest that Sherwin B. Nuland seeks to enlighten his reader in his nonfiction work, The Doctors' Plague: Germs, Childbed Fever, and the Strange Story of Ignác Semmelweis. Nuland writes with passionate enthusiasm about the history of childbed fever and Ignác Semmelweis, the discoverer of its cause, a man all but lost in the annuls of history. In helping the reader to understand Semmelweis and the importance of his discovery, the author outlines the history of the illness that sparked his single-minded quest for answers and introduces many important medical and political figures of the time. Informing about the clinical aspects takes precedence, but along the way readers learn a fair amount about the medical culture of the primary setting of the book: Vienna, in the middle of the nineteenth century.
After a lovely narrative telling the tale of a young, pregnant woman dying of childbed fever after the hospital delivery of her child, a fairly comprehensive recitation of the history of childbed fever is given. Covered are the many people who attempted to dig their way to the root of the devastating illness whose eradication is the central theme of the book. This information is given in a couple of chapters—one about the earliest postulations and another setting the scene for the medical community which Semmelweis would soon join.
Finally, the author begins telling the story of Ignás Semmelweis, a young physician, who chose obstetrics after unsuccessfully attempting entrance to more respected fellowships, because he knew he would not face rejection again. It might be said that fate led Semmelweis, who originally aspired to the practice of law, to the Allgemeine Krankenhaus and thrust his agile, inquisitive mind towards solving a problem that had bedeviled midwives, physicians, and their patients for more than 2,200 years. It was Ignás Semmelweis who finally drew the first lasting connection between the importance of hand-washing in halting the spread of infection, including that which caused childbed fever, from patient to patient.
What makes Semmelweis’s story so engaging is not only the fact that he solved a medical mystery that had an import stretching beyond hospital delivery rooms. His story shows the importance of two practices long viewed as necessary in ensuring that discoveries of scientific import are acknowledged as credible: establishing laboratory experiments that can be replicated by others in the field and publishing written accounts of all findings.
Sherwin Nuland does an excellent job highlighting Semmelweis’s resistance to laboratory experiments, which the doctor deemed unnecessary; he felt the recorded drops in mortality rates of childbed fever in hospitals which instituted mandatory hand-washing spoke for themselves. Another area the author spends even more time discussing is the effect of Semmelweis’s failure to write about his findings. Semmelweis was very fortunate that he had friends who were well respected within the medical community and wrote on his behalf. Their enthusiasm for his discovery, however, hurt Semmelweis in the end, because they didn’t adequately cover all
aspects of his research and a critical detail was neglected. The other doctors claimed that Semmelweis had found that infection was spread when doctors went into the delivery room, without adequate hand sanitizing, after dissecting corpses of those who died of childbed fever. They neglected to mention that Semmelweis also discovered that infection transferred from other sources, such as an infected knee and cancerous pus from an infected breast. This omission caused doctors at hospitals that did not practice autopsies to discount Semmelweis’s theory; since they did not deal with cadavers, their cases of childbed fever could not be attributed to the only cause that Semmelweis apparently espoused.
While the author writes in a convincing and vivid fashion about the main themes in the book, the book does have a couple of definite weaknesses. Foremost of them is that the book is in desperate need of a more definitive timeline. For the vast majority of the book the reader is bounced literally from Before the Common Era into the mid-nineteenth century and back and forth to various times in between. This structure makes following the process of discovery very challenging. The second issue that makes the book more challenging than it likely needs to be is that in a couple of chapters right at the beginning of the book the reader is subjected to a very dry, arduous recitation of names, dates, and theories. The information is necessary to the story but would have gained a more attentive audience if woven in a more anecdotal fashion into the flow of the narrative.
Overall, I definitely feel that the book’s strengths outweigh its weaknesses. Nuland creates a convincing argument for Semmelweis’s place in history—in the beginning he is a bit too enamored of his protagonist, but he does come round to an honest assessment of his subject in the end, making his opinions seem well-reasoned and valid. A complete, if disorganized, history of childbed fever is presented in such a way that the book will appeal beyond the reader of medical chronicles. General history and politics, social issues, women’s studies, and even the psychological make-up of Semmelweis are all interwoven into the narrative, making for a story with broad appeal.
