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Childbed Fever: A Scientific Biography of Ignaz Semmelweiss
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K. Codell Carter and Barbara R. Carter. 125 pages. Westport, Connecticut: Greenwood Press; 1994. $45.00.
Every student of medical history knows the story of Ignaz Semmelweiss. As a 28-year-old assistant physician in the maternity unit of the Vienna General Hospital during the 1840s, Semmelweiss was given the responsibility of obstetrically examining ward patients, supervising difficult deliveries, and organizing teaching rounds both in the morgue and in the first section of the clinical ward, the section in which most deliveries were done by medical students. Semmelweiss immediately realized that the rate of puerperal (childbed) fever was much higher in his first section than in the second section of the maternity ward, where most of the deliveries were done by nurse-midwives. He also observed that the clinical symptoms of puerperal fever were identical to those of a hospital pathologist who died after pricking his finger with a dirty autopsy instrument.
Semmelweiss thus concluded that the disease was caused by "cadaverous particles" and other decaying organic matter transmitted to the patients in the first section by medical students who arrived on the maternity wards fresh from their dissection work in the morgue. He initiated the procedure of washing with a solution containing chlorine between all clinical activities, and the rate of puerperal fever appeared to decrease dramatically.
Unfortunately, Semmelweiss's call for medical practice reforms became ensnared in the political upheavals that wracked Vienna and the hospital faculty in the late 1840s, and his work was rejected by many senior clinicians. Semmelweiss became increasingly more isolated in medical circles and answered his critics with a series of strident denunciations of the European medical establishment. With the permission of his family, he was involuntarily committed to an insane asylum and died (probably of untended wounds inflicted during a struggle) on 13 August 1865.
Detailed accounts of this story have already been published, and one must ask what fresh insight this work brings to the field. Many of the previous accounts seek either to define Semmelweiss's work in the context of the rise of the germ theory of disease or to discuss the philosophical implications of Semmelweiss's investigations with respect to a shifting paradigm of medical authority versus empiric analysis in 19th century medical practice. The current account appears to have a different purpose: to convey a sense of the tragedy and drama of the Semmelweiss story to an audience with little previous background in either medicine or history. The book succeeds in achieving this objective, and one can imagine this account finding a useful place in the syllabus of an undergraduate course on the history of medicine. However, for those who know the story, there are few new details. Although the closing chapters center on the development of the practice of antiseptic techniques for puerperal infection, the reader is left without a real appreciation for the contemporaneous events in intellectual history that drove the dual evolution of modern medical theory and medical practice. The writing is fluid and clear, but the text is marred by several glaring editorial errors (for example, the preface gives Semmelweiss's age at the time of his death as 42, whereas the text lists it as 47). This slim book will probably satisfy the neophyte in medical history but leave the serious student feeling unfulfilled.
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