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their hands with dilute chlorine and the incidence of puerperal fever
dropped dramatically. But many of his peers resisted his conclusions,
in part because he was very slow to publish his findings, and in part
because his humble origins in Hungary and his own deep sense of so-
cial inferiority had impeded his access to the medical establishment in
Vienna he had been denied positions in pathology and medicine,
88 People and Pestilence
and only then had turned to obstetrics, which was viewed as a lowly
pursuit for physicians.17
Undeniably, Semmelweis was a difficult man. Here is what he wrote
in an open letter to one of his detractors:
Herr Professor, there remains nothing else but to adopt my doctrine,
if you still want to salvage something of your reputation, whatever
of it is still left to salvage. If you continue to adhere to [false] doc-
trine, your reputation will disappear from the face of the earth . . .
Herr Professor has proven that in spite of a new lying-in hospital
furnished with the best equipment, a great deal of homicide can be
committed, if only one possesses the necessary talents.18
It is easy to be sympathetic with Semmelweis s vehemence. He was
opposed with bigotry, obstinacy, foolishness, and cupidity. And he was
a man on a mission:
My Doctrine is not established in order that the book expounding it
may molder in the dust of a library: my doctrine has a mission, and
that is to bring blessings into practical social life. My Doctrine is
produced in order that it may be disseminated by teachers of mid-
wifery until all who practice medicine, down to the last village doc-
tor and the last village midwife, may act according to its principles;
my Doctrine is produced in order to banish terror from the lying-in
hospitals, to preserve the wife to the husband, the mother to the
child.19
Rejected by the academic elite of Vienna, Semmelweis retreated to
the intellectual backwater of Pest (later amalgamated into Budapest),
Hungary, where he once again banished puerperal fever from the ma-
ternity wards by his insistence on hygiene. Near the end of his career,
Semmelweis finally brought his arguments together in a ponderous
book that first reviewed all of the available evidence for his views on
puerperal fever and then railed slanderously against his detractors.20 It
did nothing to redeem his reputation. Over the last years of his life,
Semmelweis drifted into psychosis, possibly suffering from Alzhei-
mer s disease. He was confined to an asylum and apparently beaten to
death by attendants in efforts to constrain him.21
Semmelweis s distressed life and sad end stand in stark contrast to
People and Pestilence 89
his epochal achievements. He was a pioneer in the collection and rig-
orous analysis of clinical data. It can easily be said that he was among
the founders of clinical research as we know it today. The principles
that he enunciated and authenticated saved innumerable lives and
eventually transformed obstetrical practice. Toward the end of his ca-
reer, he applied the same principles to gynecological surgery, thus tak-
ing the first step toward the sterile practices that are now routine in all
operating rooms. In the words of one biographer, he was  a martyr to
the world s stupidity, . . . oneof thegreat tragic figures of all history. 22
America s own Oliver Wendell Holmes also figured out the origin of
puerperal fever, some years in advance of Semmelweis. Holmes had no
compunctions about publication or forceful argument:  The disease
known as Puerperal Fever is so far contagious as to be frequently car-
ried from patient to patient by physicians and nurses. 23 Acting on this
belief, Holmes was able to greatly reduce the incidence of puerperal fe-
ver in the maternity wards of Boston. But like Semmelweis, Holmes
saw his doctrine resisted and ignored. At the time, neither man was
aware of the other s work, although Holmes later made guarded refer-
ence to secondhand reports of Semmelweis s claims.
One day after the death of Semmelweis, on August 12, 1865, the
Glasgow surgeon Joseph Lister applied the first antiseptic dressing in
history, to a compound fracture of the tibia of an eleven-year-old boy
who had been run over by a cart. Lister used carbolic acid for anti-
sepsis, and the results exhilarated all observers. The wound healed
without so much as a hint of the otherwise inevitable infection.24
In due course, Lister applied antisepsis to surgery of all sorts. His
successes soon made him a legend. Before Lister, postoperative wards
were cesspools of gangrenous wounds that emitted a nauseating
stench that clung to the surgeon s clothes at the dinner table and
caused mortality rates as high as 75 percent. After Lister, surgeons
knew the enemy for the first time and could take measures to defeat
it, particularly aseptic surgical procedures aimed at preventing infec-
tion procedures clearly preferable to the antisepsis that Lister had
devised to eliminate infection once it had occurred. Ignaz Semmelweis
had been vindicated and the modern era of microbiology had begun.
Lister triumphed where Semmelweis had failed because of two fac-
tors. The first was his personality: he was a saintly man who left his
90 People and Pestilence
Quaker faith in order to marry the woman he loved, but retained the
missionary zeal required to prevail over the initial doubts of his peers.
The second factor was Lister s scholarly nature: he was a careful stu-
dent of the scientific literature who seized early the emerging evidence
that contagious disease is caused by living microorganisms and wasted
no time in alerting the world to his results.
Microbes Uncovered
Microorganisms were discovered late in the seventeenth century by
Antoni van Leeuwenhoek, a Dutch draper who became fascinated
with the recently invented microscope, mastered both its fabrication
and use, and used it to examine virtually anything at hand from
slime to semen. Leeuwenhoek s written records and drawings suggest
that he succeeded in identifying all of the major forms of microbes ex-
cept viruses, which cannot be seen with an ordinary microscope. He
even recorded the first description of what we now call Giardia, after
examining his own diarrhea. Leeuwenhoek transmitted his drawings
to the Royal Society of London for dissemination and preservation,
thereby creating one of the most elegant visual legacies in biomedical
science. [ Pobierz całość w formacie PDF ]