Author: Theodore G. Obenchain
The author of this biography portrays it as ‘a tragically stirring narrative of a man with flagrant in-born flaws, working against impossible odds, who devoted his life to the solution of a great scourge that had been decimating the feminine half of the populace for more than a century’. Set at the famous Vienna General Hospital where ‘gravid young women typically spent the terminal two months of their pregnancy’, the biography recounts how one physician solved the riddle of the disease that was mysteriously killing them after birth. And at the heart of the tragic biography is how its subject, Ignaz Semmelweis, became a ‘Cassandra‘ whose ‘repeated warnings to his contemporaries concerning the contagiousness of puerperal fever‘ were ignored ‘by an audience unable or unwilling to believe his warnings’. The portrait of Semmelweis that emerges is of a man who was driven by ‘some unique, indefinable aspect of his persona’ to dedicate his life ‘to the conquest of this dreadful killer of young mothers’. Whilst the biography acknowledged that others before Semmelweis had documented the communicable nature of puerperal fever, the author nevertheless asserts that it was only Semmelweis ‘who ably gathered all disparate parts of the puzzle into one unifying scheme‘ (pages 2, 4, 19, 23 and 98).
The graphic portrait of puerperal fever that the book painted was of a very gruesome affliction which, during the time of Semmelweis, ‘accounted for approximately half of all maternal deaths‘, and ‘ranked second only to tuberculosis as a cause of death in women’. The author demonstrated the almost uniformly inexorable course of the disease with the illustrative case of Renate, a patient of Semmelweis who developed a fever, a rapid pulse, nausea, malaise, and abdominal pain shortly after a spontaneous delivery, and who rapidly progressed to delirium, confusion, and uncontrollable rigors which the author said ‘signalled the onset of fulminating disease‘. With the onset of seizures, the author added, the patient began a ‘calamitous descent over the medical precipice‘ where ‘the physician was rendered feckless…a mere observer with nothing to offer’. Arguing that the suffering and deaths from puerperal fever of his patients ‘began to weigh on him psychologically’, the book described how Semmelweis became ‘haunted by their screams piercing the night air’, the outcome being that he became ‘dispirited‘, developed a deepening ‘melancholy‘, and experienced recurrent bouts of depression (pages 7-12, 20, 23 and 86-87).
In the book’s detailed biographical account of Semmelweis, the author chronicled key landmarks of his early life, from his birth into comfortable family circumstances, to his schooling in which he ‘consistently excelled academically’. The book also covered his medical training, particularly describing how his scientific thinking was moulded by Josef Skoda – the progressive physician who the author said helped Semmelweis to refine ‘his senses of induction and deduction‘, and who taught him ‘to think like a scientist’. Crucially, the author pointed out that Skoda and other physicians such as pathologist Karl Rockitansky and dermatologist Ferdinand von Hebra, ‘created the foundations of scientific bedside medicine’ and ‘provided a great base of stability for Vienna’s New School of medical thought’, of which he said Semmelweis would ‘become the quintessential product and transcend it’. The author contrasted this new outlook with that of the Old School as represented by obstetrician Johann Klein and ophthalmologist Anton Rosas – physicians who he said ‘placed their faith in hierarchical social schemes‘. It is understandable therefore when the book credited Skoda and von Hebra for recognising the logic in the concept advanced by Semmelweis, and supported his efforts, albeit unsuccessfully, to establish his theory (pages 24, 27-28, 47-56, 98-110).
The most striking feature of the biography is undoubtedly its documentation of the single-mindedness with which Semmelweis pursued ‘his primary mission‘ of unravelling ‘the enigma of puerperal fever’. In this narrative, the author described how, in his first five years at Vienna General Hospital, he studied patient case records, researched the prevailing theories, and carried out countless autopsies. The author also recounted how Semmelweis, having explored all the possible variables, began to ‘question the wisdom’ of medical students ‘performing deliveries immediately after having performed cadaveric dissections‘. To test his idea, the author said Semmelweis allocated medical students and student midwives to different obstetric teams, and discovered that the maternal mortality rate was much higher in the medical students’ group. The book noted that on the strength of his findings, Semmelweis instituted an effective disinfection protocol in which everyone entering the ward cleaned their hands with chloride solution (pages 61-63 and 67-70).
The tragedy of Semmelweis was the resistance his ideas came up against despite the success of his intervention. For example, his superiors remained ‘unmoved‘ by his experiment, the author explaining that this was because the concept ‘was just too revolutionary to be acceptable’ to them. And at the heart of the resistance to his hypothesis was the dominance of the Hippocratic humoralist theory of disease which had been transmitted down the generations by such medical ‘elders’ as Thomas Sydenham, Herman Boerhaave, and Gerard von Swieten. Indeed the author asserted that ‘the Sydenham brand of humoralism‘, which associated epidemics with ‘meteorological phenomena‘, had become ‘densely interwoven into the fabric of medical theory throughout the Western world’, and that ‘generations of young physicians-to-be were thus indoctrinated in the same medieval theories that had now become hopelessly anachronistic‘. The author further explained that the medical establishment aggressively repressed any alternative hypotheses to the humoralist theory thereby making it ‘virtually impossible for any new, competing theories to arise, let alone fluorish, no matter how well reasoned or compelling they might be’. It is instructive that insightful physicians who recognised the transmissible nature of puerperal sepsis before Semmelweis, such as Scottish surgeon obstetrician James Simpson, and American physician Oliver Wendell Holmes, faced similar hostility (pages 3, 28-37, 40-42, 77-82, 90-96 and 152-153).
The rejection of his theory by most of his contemporaries had devastating consequences for Semmelweis, the author narrating how, for example, his job was ‘terminated‘, and how he became ‘fully marginalized, powerless, essentially emasculated‘. Furthermore, the author said, his attempts to pursue his work back in his ‘native Budapest‘ failed because it turned out to be ‘less than a nurturing environment for his research’. The repercussions of these setbacks on Semmelweis’s mental health formed a major theme of the book in which the author described the ‘metamorphosis‘ of his personality into a ‘more serious demeanor‘, and how ‘his darker qualities‘ emerged. In characterising these further, the book said Semmelweis became an ‘over-exacting, impatient, and demanding overseer’ who was ‘chronically irritable‘ and ‘overtly eccentric‘, and that his colleagues at the medical faculty found him ‘to be hypercritical and intolerably punctilious‘. The book described how Semmelweis eventually descended into manic-depressive illness, graphically capturing how his mental illness manifested with delusions of grandeur, hypersexuality, and the utterance of obscenities. The narrative also documented how this led to a ‘precipitous decline‘ to insanity which rendered him ‘incompetent‘, culminating in institutionalisation and eventual death (pages 111-127, 138-146, 164, 179-189 and 197-205).
This is a tragic biography of a humane doctor whose concern for his patients dying of puerperal fever set him on a passionate mission to solve the riddle of the disease. With its lucid writing and focused narrative, the book provides a most enlightening and reflective perspective of one of history’s most insightful, even if tortured, physicians. With a forensic approach and detailed research, the biography not only vividly narrates the life and work of its subject, it also graphically captures the medical, social and cultural contexts which enabled his breakthrough as well as its rejection by the medical establishment. The author’s retrospective diagnosis of manic depressive illness, a label that he acknowledged did not exist in Semmelweis’s time, is open to debate, but it appears well-reasoned and plausible.
This biography conveys key lessons for healthcare, both in its advocacy of the empathy that drives humane care, and in its emphasis that well-thought out observation and experimentation form the basis for effective research. The book is also a cautionary commentary on the medical establishment’s tendency to stick to orthodox views, as misguided as they may be, and to reject any ideas that threaten the status quo. The book’s biographical sketches of the physicians who influenced Semmelweis are also inspiring in their promotion of the highest ideals of medical practice. The book’s lessons are all relevant to contemporary medical practice, and I recommend it to all doctors.
Publisher, Place, Year: University of Alabama Press, Alabama, 2016
Number of chapters: 16
Number of pages: 249
Star rating: 5