Thursday, May 17, 2012

Book Review or, Why I'm Glad I Live Now

There's this really horrible infection called puerperal fever (also called childbed fever) that once plagued maternity wards all over Europe.  Women would give birth, then suddenly sicken and die and often so would their newborns.  When dissected, they had pockets of infection in their body, usually in the uterus but often in other places as well.

It turns out that these women would be infected by doctors and their students as a result of contact with another infected patient. Even worse, these doctors would go dissect cadavers in the morning and come to deliver babies in the afternoon, never taking the time to disinfect their hands.  We recoil at this now, but remember that before Louis Pasteur and microscopes, there was sense of microbes or bacteria as causing disease.  If your hands looked clean, why bother washing them?

Meanwhile, women giving birth in hospitals all over Europe were dying in mass numbers, and seemingly nothing could be done to stop it.

The discovery of how to prevent the transmission of childbed fever is explored in Sherwin B. Nuland's The Doctors' Plague (2003).  A fascinating read, I picked it up after hearing some writing instructors discussing it as a text for use in a science writing class. (Also, I have a not-so-secret love of science and nonfiction--my next read may be The Ghost Map by Steven Johnson).  Nuland interweaves the story of medical advances and the sad tale of Ignac Semmelweis, a Hungarian physician who, while working in Vienna, discovered how to stop epidemics of puerperal fever: have all nurses, doctors, and students wash their hands in a chloride solution (scrubbing under the nails to get rid of cadaver bits) before entering the ward.  (Clean sheets and tools were also essential).

Poor Semmelweis befriended no one with his tactics, unfortunately, and although his theory of the fever's transmission has some optimistic support among the younger physicians who were his friends and colleagues, it wasn't until Pasteur discovered microbes and Joseph Lister figured out what led to gangrene that his theory received widespread acceptance.

Nuland's book digs into how the older vanguard can hold back scientific (and medical) progress, how new discoveries are made, and the need for scientists to publish their ideas in an accessible and clear way.  Semmelweis published his theory at the very end of his life, but it was so convoluted, long, repetitive, and full of diatribes against the doctors who opposed him that it was virtually unreadable.  Had Semmelweis written earlier with the help of better speakers and had he been able to befriend those in the profession instead of alienate them, his theory might have been better received, and (eventually) accepted.

Nuland's exploration on the communication aspect is particularly fascinating to me, as a science writing teacher and someone interested in the rhetoric of science.  The book was a fast, easy read, and although it might scare off some of the more squeamish readers, it was interesting and informative.  (And it made me grateful that I wasn't a woman giving birth in the 1800s in a hospital where anyone in the teaching ward could just come and poke me with their dirty fingers.)  I recommend it if you're looking for an interesting read and you love science-based nonfiction.

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