Superfreakonomics_ global cooling, patri - Steven D. Levitt [61]
So perhaps one of the wild guesses listed above was correct: did the very presence of men in such a delicate feminine enterprise somehow kill the mothers?
Semmelweis concluded that this too was improbable. After examining the death rate for newborns in the two wards, he again found that the doctors’ ward was far more lethal than the midwives’: 7.6 percent versus 3.7 percent. Nor was there any difference in the death rate of male babies versus females. As Semmelweis noted, it was unlikely that newborns would “be offended by having been delivered in the presence of men.” So it was unreasonable to suspect that male presence was responsible for the mothers’ deaths.
There was also a theory that patients admitted to the doctors’ ward, having heard of its high death rate, were “so frightened that they contract the disease.” Semmelweis didn’t buy this explanation either: “We can assume that many soldiers engaged in murderous battle must also fear death. However, these soldiers do not contract childbed fever.”
No, some other factor unique to the doctors’ ward had to figure in the fever.
Semmelweis had by now established a few facts:
Even the poorest women who delivered their babies on the street and then came to the hospital did not get the fever.Women who were dilated for more than twenty-four hours “almost invariably became ill.”Doctors did not contract the disease from the women or newborns, so it was almost certainly not contagious.
Still, he remained puzzled. “Everything was in question; everything seemed inexplicable; everything was doubtful,” he wrote. “Only the large number of deaths was an unquestionable reality.”
The answer finally came to him in the wake of a tragedy. An older professor whom Semmelweis admired died quite suddenly after a mishap. He had been leading a student through an autopsy when the student’s knife slipped and cut the professor’s finger. The maladies he suffered before dying—bilateral pleurisy, pericarditis, peritonitis, and meningitis—were, Semmelweis observed, “identical to that from which so many hundred maternity patients had also died.”
The professor’s case held little mystery. He died from “cadaverous particles that were introduced into his vascular system,” Semmelweis noted. Were the dying women also getting such particles in their bloodstream?
Of course!
In recent years, Vienna General and other first-rate teaching hospitals had become increasingly devoted to understanding anatomy. The ultimate teaching tool was the autopsy. What better way for a medical student to limn the contours of illness than to hold in his hands the failed organs, to sift for clues in the blood and urine and bile? At Vienna General, every single deceased patient—including the women who died of puerperal fever—was taken directly to the autopsy room.
But doctors and students often went to the maternity ward straight from the autopsy table with, at best, a cursory cleansing of their hands. Although it would be another decade or two before the medical community accepted germ theory—which established that many diseases are caused by living microorganisms and not animal spirits or stale air or too-tight corsets—Semmelweis understood what was going on. It was the doctors who were responsible for puerperal fever, transferring “cadaverous particles” from the dead bodies to the women giving birth.
This explained why the death rate in the doctors’ ward was so much higher than in the midwives’ ward. It also explained why women in the doctors’ ward died more often than women who gave birth at home or even in the streets, and why women in a longer state of dilation were more susceptible to the fever: the longer a woman lay in that state, the more often her uterus was poked and prodded by a gaggle of doctors and medical students, their hands still dripping with the remnants of their latest autopsy.
“None of us knew,” as Semmelweis later lamented, “that we were causing the