infection and lethal sepsis. Death was an excruciating certainty and an
almost welcome respite from the ravages of fever.
Semmelweis began investigating the oddly lethal effect of physician
care, and as a young trainee, became responsible for the welfare of the
women in the First Division. He “sought knowledge in the library, the
autopsy room, and at the bedside, and few of his waking hours were spent
elsewhere.”^2 In his reading, he realized his hospital was not unique: there
were publications in the preceding decades that detailed similarly poor
outcomes among obstetric physician deliveries. In London, between 1831
and 1843, the mortality rate when delivered at home was ten for every ten
thousand mothers, versus London’s General Lying-In Hospital where six
hundred women per ten thousand died of puerperal fever—a sixtyfold
increase.^3 Similar articles from Paris, Dresden, Australia, and America
showed the same trend.
Ignác Semmelweis, twenty-nine years old, considered every variable.
He contemplated the different techniques of midwives versus physicians,
the surroundings, the conditions of the buildings, the exposure of the
women to medical students, the way drugs were administered, and the
protocol of postpartum care. Semmelweis even altered some of the
physicians’ practices to match those of the midwives, including altering
the ventilation, but with no change. Doctors were still more dangerous to
pregnant women than midwives. Semmelweis was “like a drowning man,
who grasps at a straw;” nothing was adding up.^4 If it was not the air, nor
the bed linens, and not the delivery technique, what could possibly explain
the scandalous difference?
As the awful death hastened by puerperal fever was becoming almost
routine for Semmelweis, he continued his daily practice of dissecting
cadavers in the deadhouse of the Imperial and Royal General Hospital,
thanks to the “kindness of Professor Rokitansky, of whose friendship I
could boast ...”^5 Engulfed in disease, death, fever, and confusion,
Semmelweis decided to take a break, and departed for Venice for a
vacation, hoping to clear his mind and somehow untangle the clues behind
the problem that tortured him.
When Semmelweis returned to Vienna, a catastrophic finding awaited
him: his close friend, Jakob Kolletschka, a Rokitansky disciple and
forensic pathologist, was dead. Kolletschka had been performing an
autopsy days before when his finger was accidentally sliced by a student’s