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24 May 2011


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1. I really did enjoy this book. I found it interesting because I previously knew nothing about the subject matter and learned a lot along the way, it was written in a casual but informative way making it an easy read, and Nuland provided plenty of detail to keep you hooked but not too much to make it tiresome.

2. The thing I liked the best was how the story unfolded in a way that made truth seem stranger than fiction. It also made me realize that human nature hasn't changed much and history is still repeating itself as far as our quest for knowledge and our ability to screw things up because we can't see clearly because egos get in the way.

3. I think I did find Semmelweis a tragic character because he was his own worst enemy in a way. His genuis helped him solve the riddle, but his "difficult" nature got his and in other people's way which kept the riddle unsolved as far as everybody else was concerned.

4. The book really is all three: Histobiograscience. Or maybe Mediobiographistory. Sci-Bio-History?!

1. I found the book interesting. I had never heard of childbed fever or Semmelweis before picking it up (Alas my high school curriculum was apparently sorely lacking as well!).

2. Two things: (1) the fact that the women who came to the hospital “knew” that the ward tended to by the midwives offered them a better chance at survival. I suppose it is easy to say so now, knowing what we do about germs, but how obvious does it have to be that something is wrong when even the patients notice the statistics?; (2) as Greta pointed out, history continually repeats itself. Our understanding of medicine has advanced, but doctors and scientists are still human and flawed.

There are a lot of hot button medical issues that could be used to illustrate this point, but I am just going to use a less controversial one: ulcers. In the early 80’s, researchers in Australia discovered that ulcers were actually caused by bacteria (not by stress or diet as previously supposed) and can be cured by killing the offending bacterial. I am not 100% clear on how long it took the medical community to accept this, but something like 10 years. 10 years!

3. I found the story in whole to be tragic, but I didn’t feel much sympathy for Semmelweis. He was his own worst enemy. And because he refused to substantiate his theory with laboratory tests, he didn’t really solve the riddle of childbed fever; he made an educated guess and happened to be right.

4. It is all three, isn’t it? That is both maybe the strength and the weakness of the book. But considering it is part of a series, Nuland felt possibly compelled to keep it brief and hit all three points.

I'm glad you enjoyed this book; I did too. I prefer my science books short and easy-to-understand, and I think Nuland did a good job of hooking the reader in with the first chapter (the historical vignette with the woman going to give birth).
What I wondered was how much Semmelweis could help being "difficult"--what would be the official diagnosis of his personality today, I wonder. I thought the larger picture was one of tragedy--how sometimes we can't see past an unpleasant personality or manner to breakthroughs and intelligence.
I like the term Histobiograscience. That's what I'd call "The Immortal Life of Henrietta Lacks," too.

I think it often happens where people have some insight into what's going on, but nobody talks about it or sees the big picture in time. (And of course, then as now, no one was listening to women's insight on health matters, I suppose.) But yes: fascinating. And just too bad for you if you got put in the wrong ward.
I shouldn't be so hard on the medical community but I wonder what they're missing right now; thanks for the ulcer story. Very enlightening! Of course, I have no science/medical know-how, so I guess I shouldn't complain if I can't help.
I must admit I felt sympathy for Semmelweis. I wonder how much he could help and how much he couldn't. I feel it's unfortunate that he had friends, but never anyone who could shake him into even a collaboration that would have served to get the info out better.
Did you feel the book was too short or too weak on detail? Your last comment makes it sound like you do think the book had some weaknesses...

1. I enjoyed this book especially since I had the teaser from "The Birth of Love." The author did a great job describing the historical context of medicine. For example, doctors for a long time didn't attribute cancer to a particular organ. Instead, they treated the person's "constitution." (Interestingly, there seems to be a switch back to treating patients holistically - although that's not what they meant back then.)

2.I also thought it was interesting that the women knew which ward was better. I can't remember which book described women hoping to go into labor the day that they would be assigned to the midwives' ward.

The one thing I never understood was how doctors and students didn't WANT to wash their hands. Even if they didn't understand the connection between working with cadavers and treating living patients, I think one would want to get the stinky gooky stuff off their hands. Didn't they eat lunch in the middle of the day.

Because I'm a big geek, I used this book in a library instruction session on the development of knowledge.

Remember the big study that said women over 40 no longer need a mammogram every year? Some doctors changed their practice and others didn't.

3. Something happened to Semmelweis during his career going from a jovial young man to bitter and defeated one. I think bumping your head against a bureaucratic and inflexible wall of a system can do that to you.

I didn't understand why his friends and colleagues who believed him
didn't do the research themselves especially when they realized that Semmelweis wasn't going to do it. They could have worked with him but not expect any collaboration. I couldn't see my own doctor going from working with people to doing research. It's just not in him.

4. I'll go with a combination of all three, too, but if I had to choose, I'd say history.

Great discussion, everyone!

1. I did enjoy it - as mentioned above, it was short and not full of jargon or tough medical language. As a woman (well as a human really) was outraged of course and generally saddened by his failure.

2. I found it interesting, although not really surprising once I thought about it, that Semmelweis and other doctors of the time had working theories about infection and bacteria and transmition of these diseases several decades before germ theory took hold.

3. I did find him to be tragic but was also frustrated with his pig-headedness that led to much of the failure to transmit his ideas. It is easy to pick on doctors for their failure to accept change and new ideas, largely, I think, because their failure actually results in death and mayhem. However, I have seen stories similar to Semmelweis' in my own profession (librarianship). People do not like to perceive themselves as incorrect and professionals who have climbed the professional ladder are especially prone to an inablity to think outside the box.

4. I felt it was more science-y. It is books like this that make cataloging especially diffigult ;-)

Jessi makes a good point that arrogance and the inability to think outside the box is not just limited to doctors and/or scientists!

CR, I liked TDP, because it was a brief glimpse into something I know nothing about. But I do think that the book would disappoint a serious reader who was interested in the history of germs or a fuller biography of Semmelweis. Personally, I would have liked to know more about Semmelweis and his family (his son killed himself? Why?), but maybe that information is either not available or wasn’t included due to page number constraints.

I agree, this has been another really good discussion. My thanks to all.
I too enjoyed the history of medicine aspect of this book, and thought Nuland did a good job of explaining who knew what, when. Where we are now it's so weird to think that germ theory's really not very old in the scheme of things. So for Nuland to give the historical context was, for me, particularly helpful.
How did this book work in the course you taught?
I also think that hitting your head against the wall of the "status quo" can be quite detrimental to your sanity, frankly. I can't say I was sold on Nuland's Alzheimer's theory, although some of Semmelweis's more erratic behavior toward the end probably can't be attributed to his work frustrations.

I agree with Ruthiella that your point about people thinking out of the box in any field is rare. Especially now when we're all just desperate to hold onto whatever jobs we get. It strikes me that this economy might also be bad for innovation.
I also agree that this book would be a tough one to catalog, although I'd say science myself. But it's a great reminder to think about nonfiction in terms other than pure subject matter--or at least to think about it in terms of several subject matters!

I had that exact same thought as you (re: wanting a bit more detail about Semmelweis). Now I'm going to have to look up why his son killed himself. I must admit I was waiting for an afterword or epilogue or something like that to revisit that topic, since Nuland bothered to bring it up at all.

CR, I was wondering too if there might be an alternative diagnosis in the DSM-IV-TR for Semmelweis's "personality disorder". If you find out why his son killed himself, I'd be interested to know why.

1. I mostly enjoyed this book, and was interested, but would have liked to have had MORE. More background on the understanding of medicine at that time, more biography of Semmelweis, more info on the political scene in the Austro-Hungarian empire... But I'm just geeky that way.

2. I am intrigued by many things in the book: germ theory, the fascination with autopsy, the intractibility of the medical world (then and now...). It seems to me that problems that mostly affect women (IBS, fibromyalgia, etc.) are often understudied, and I wonder if this was the case even back then.

3. Semmelweis is tragic, because he really believed in his theory and couldn't find a way to make everyone else believe also. It's a shame that he alienated anyone who could have helped him. I don't know that his difficult nature had anything to do with the insight he had into "cadaveric particles" and childbed fever.

4. I can't say that the book is biography because Semmelweis doesn't even make an appearance until 1/3 way into the book, and as others have noted it skims over large portions of his life. It's not really science either - not enough sources. I don't know that it's history either, because of the opening fiction (which really put me off), and the ending author's note. It's a little of each which is why I thought it could have been so much better in the hands of another author.

Yes, I think I'd have to read a much more in-depth bio of Semmelweis to get a better handle on what was really going on there. Of course, then I'd also have to read the DSM-IV. Neither of which is going to happen. Sigh. If I find out about his son I'll post about it, though.

Fascinating stuff in your comments. I understand the wanting MORE--but my default reading preference is always for shorter books. For that reason I enjoyed this one--wild story, explained in under 200 pages. I'd like to be geekier and want more but I find there's just too many subjects to read on to read big meaty books on all of them!
I agree with you that there were many fascinating sides to the medical story here. Have you read Robert Morris's "The Blue Death" (about cholera)? It strikes me that you might like it, but maybe it wouldn't be rigorous enough for you either. But for some reason I thought of it when I was reading your comments.
I wondered if his "difficult" nature might have included other traits that helped him solve the mystery--perseverence (or stubborness) or a strange confidence that made him trust his deduction without wanting to experiment.
Why did the fiction put you off, may I ask? Because it was fiction, or because it was rather melodramatic fiction? I wonder if you'd like others in this "Great Discoveries" series--I think they're meant to be kind of lightweight NF intros to subjects that readers wouldn't normally seek out on their own.

1. I liked it a lot. It was well-written and while the science was good, I don't think it was so science-y that it would put people off who think they don't like to read about science.

2.This really has little to do with anything actually in the book, but I couldn't stop thinking about the swinging pendulum of trends in childbirth. These guys didn't wash their hands, and a bunch of women and children died because of it. Mid-twentieth century, everything was sterilized within an inch of its life, surgical masks everywhere, and laboring women routinely underwent icky procedures--the details of which I won't spell out here, but I'm sure you know all about--designed to keep everything as clean and sanitary as possible. When fathers were let into delivery rooms, 1980s or so, they had to scrub and suit up like the doctors, just so they could stand at the head of the bed and watch. When both of my kids were born in the '90s, the bed was clean, the medical folks had scrubs and gloves, but nobody felt compelled to disinfect me and my husband was not, to the best of my recollection, even asked to wash his hands before cutting the cords, let alone go through pre-delivery decontamination. He hadn't been dissecting any corpses, but still.

Obviously Semmelweis wasn't wrong, but a hundred years later, the obstetrical establishment had gone to an opposite extreme from what was common practice in his time. Which also wasn't precisely wrong, but was maybe unnecessary.

(And +1 to Venta's remark about the handwashing. Yeesh.)

3. While I did want to figuratively shake Semmelweis to make him get him off his butt and do something--anything--to prove his theory, I could also understand how a person who is not necessarily a gifted politician can get drowned out by powerful people with interests to protect. It usually isn't enough to be right or speak the truth when the establishment doesn't want to hear the truth. He could have benefited from a good PR firm or a consultant to package his ideas and get them out there, since he clearly didn't have the necessary instincts or interpersonal skills to do so himself.

4. To me, this felt most like history. However, I can't really see it living in the 900s. I wonder if the fact that Nuland is a doctor has anything to do with it being cataloged with medical books? Probably not, but if someone like Erik Larson had written it, would it seem more like history than science?

Yes, I liked this book a lot too. The best kind of science for me--"science lite." The story and a few gory details, but nothing too terribly technical.
And thanks for the insight re: how much standards change in the obstetrical (and any medical) field. Fascinating stuff really. And I wonder how much of those icky procedures in the 50s were meant to send women the message that the men doctors were in charge, and they needn't make any suggestions regardint their own delivery process.
We all sometimes need good PR firms to help us not be our own worst enemies, I guess. I agree with you that Semmelweis needed something or someone to be the smoother one in the partnership, but it never happened.
And, I'm with you and Venta in the handwashing. Good lord, I became a serial handwasher after just working at the library--you're telling me it wouldn't feel good to wash after touching cadavers? I'm guessing water wasn't as easily available, or maybe they rinsed their hands or wiped them but didn't sufficiently scrub them. It's a mystery.


Thanks for the suggestion for "The Blue Death". It will go on my TBR list. I do usually read the longer, more in depth books. Recently finished all 700 or 800 pages of "The Emperor of All Maladies".

The fiction was melodramatic, for me. I am more impressed with facts, or give me a full fiction book. I don't like to mix my genres so much. My version of kosher reading, maybe. I just remember thinking, "Why is she young? What's the point of the flaky sperm-donor?" It might have been better to have had a fiction about a mother who had previously delivered on the midwife side and now was in the other ward.

I very much enjoyed TDP and was satisfied with the length of it per my interest. I did not however care for the intro because I wanted to know of the girl was true and felt mislead that it was just setting a scenario.
I just didn't understand why Semmelweis didn't do more substantiated research and lab work to verify/prove his theory but also especially confused why no one else picked up that ball and ran with it. Why couldn't he have assigned it to a new med student to do the grunt work, anything! something. And how many years passed by with only his friends bugging him to write it all down. But I get it and I don't, 'it was a different time and place'.
I have no issues with Nuland's theory of early onset Alzheimer's for this tragic figure.
(I had a comment typed up days ago but it wasn't accepted, and then I got distracted. oops)

"The Blue Death" may not be rigorous enough for you (I liked it and I'm not the most rigorous of science readers, I'll admit) but I like its dual focus on past cholera epidemics and the scary state of our current water pipes infrastructure.
Really interesting about why you didn't like the fiction part of the Nuland. For loving NF, I must admit I don't mind the mixing of genres--perhaps because I view most NF as being opinion and the facts as compiled by people with opinions more so than literal "fact" or "truth." The intro chapter really got me this time around, as a matter of fact--I first read this book years ago, long before I had a kid, and I think I was originally just annoyed at the boy smooth-talking the girl into eventual pregnancy. This time around I thought of her hope that a new baby, a new life, would return her to a more hopeful way of life, and it just broke my heart. Oh my God, I'm turning sappy. :) I'm explaining that poorly but it really did affect me differently.

I really enjoyed TDP too. (And I'm sorry your comment didn't get accepted--I've heard that from others so I took off the anti-bot password thing.)
SO interesting to hear you and others really didn't like the opening fiction chapter, and thanks for saying why. On a continuum, do you tend to view NF as really factual? It's hard to explain, but I seem to have this sense of NF as just another type of fictional storytelling--only using stories that have really happened to people or that they have researched. But everyone writing NF still has their own "spin"--which I think makes me more open to a blend of fic and NF than some. Maybe? Interesting question.
I totally agree about frustration with Semmelweis. It makes me wonder how many other discoveries were floating around out there years before they were "discovered."

oh good question! If it had been set up as a 'imagine this"' idea, I might have been all aboard for the fiction intro. I actually love narrative nonfiction and historical fiction, but maybe I upfront thought this was strictly bio/history and so felt mislead?
I do like NF as another type of storytelling. I think. Will ponder.

I'm not sure what I initially thought of the fiction intro, but I do recall that as soon as I started the "real" part of the book, I thought, "Oh, that bit was just dramatic illustration. Got it." I don't have a general opinion on mixing fiction and non-fiction that way, but in this case it was very effective for me, and I think if he had just described what would normally happen when a woman came in to give birth and then contracted childbed fever, I would have found it less interesting.

I'm late to the discussion but here goes:

I think I would have found this story more interesting if it had been written with a feminist perspective. After having recently read the HeLa book and the Emperor of All Maladies, I found the writing style dry and dull. Still, I'm glad I read it and thankful that it was a short book.

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