Blood and Guts by Richard Hollingham

Snow's efforts surgeons used a lint mask and measured the chloroform
using charts and a specially designed 'drop bottle'. Now
(relatively) safe, chloroform could be used in the most difficult of
circumstances and was the favoured anaesthetic in battlefield
hospitals. Still, not everyone was convinced: some older surgeons
were still suspicious of pain relief, preferring to hear the 'lusty
screams' of soldiers as they went under the knife, a sure sign that
the men were fighting for survival.
    The invention of anaesthesia meant that surgeons had now
conquered the third barrier to successful surgery. This, allied with
a full understanding of anatomy and the ability to stem blood flow,
meant they could now attempt new and more daring operations.
People would seek treatment earlier. Women in particular might
see a surgeon to have a small lump removed from their breast
before the cancer took hold.
    In theory, more lives than ever should have been saved. In practice,
more and more people were dying. One out of five patients
would probably end up in the dead house. In some hospitals, half of
those operated on would be expected to die. Disease would ravage
entire hospital wards. The disease even had a name: 'hospitalism'.
Admittance to some hospitals amounted to a death sentence, and
many people decided they would rather take their chances at home.
Despite all the advances in science and medicine, no one could
figure out why so many patients were dying.
NOW WASH YOUR HANDS
    Vienna, 1846
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    Childbed or puerperal fever was a terrible disease. Within days of
giving birth, the mother would start to experience discomfort, soreness
and a rising temperature. Abscesses and sores developed and
spread across the body, accompanied by a swelling of the abdomen.
As the infection spread, it devoured tissues and attacked the vital
organs. Meningitis – a swelling in the lining of the brain – might be
accompanied by fits and periods of unconsciousness. Few women
recovered. And while this was bad enough, in many cases their
newborn babies died too.
    In one clinic in the maternity wing at Vienna General Hospital,
puerperal fever was killing hundreds of mothers each year. In
January 1846, out of 336 births, there were 45 deaths. In February
of the same year, 53 out of 293 women died. This was a death rate of
18 per cent – one in five patients.
    There were two clinics at the hospital. In the First Clinic the
patients were seen by doctors – mostly medical students. The
Second Clinic was run entirely by midwives. When the authorities
divided the maternity unit into the two clinics, they expected to see
a rise in mortality rates in the ward where the midwives were in
charge. It was, they argued, only common sense: midwives received
less training, were less scientific in their approach and, of course,
less rigorous in their intellect (there were no women doctors).
    But the opposite was happening. In the clinic run by midwives
there were far fewer deaths. In 1846 a total of 459 women (11.4 per
cent) died in the doctor's clinic compared with 105 (2.7 per cent)
in the midwives' care. It was a striking difference – and one that
soon became well known throughout the city.
    The two clinics admitted patients on alternate days. The
changeover between the clinics was at four o'clock in the afternoon.
Women in the advanced stages of labour would delay admission as
long as possible so that they would be admitted to the midwives'
rather than the doctors' clinic. As a result, women were giving birth
in the street or in carriages. Others would run screaming from the
hospital or had to be dragged through the corridors when they
discovered they'd been put in the First Clinic.
    Something needed to be done. A commission was set up to
investigate the disparity. Its conclusions were desperate. Male
student doctors, 'particularly foreigners', were blamed for being too
rough in their examinations. Most foreign students were removed.
When this failed to reduce the death