“What meditations are induced by those results! It is impossible not to observe that, the further we penetrate into the experimental study of germs, the more we perceive sudden lights and clear ideas on the knowledge of the causes of contagious diseases! Is it not worthy of attention that, in that Arbois vineyard (and it would be true of the million hectares of vineyards of all the countries in the world), there should not have been, at the time when I made the aforesaid experiments, one single particle of earth which would not have been capable of provoking fermentation by a grape yeast, and that, on the other hand, the earth of the glass houses I have mentioned should have been powerless to fulfil that office? And why? Because, at a given moment, I covered that earth with some glass. The death, if I may so express it, of a bunch of grapes thrown at that time on any vineyard, would infallibly have occurred through the saccharomyces parasites of which I speak; that kind of death would have been impossible, on the contrary, on the little space enclosed by my glass houses. Those few cubic yards of air, those few square yards of soil, were there, in the midst of a universal possible contagion, and they were safe from it.”
And suddenly looking beyond those questions of yeast and vintage, towards the germs of disease and of death: “Is it not permissible to believe, by analogy, that a day will come when easily applied preventive measures will arrest those scourges which suddenly desolate and terrify populations; such as the fearful disease (yellow fever) which has recently invaded Senegal and the valley of the Mississippi, or that other (bubonic plague), yet more terrible perhaps, which has ravaged the banks of the Volga.”
Pasteur, with his quick answers, his tenacious refutations, was looked upon as a great fighter by his colleagues at the Academy, but in the laboratory, while seeking Claude Bernard’s soluble ferment, he tackled subjects from which he drew conclusions which were amazing to physicians.
A worker in the laboratory had had a series of furuncles. Pasteur, whose proverb was “Seek the microbe,” asked himself whether the pus of furuncles might not have an organism, which, carried to and fro,—for it may be said that a furuncle never comes alone—would explain the centre of inflammation and the recurrence of the furuncles. After abstracting—with the usual purity precautions—some pus from three successive furuncles, he found in some sterilized broth a microbe, formed of little rounded specks which clustered to the sides of the culture vessel. The same was observed on a man whom Dr. Maurice Raynaud, interested in those researches on furuncles, had sent to the laboratory, and afterwards on a female patient of the Lariboisière Hospital, whose back was covered with furuncles. Later on, Pasteur, taken by Dr. Lannelongue to the Trousseau Hospital, where a little girl was about to be operated on for that disease of the bones and marrow called osteomyelitis, gathered a few drops of pus from the inside and the outside of the bone, and again found clusters of microbes. Sown into a culture liquid, this microbe seemed so identical with the furuncle organism that “it might be affirmed at first sight,” said Pasteur, “that osteomyelitis is the furuncle of bones.”
The hospital now took as much place in Pasteur’s life as the laboratory. “Chamberland and I assisted him in those studies,” writes M. Roux. “It was to the Hôpital Cochin or to the Maternité that we went most frequently, taking our culture tubes and sterilized pipets into the wards or operating theatres. No one knows what feelings of repulsion Pasteur had to overcome before visiting patients and witnessing post-mortem examinations. His sensibility was extreme, and he suffered morally and physically from the pains of others; the cut of the bistoury opening an abscess made him wince as if he himself had received it. The sight of corpses, the sad business of necropsies, caused him real disgust; we have often seen him go home ill from those operating theatres. But his love of science, his desire for truth were the stronger; he returned the next day.”
He was highly interested in the study of puerperal fever, which was still enveloped in profound darkness. Might not the application of his theories to the progress of surgery be realized in obstetrics? Could not those epidemics be arrested which passed like scourges over lying-in hospitals? It was still remembered with horror how, in the Paris Maternity Hospital, between April 1 and May 10, 1856, 64 fatalities had taken place out of 347 confinements. The hospital had to be closed, and the survivors took refuge at the Lariboisière Hospital, where they nearly all succumbed, pursued, it was thought, by the epidemic.
Dr. Tarnier, a student residing at the Maternité during that disastrous time, related afterwards how the ignorance of the causes of puerperal fever was such that he was sometimes called away, by one of his chiefs, from some post-mortem business, to assist in the maternity wards; nobody being struck by the thought of the infection which might thus be carried from the theatre to the bed of the patient.
The discussion which arose in 1858 at the Académie de Médecine lasted four months, and hypotheses of all kinds were brought forward. Trousseau alone showed some prescience of the future by noticing an analogy between infectious surgical accidents and infectious puerperal accidents; the idea of a ferment even occurred to him. Years passed; women of the lower classes looked upon the Maternité as the vestibule of death. In 1864, 310 deaths occurred out of 1,350 confinement cases; in 1865, the hospital had to be closed. Works of cleansing and improvements gave rise to a hope that the “epidemic genius” might be driven away. “But, at the very beginning of 1866,” wrote Dr. Trélat, then surgeon-in-chief at the Maternité, “the sanitary condition seemed perturbed, the mortality rose in January, and in February we were overwhelmed.” Twenty-eight deaths had occurred out of 103 cases.
Trélat enumerated various causes, bad ventilation, neighbouring wards, etc., but where was the origin of the evil?
“Under the influence of causes which escape us,” wrote M. Léon Le Fort about that time, “puerperal fever develops in a recently delivered woman; she becomes a centre of infection, and, if that infection is freely exercised, the epidemic is constituted.”