Medical matters: Recognition at last for man who should be household name

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AS THE ship sailed out of Aberdeen harbour, Dr Alexander Gordon took in a view he had seen every morning in a painting in the drawing room of his home in Belmont Street.

It had been one of the first purchases that he and his wife, Elizabeth, had made, but little did Dr Gordon know at the time that he would gaze upon the same scene as he left the city for the final time, with his life, reputation and marriage in tatters, but having sown the seeds of a medical breakthrough.

It is appropriate that the vessel on which Dr Gordon left Scotland was called the Adamant, for it would be this trait that would lead him to publish in 1795 his Treatise on the Epidemic Puerperal Fever. The Scottish doctor's genius was to discover that the bacterial infection that took root in the genital tract after birth was being transmitted from woman to woman by birth attendants.

"I myself," he wrote, "was the means of carrying the infection to a great number of women."

At a time when the victim was often blamed for her own demise on account of sinfulness or failing to ventilate the room to disperse foul miasmas – the "unwholesome exhalations" that medical practitioners believed caused ailments – Dr Gordon's belief that those sent to aid women were, in fact, the cause of harm was viewed by the medical establishment as abhorrent.

It was knowledge hard earned during Aberdeen's three-year puerperal fever epidemic that began in December 1789 and killed hundreds of mothers. Sadly, it was knowledge ignored, and it was not until decades later that others came to the same conclusions and claimed the credit.

In America in 1843, Oliver Wendell Holmes wrote The Contagiousness of Puerperal Fever and said: "In my own family, I had rather that those I esteemed the most should be delivered unaided, in a stable, by the mangerside, than that they should receive the best help, in the fairest apartment, but exposed to the vapours of this pitiless disease."

The following year, Dr Ignaz Semmelweis, of Vienna General Hospital, noticed the same pattern and argued the case at a time when the world was ready to listen.

Now, almost 210 years after Dr Gordon's death in 1799, he has found a champion, a literary advocate who has pressed his case into the form of fiction.

Critically acclaimed Rebecca Abrams is author of the novel Touching Distance that tells the story of Dr Gordon and his time in Aberdeen at the height of the epidemic.

"I first came across Alexander Gordon in a medical history book I found by chance," she explains. "It had the striking title The Tragedy of Childbed Fever and included a short but riveting chapter about Gordon. I've never before been mugged by someone in a book, but that's pretty much what happened with Gordon. From the moment I came across his story, I was totally hooked.

"Here was a young 18th-century doctor who set out to discover what was killing his female patients and ended up making one of the greatest medical discoveries of his age, a discovery that brought him not fame but complete ruination.

"Gordon effectively discovered germ theory a century before Lister. The man should be universally renowned. Instead, he is virtually unheard of."

Sadly, puerperal fever remains potentially lethal. Gillian Smith, the director of the Royal College of Midwives in Edinburgh, says: "Puerperal fever, or sepsis, still remains a problem and all midwives and medical staff working in obstetrics are trained to look out for it, hence the reason that mum's temperature and pulse are checked in the postnatal period."

Across Britain between 2003 and 2005, 18 women died of genital tract sepsis, but this also includes early pregnancy deaths due to sepsis. That is 0.85 per 100,000 maternities. "This is considerably less than in the times of Alexander Gordon, who would have seen hundreds die," Smith says.

"Hygiene has greatly improved with hand-washing, hospital cleanliness and, of course, the use of antibiotics, which means, properly treated, women who would have previously died now survive."

Midwives today still come across his name, but he is known by few others and Abrams has her own opinion on why this is. "Gordon made a lot of enemies in Aberdeen. He was not endowed with much tact and certainly didn't suffer fools gladly. He was also responsible for delivering most of the women in the town and was the leading obstetrician in Aberdeen at the time. So when the women started dying, he was in the firing line. To make matters worse, the 'cure' he came up with – aggressive blood-letting – was extremely unpopular with the local midwives, who believed you should never bleed a woman who'd just given birth.

"This was a small, close-knit community with lots of cousins and siblings married to one another – the deaths of so many young mothers in such a short space of time would have been devastating. People wanted someone to blame. Gordon was the scapegoat."

The novel involved numerous trips to Aberdeen for the Oxford-based author, accompanied, at least in spirit, by her subject. "Sometimes I'd talk to him, ask him what he was doing and thinking and feeling at a certain point," she says. "Other times, he talked to me – usually along the lines of, 'Gweed's sake, woman! I've waited 200 years for you to tell my tale. Now, get on wi't!'"

&#149 Rebecca Abrams will talk about Touching Distance (Macmillan, 12.99) at Waterstones, Union Bridge, Aberdeen, at 7:30pm tomorrow.