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    Book Review

     Autumn 2008

  
   
    Amalia's Tale
     A Poor Peasant, an Ambitious Attorney, and a Fight for Justice
     By David I. Kertzer
     Houghton Mifflin Company, Boston. pp. 237, 2008

     This is the story of a poor woman, Amalia Bagnacavalli, the hospital negligence causing her to contract
    a serious and often fatal disease and the young attorney that fought aggressively for her benefit. It
    could have been set in the present day since the opposing sides and arguments are timeless but is
    actually about a peasant woman that wet nursed a sick infant from the local foundling hospital. The
    hospital was located in Bologna, Italy, the time 1891 and the disease was syphilis. The events are true
    and amazingly well researched by the author. The book reads like an historical novel, revealing much
    social history of late 19th century Italy and especially Bologna.

    The custom of the day was to hire peasant women from the towns and villages surrounding Bologna to
    wet nurse infants. The pay was meager: 9 lira per week. Still there were many who accepted the
    offer, especially in the winter months when family income was practically nil and food very limited in
    quality and amount. The women had to agree to stop nursing their own child at the age of one year to
    insure a steady milk supply for the foundling infants.

    The head of the foundling hospital board was Count Isolani, a prominent noble in the fast socializing
    Italy at that time. The policy of the hospital was that no sick child should be sent out for nursing,
    especially those with communicable diseases. This rule was often ignored and lies at the heart of
    the negligence allegation against the hospital and its doctors and the subsequent lawsuit.

    Much of the story depends on the medical evidence obtained from Amalia's hometown doctor, Carlo
    Dalmonte, the court-appointed physician experts and one consulted by the plaintiff's attorney, Augusto
    Barbieri. Amelia at first refused to accept the infant Paola from the foundling hospital because she
    had a spinal deformity and was congenitally blind. She ultimately relented; she and her family needed
    the money. When Amalia developed a lesion on her nipple and Dr. Dalmonte noted a similar one on the
    infant's lip, he correctly suspected that the child had congenital syphilis and had transmitted the
    disease to Amalia while nursing. This theory was rejected by the hospital doctors who claimed that
    Amalia had probably contracted the disease by sexual contact or by nursing another infant.
  
    She consulted Barbieri who took the case despite his client's lack of funds since he was young and
    anxious to establish a reputation in Bologna legal circles and after some failed attempts to settle,
    the trail began with only judges, no jury. Dr. Dalmonte testified as to his findings but he was considered
    a mere poorly trained "country doctor" who was more-or-less unreliable because he could not recall
    all the details of the case. The hospital doctors stated they could not find the labial chancre on the
    infant and that she did not in fact have syphilis, that her blindness was caused by a gonnhoreal
    infection. The count, anxious not to have to pay a judgment from the hospital board, supported the
    defense lawyers vigorously.

    The court-appointed medical experts played a significant role. Dr. Ravaglia, former head of the syphilis
    clinic in Bologna, stated that the infant did not have syphilis before she was taken by Amalia and that
    they did not see the lip lesion. A buttocks rash and the blindness were given alternate explanations.
    Basically he supported the contention that the hospital doctors were not negligent and that if indeed
    the infant was infected, it was not congenital and that she acquired it from Amalia herself or while
    in Amalia's care. When Barbieri protested about Dr. Ravaglia's testimony, the court appointed a second
    expert, Dr. Roncati, head of the hospital and a psychiatrist with medical and political connections whose
    knowledge of syphilis was at least questionable. The court found for the defense. The legal theory
    that held an employer responsible for an employee's work-related injury was not yet a part of Italian
    jurisprudence.

    In a modern manner, the young attorney convinced another expert, the chief of dermatology
    and syphilology at the University of Bologna, Professor Mojocchi, to review the case and offer a
    second opinion. Although the court did consent to read his written opinion supporting the plaintiff,
    it did not allow him to testify. He confirmed Dr. Dalmonte's view of the case that Amalia had contracted
    the disease from the infant's lip lesion but was unable to convince the court that the hospital and its
    governing board were guilty of negligence. The case ended with a verdict in favor of the defense, much
    to the relief of the anxious Count Isolani. He was afraid that a verdict of negligence would set a  
    precedent and the hospital would be inundated with lawsuits by an army of syphilitic peasant women.

    But Barbiere wasn't through. Although he took the case on contingency, he discovered that there
    was good publicity from it and he was becoming well known in the legal community. Almost four years
    after the case began, he appealed to a higher court. This tribunal sustained the lower court's finding
    that the hospital doctors had failed to follow their own rules about careful examination of the infant
    before releasing her for wet nursing and that indeed Paola had congenital syphilis that she transmitted
    to Amalia. The acquisition of a microscope and the hiring a syphilis specialist by the hospital were
    strongly recommended.

    But the appeals court also reversed the lower court's finding that the hospital and its board were not
    liable for Amalia's illness which by this time accounted for the death of two of her other children and
    the acquisition of the disease by her husband. Interestingly the appellate judges noted that they were
    under no obligation to rely on the court appointed experts and they themselves must rule on the
    adequacy and reliability of the scientific evidence. This finding is strikingly similar to the U.S. Supreme
    Court's decision in Daubert v. Merrell Dow Pharmaceuticals Inc. of 1993. In the end, the hospital
    board was forced to pay Amalia a settlement and a a monthly income of 15 lira and all her legal fees.
    Needless to say, Barbieri was elated.

    But the story is far from over; many twists and turns remain, medically, legally and of course,
    financially. We shall leave this for the reader to explore and enjoy. Many of the principles and
    medical-legal controversies of the time when medical malpractice was beginning as a cause of legal
    action remain with us today in modern law. Further, the author's skill in weaving a compelling and
    personally moving story with social history from over 100 years ago that bears comparison to an
    academic effort is simply remarkable. He includes a lengthy list of sources at the end of the book and
    posts an epilogue describing some of his methods and objectives. A relatively short book, well worth
    the time to read it.

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