Childbed fever: causes, transmission, and historical treatment

¶ … deaths in childbirth were a major problem for the medical community (Ey). The most significant cause for the large number of women dying during this process was the occurrence of puerperal sepsis which was more commonly known as childbed fever. A variety of theories were offered to explain this phenomena but some dated theories surrounding the causes of diseases such as malaria and typhoid made progress toward reaching a cure for childbed fever more difficult. The prevailing thought was that both diseases were caused through contact with water and this fact, added to the lack of indoor plumbing, caused doubt to be raised when Hungarian born Ignaz Phillip Semmelweis first suggested his germ theory and its relationship to childbed fever.

Semmelweis, before Lister introduced his germ killing theory, began insisting that the failure to properly wash one's hands between procedures was the cause of infections and, therefore, the reason why childbed fever was such a prominent problem among maternity wards throughout Europe. Semmelweis developed his initial theory by observing the differences between how physicians in the hospitals administered to pregnant mothers and how midwifes were caring for their patients. The difference, Semmelweis theorized was in the hand washing- physicians did not include it as part of their procedure while midwifes did. Subsequently, Semmelweis insisted upon proper hand washing between procedures in the hospitals where he was the supervisor and he began to test his theories. He publishes his findings in 1861 but his publication is not well received. It is not until Lister eventually publishes the results of his own work in 1870, A Method of Antiseptic Treatment Applicable to Wounded Soldiers in the Present War, that germ theory began to be widely accepted. Lister, however, gives credit to Semmelweis for providing the inspiration for his work.

The beauty of Semmelweis' theory was it simplicity. Today the procedures that he was recommending are considered a routine part of any medical procedure but in his generation the suggestion that physicians could be the source of spreading infection was looked upon with disdain (Biddle). As a result, Semmelweis' theory was largely ignored and criticized. Nevertheless, in the institutions where Semmelweis practiced his hand and instrument washing procedures were followed religiously and resulted in significantly fewer cases of childbed fever. Interestingly, despite the remarkable success of his methods, Semmelweis continued to be subject to criticism and, unfortunately, he did not react well to such criticism. He eventually fell into a deep depression and died in an asylum at the early age of 47.

The controversy surrounding germ theory and the considerable problem brought about by childbed fever demonstrates how difficult it often is to bring about change in institutions like the practice of medicine. Although the mechanism for examining the relationship between germs and infection had been available for several hundred years since the invention of the compound microscope, physicians in the 19th century refused to believe that their procedures could have any relationship to the fact that women were dying in childbirth. It was only through the isolated efforts of physicians such as Oliver Wendell Holmes in the United States and Semmelweis in Austria and Hungary, and the scientific work of Joseph Lister and Louis Pasteur that the medical community as a whole began to recognize that the germ -- streptococcus -- was the cause of such widespread problems (Cork). It took even longer for physicians to recognize that the problem could be eradicated through the adoption of a simple procedure such as hand washing.

The universal acceptance of germ theory did not occur until the early years of the 20th century but its acceptance had a remarkable effect on the incidences of childbed fever throughout Europe and the United States. Instead of double digit percentages of women dying from childbirth, the numbers began to fall to percentages in the range of 2-3% as hand washing and instrument sterilization became a routine part of all deliveries.

The efforts and observation skills of Semmelweis contributed significantly to stemming a serious problem. His simple insistence that physicians and other personnel assisting in the birth procedure in one Vienna Hospital follow his hand washing procedure stemmed an epidemic. The use of his procedure reduced the cases of fatal childbed fever from 18% of all births to 3% (Raju). Remarkably, this reduction occurred almost instantly, yet, the acceptance of his methods was still not accepted by the medical community.