Research Paper on "Dr. Ignaz Semmelweis and Puerperal Fever"

Research Paper 5 pages (1721 words) Sources: 5

[EXCERPT] . . . .

Dr. Ignaz Semmelweis and puerperal fever

The last two centuries of medical history are rich in discovery and innovation, and includes such medical breakthroughs as the isolation of penicillin and computer-assisted surgery. One such medical breakthrough of the 19th century is accredited to Dr. Ignaz Semmelweis, who is known as the "father of infection control" for recognizing the correlation between the incidence of puerperal fever in birthing mothers and physicians who did not wash their hands following autopsy (Best & Neuhauser, 2004, p. 233). While working at a teaching hospital in Vienna, Dr. Semmelweis observed that women delivered by physicians and medical students experienced a higher rate of post-delivery mortality than the women who were birthing outside of the doctor's maternity clinic. The women in Dr. Semmelweis's clinic were contracting puerperal fever, known as childbed fever, a condition caused by a bacterial infection which leads to puerperal sepsis, a form of septicaemia that is often fatal if untreated (Costa, 2002).

Dr. Semmelweis theorized that disease particles were on the hands of physicians and students, and were transferred from cadavers to birthing women. To address the problem, Dr. Semmelweis made a chlorinated lime solution in which physicians were directed to wash their hands following autopsy; the mortality rate from puerperal fever in the hospital dropped from 18% to less than 3% in just a five-month period, June-November 1847 (Costa, 2002). Although Dr. Semmelweis's discovery revolutionized how physician's viewed disease transmission and reduced the incidence of puerperal fever, puerperal sepsis remains one of the major causes of maternal death and is responsible for 15% of all maternal deaths in developing countries (WHO, 2008). The incidence of puerperal fever in the 21st century is still widely the result of unsanitary birthing environments. In the 19th century, Dr. Semmelweis's observations and research were groundbreaking, and hand washing is now a standard, required medical practice and is revered as the fundamental measure used to prevent bacterial and viral infections from spreading.

In 1844, Dr. Semmelweis earned his MD degree from the University of Vienna and eventually specialized in obstetrics (Costa, 2002). Dr. Semmelweis was appointed the assistant lecturer in the First Obstetric Division of the Vienna Hospital. In the First Division, medical students received their physician training, in the Second Division, midwifery students received their midwife training. While working in the First Division, Dr. Semmelweis noticed that women who were delivered by doctors and medical students had a higher post-delivery mortality rate than the women who were delivered by the students of midwifery in the Second Division (Best & Neuhauser, 2004). The birthing mothers were contracting puerperal fever, known as childbed fever. Puerperal fever is the result of a puerperal infection, which is a general term used to describe any infection of the genital tract following delivery, and if untreated, leads to puerperal sepsis and often death (Dolea & Stein, 2003). The morality rate from puerperal fever in the First Division was 16% of all women giving birth in the years 1841-1843, whereas the Second Division had an approximate mortality rate of only 2% (Costa, 2002).

The disparity in mortality rates between the two divisions motivated Dr. Semmelweis to entertain various hypotheses to understand why more women were dying of puerperal fever in the First Division than the Second. During the time of Dr. Semmelweis's employment at the Vienna hospital, the majority of the patient population in both the First and Second Divisions were unwed mothers. It was estimated that the population of Vienna, during the time of Dr. Semmelweis's research, included between 2,000 and 10,000 prostitutes, and 500 to 4,000 kept mistresses (Carter & Carter, 2005). During this time, "unwed mothers accounted for half of the live births" (Carter & Carter, 2005, p. 1). To reduce the incidence of infanticide of illegitimate children, the Vienna Hospital acted as a charity hospital for women who were unable to care for their children. In exchange for free medical and foster services, the women were used for the training of doctors and midwives (Carter & Carter, 2005). The patient population and socioeconomic status of the patients between the two divisions were relatively the same, which would exclude the patient background as a potential risk factor for puerperal fever.

Obsessed with identifying the cause of the greater mortality rates of post-delivery mothers in the First Division, Dr. Semmelweis evaluated every imaginative source of difference between the two, including religious practice, to eliminate the differences between the divisions that would be responsible for puerperal fever (Carter & Carter, 2005). The people who delivered the babies were the only prominent differences between the women contracting puerperal fever and those who were not. In the First Division, physicians and medical students were delivering, midwives and midwifery students were delivering in the Second. Dr. Semmelweis also noted that women who gave birth before arriving to the hospital had a much lower incidence of puerperal sepsis (Costa, 2002).

Dr. Semmelweis noted that the physicians and medical students conducted autopsies every morning on the women who died in the hospital on the previous day, however, the midwives and their students did not perform any autopsies in the Second Division (Costa, 2002). Although this difference between the two divisions is quite significant, Dr. Semmelweis did not understand its correlation to puerperal fever until his friend and colleague, Jakob Kolletschka, died of septicaemia after being accidentally injured with a scalpel during an autopsy (Costa, 2002). While reading the autopsy report on Kolletschka, Dr. Semmelweis recognized the similarities of the pathological results to those of the women dying of puerperal fever (Costa, 2002). Dr. Semmelweis started to operate under the belief that the agents that caused septicaemia in Kolletschka were the same that caused puerperal fever in the female patients from the First Division of the hospital.

Dr. Semmelweis explained the sepsis-causing agents were transmitted by "the fingers and hands of students and doctors, soiled by recent dissections, [which] carry those death-dealing cadavers' poisons into the genital organs of women in childbirth" (Costa, 2002, p. 669). Prior to Dr. Semmelweis's discovery, hand washing was not common practice. Germs, bacteria, and disease transmission were not understood (or in some cases, not yet discovered). To address the problem, Dr. Semmelweis worked with various cleansing agents and made a chlorinated lime solution for hand washing. In May 1847, Dr. Semmelweis ordered all physicians and students working in the First Division to wash their hands in the cleaning solution prior to delivery and vaginal exams (Costa, 2002). After only five months of implementing hand washing practice, from June to November 1847, the mortality rate from puerperal fever in the First Division lowered from 18% to 3%, which was almost equal to the mortality rate in the Second Division (Costa, 2002). Although Dr. Semmelweis's findings were revolutionary for the time, his conclusions did not receive immediate acclaim, and he was instead met with skepticism and ridicule. His contract with the Vienna Hospital was not renewed, and after publishing his observations in 1861, his findings were widely dismissed (Costa, 2002). It was not until the end of the 19th century and early 20th century did the collective evidence provided by Semmelweis, and scientists such as Billroth, Pasteur, and Lister, did hygienic practice become a priority in medical practice (Costa, 2002).

The understanding of skin-to-skin transmission for infection was a novel concept in the 19th century. In the present, hand washing and hygienic measures are commonplace, and are required by medical personnel and are expected by people of any profession to reduce germ transference. Dr. Semmelweis was an innovator in the medical community and the implications of his research has saved countless lives. In the 21st century, puerperal sepsis still accounts for 15% of all maternal deaths in developing countries (WHO, 2008; Dolea & Stein, 2003). The incidence of puerperal sepsis is the highest in developing countries that are resource-poor, and have limited access to both sanitary environments for labor and delivery and antibiotic treatment (Dolea & Stein, 2003). The greatest preventative measure to reduce puerperal fever, and ultimately post-delivery death by way of puerperal sepsis, continues to be hand washing, hygienic practice, and sanitary delivery environments.

One of the most highly regarded medical discoveries of the 19th century is accredited to Dr. Ignaz Semmelweis for recognizing the sanitary benefits of hand washing. While specializing in obstetrics at the Vienna Hospital, Dr. Semmelweis noticed that women who were delivered by physicians and medical students in the First Division of the hospital experienced greater post-delivery mortality rates than the women delivered by midwife students in the Second Division of the hospital. The incidence of puerperal fever, known as childbed fever and is the precursor to puerperal sepsis, was greater in the First Division than the Second and accounted for the higher post-delivery mortality rate in birthing mothers. After eliminating several potential differences between the two divisions, Dr. Semmelweis noted the only prominent difference between women contracting puerperal fever were the people who were delivering their babies.

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