The Doctors’ Plague

The Doctors’ Plague: Germs, Childbed Fever and the Strange Story of Ignác Semmelweis by Sherwin B. Nuland, W. W. Norton & Company, 2004. 

Puerperal Fever

Puerperal fever became more common after the medicalization of childbirth. During the 19th century in Europe and America, midwives were often replaced by doctors. A new surgical specialty developed, called obstetrics. Puerperal fever was much more common in hospital deliveries than in home deliveries.

Ignác Semmelweis

Ignác Semmelweis grew up in a German speaking community of Hungary. He spoke German with a Buda-Swabian accent and always felt out of place in both Hungary and Austria. His main supporters were: Karl von Rokitansky, Joseph Skoda, and Ferdinand Hebra. 

Allgemeine Kankenhaus

The Allgemeine Kankenhaus (hospital) of Vienna opened in 1784. It was a huge hospital that provided medical care to the poor. Allgemeine Krankenhaus had meticulous record keeping. During the early nineteenth century, it developed the specialty of pathology. The hospital had a rule that every patient who died in the hospital was given a postmortem examination in the autopsy room. The main promoter of autopsies was Carl von Rokitansky. Other great physicians at the Allgemeine Krankenhaus included Joseph Skoda, who was an expert at the use of the stethoscope to diagnose disease, and Ferdinand Hebra, the founder of dermatology.

Experiments

In 1847, at the Allgemeine Krankenhaus, Semmelweis started his experiments. His results provided a statistically rigorous confirmation that puerperal fever was contagious. He made six observations: (1) Many fewer deaths from puerperal fever in the division that used midwives instead of doctors, (2) There was no epidemic of puerperal fever outside the hospital, only inside the hospital, (3) No correlation of puerperal fever with the weather, (4) Trauma during delivery increased the likelihood of puerperal fever, (5) When the ward was closed for a time, requiring that the births take place elsewhere in the hospital, puerperal fever would substantially decrease, (6) Babies born to women who had puerperal fever often also died of fever. 

Semmelweis Lehre

The Semmelweis Lehre (Doctrine) was used to instruct obstetrical units at the Allgemeine Krankenhaus. Health care workers were required to wash their hands with chloride of lime (calcium hypochlorite) disinfectant before touching a woman in childbirth.