Conditions and Diseases

What is the outlook for an individual who has been infected with puerperal fever?

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11/22/2007

Puerperal fever (from the latin puer, child), also called childbed fever or puerperal sepsis, is a serious form of http://www.answers.com/topic/sepsis contracted by a woman during or shortly after http://www.answers.com/topic/childbirth or http://www.answers.com/topic/abortion. It is usually attributable to unsanitary conditions. Puerperal fever is now rare due to improved http://www.answers.com/topic/hygiene during delivery, and deaths have been reduced by http://www.answers.com/topic/antibiotic. Hospitals for childbirth became common in the 17th century in many European cities. These "lying-in" hospitals were established at a time when there was no knowledge of http://www.answers.com/topic/antiseptic and patients were subjected to crowding, frequent vaginal examinations, and the use of contaminated instruments, dressings, and bedding. The first recorded epidemic of puerperal fever occurred at the http://www.answers.com/topic/h-tel-dieu-de-paris in http://www.answers.com/topic/1646. Hospitals throughout Europe and America consistently reported death rates between 20% to 25% of all women giving birth with intermittent epidemics with up to 100% fatalities of women giving birth in childbirth wards.http://www.answers.com/topic/puerperal-fever#wp-_note-0 A number of physicians began to suspect contagion and hygiene as causal factors in puerperal fever. In http://www.answers.com/topic/1795, Alexander Gordon of Aberdeen, Scotland suggested that the fevers were infectious processes, that physicians were the carrier, and that "I myself was the means of carrying the infection to a great number of women."http://www.answers.com/topic/puerperal-fever#wp-_note-1 Thomas Watson, Professor of Medicine at King's College Hospital, London, wrote 1842 he wrote: "Wherever puerperal fever is rife, or when a practitioner has attended any one instance of it, he should use most diligent http://www.answers.com/topic/ablution." Watson recommended http://www.answers.com/topic/hand-washing with http://www.answers.com/topic/chlorine solution and changes of clothing for obstetric attendants "to prevent the practitioner becoming a vehicle of contagion and death between one patient and another." http://www.answers.com/topic/puerperal-fever#wp-_note-2 In http://www.answers.com/topic/1843, http://www.answers.com/topic/oliver-wendell-holmes-sr published The Contagiousness of Puerperal Fever and controversially concluded that puerperal fever was frequently carried from patient to patient by physicians and nurses and suggesting that hand-washing, clean clothing, and avoidance of autopsies by those aiding birth would prevent the spread of puerperal fever.http://www.answers.com/topic/puerperal-fever#wp-_note-3 Holmes stated that ". . . 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 vapors of this pitiless disease."http://www.answers.com/topic/puerperal-fever#wp-_note-4 Holmes' conclusions were ridiculed by many contemporaries, including Charles Meigs, a well-known obstetrician, who stated "Doctors are gentlemen, and gentlemen's hands are clean."http://www.answers.com/topic/puerperal-fever#wp-_note-5 In http://www.answers.com/topic/1844, http://www.answers.com/topic/ignaz-semmelweis was appointed assistant lecturer in the First Obstetric Division of the Vienna Hospital where medical students received their training. Working without knowledge of Holmes' essay, http://www.answers.com/topic/ignaz-semmelweis noticed his ward's 16% mortality rate from fever was substantially higher than the 2% mortality rate in the Second Division where midwifery students were trained. http://www.answers.com/topic/ignaz-semmelweis also noticed that puerperal fever was rare in women who gave birth before arriving at the hospital. http://www.answers.com/topic/ignaz-semmelweis noted that doctors in First Division performed autopsies each morning on women who had died the previous day but the midwives were not required to perform such autopsies. He made the connection between the autopsies and puerperal fever after a colleague, Jakob Kolletschka, died of septicaemia after sustaining an accidental wound to the hand during an autopsy. http://www.answers.com/topic/ignaz-semmelweis began experimenting with various cleansing agents and, from May 1847, ordered that all doctors and students working in the First Division wash their hands in chlorinated lime solution before starting ward work, and later before each vaginal examination. The mortality rate from puerperal fever in the division fell from 18% in May 1847 to less than 3% in June-November of the same year.http://www.answers.com/topic/puerperal-fever#wp-_note-6 While his results were extraordinary, he too was treated with skepticism and ridicule (see http://www.answers.com/topic/ignaz-semmelweis). The true mechanism of puerperal fever was not generally understood until the start of the http://www.answers.com/topic/20th-century. In http://www.answers.com/topic/1879 http://www.answers.com/topic/louis-pasteur showed that http://www.answers.com/topic/streptococcus was present in the blood of women with puerperal fever. By the turn of the century, the need for http://www.answers.com/topic/antiseptic techniques was widely accepted, and their practice along with the mid-century introduction of new antibiotics greatly diminished the rate of death during childbirth. Quoted from wikipedia