Puerperal fever (from the latin puer, child), also called childbed fever or puerperal sepsis, is a serious form of septicaemia contracted by a woman during or shortly after childbirth or abortion. Historically its spread was usually attributable to unsanitary conditions, but in modern medicine can still be caused by the naturally occurring Group A Streptococcus bacterium, amongst others. Puerperal fever is now rare due to improved hygiene during delivery, and deaths have been reduced by antibiotics. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // O00-O99 - Pregnancy, childbirth and the puerperium (O00-O08) Pregnancy with abortive outcome (O00) Ectopic pregnancy (O01) Hydatidiform mole (O02) Other abnormal products of conception (O03) Spontaneous abortion (O04) Medical abortion (O05) Other abortion (O06) Unspecified abortion (O07) Failed attempted abortion (O08) Complications following abortion and ectopic and molar pregnancy... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Sepsis (in Greek Σήψις) is a serious medical condition caused by a severe systemic infection leading to a systemic inflammatory response. ... Parturition redirects here. ... Hygiene refers to practices associated with ensuring good health and cleanliness. ... Staphylococcus aureus - Antibiotics test plate. ...

History

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 antisepsis and patients were subjected to crowding, frequent vaginal examinations, and the use of contaminated instruments, dressings, and bedding. An antiseptic is a substance that kills or prevents the growth of bacteria on the external surfaces of the body. ...

The first recorded epidemic of puerperal fever occurred at the Hôtel-Dieu de Paris in 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.^[1] Hôtel-Dieu de Paris, is regarded as the oldest hospital in the city of Paris. ... 1646 (MDCXLVI) was a common year starting on Monday (see link for calendar) of the Gregorian calendar (or a common year starting on Thursday of the 10-day slower Julian calendar). ...

A number of physicians began to suspect contagion and hygiene as causal factors in spreading puerperal fever. In 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.”^[2] 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 ablution." Watson recommended handwashing with 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." ^[3] 1795 was a common year starting on Thursday (see link for calendar). ... It has been suggested that this article or section be merged with ritual purification. ... Hand washing is the act of cleansing the hands with water or other liquid, with or without the use of soap or other detergents, for the purpose of removing soil or microorganisms. ... General Name, symbol, number chlorine, Cl, 17 Chemical series halogens Group, period, block 17, 3, p Appearance yellowish green Standard atomic weight 35. ...

Prevention via hygienic measures

In 1843, Oliver Wendell Holmes 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.^[4] 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."^[5] Year 1843 (MDCCCXLIII) was a common year starting on Sunday (link will display the full calendar) of the Gregorian Calendar (or a common year starting on Friday of the 12-day slower Julian calendar). ... Oliver Wendell Holmes Sr. ...

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."^[6]

In 1844, 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, 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. Ignaz Semmelweis also noticed that puerperal fever was rare in women who gave birth before arriving at the hospital. 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. Jan. ... Ignaz Semmelweis (1860 portrait): advised handwashing with a chlorinated-lime solution in 1847. ...

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.^[7] While his results were extraordinary, he too was treated with skepticism and ridicule (see Rejection of Semmelweis). Ignaz Semmelweis (1860 portrait): advised handwashing with a chlorinated-lime solution in 1847. ...

The true mechanism of puerperal fever was not generally understood until the start of the 20th century. In 1879 Louis Pasteur showed that streptococcus was present in the blood of women with puerperal fever. By the turn of the century, the need for 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. (19th century - 20th century - 21st century - more centuries) Decades: 1900s 1910s 1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s As a means of recording the passage of time, the 20th century was that century which lasted from 1901–2000 in the sense of the Gregorian calendar (1900–1999... 1879 (MDCCCLXXIX) was a common year starting on Wednesday (see link for calendar). ... Louis Pasteur (December 27, 1822 – September 28, 1895) was a French chemist best known for his remarkable breakthroughs in microbiology. ... Streptococcus is a genus of spherical shaped Gram-positive bacteria, belonging to the phylum Firmicutes[1] and the lactic acid bacteria group. ... An antiseptic solution of Povidone-iodine applied to an abrasion Antiseptics (Greek αντί, against, and σηπτικός, putrefactive) are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. ...

Modern Occurrence

In 2004 a mother, Jessica Palmer, died of puerperal fever, caused by Group A Streptococcus in the UK. The case was much publicised in the media, and the mother's widower subsequently set up a website to highlight the continuance of the disease, its symptoms and how easily treatable it is. The group A streptococcus bacterium (Streptococcus pyogenes, or GAS) is a form of Streptococcus bacteria responsible for most cases of streptococcal illness. ...

References

1. ^ Loudon I. Deaths in childbed from the eighteenth century to 1935. Med History 1986; 30: 1-41
2. ^ Oliver Wendell Homes: The Contagiousness of Puerperal Fever paragraph 16
3. ^ The Medical Journal of Australia - "The contagiousness of childbed fever: a short history of puerperal sepsis and its treatment"
4. ^ Oliver Wendell Holmes: The Contagiousness of Puerperal Fever
5. ^ Harvard Gazette: How Oliver Wendell Holmes helped conquer the black death of childbed
6. ^ Wertz RM, Wertz DC. Lying-in: a history of childbirth in America. New York: New York Free Press, 1977.
7. ^ Raju TN. Ignac Semmelweis and the etiology of fetal and neonatal sepsis. J Perinatol 1999; 19(4): 307-310.