Puerperal fever was a feared disease throughout Europe of women who delivered a child in a public hospital. In the most modern hospital in Vienna, the Allgemeine Krankenhaus,as many as one quarter of the patients in labor in the First Division would die of the disease.  It should be mentioned that the germ theory of disease propounded by Pasteur and Koch was twenty years in the future.  Pasteur was yet to lecture the physicians of Paris on the need to use clean instruments, bandages and to wash their hands. 
     Puerperal infection is  recognized today as occurring in various parts of the female reproduction organs resulting from contamination of the surfaces following childbirth or abortion.   Generally this is due to an unhygienic environment  or unclean instruments used during surgery.  The infection can spread to other organs including the genital tract and well as the blood and lymph to cause blood poisoning, and lead to widespread infection throughout the body.  Pus and exudates accumulate in various tissue parts  A variety of microorganisms can cause the infection including group A hemolytic staphylococci, E. coli and Clostridium welchii.  Fever occurs, organs degenerate and in a few days as many as one-quarter of the ill may die.   Puerperal fever is rarely seen today in countries practicing hygienic medicine.
     Ignaz Semmelweis, received his medical degree in 1844 from the University of  Vienna and was appointed assistant physician in midwifery in 1847.  The Vienna hospital and its medical staff were widely noted for pathological examination involving autopsy of every patient dying during treatment often followed by examination of their patients on the wards.  Semmelweis took note of the curious data arising from the fluctuating puerperal infection rates of the two delivery wards in the hospital.   The Second division manned by nurses and midwives always had an infection rate about one-third that of the First Division.   The procedure in the latter division was for the young physicians and trainees to spend the morning dissecting cadavers of patients who had died of puerperal fever followed by checking on their live patients in their ward and delivering newborn as required.  These examinations involved multiple internal probing of the womb, uterus and other parts of the female reproductive system using their bare, unwashed fingers and hands.  In contrast, the staff of the Second Division generally monitored their patients and participated in the deliveries.  Despite years of investigation, it wasn't clear why the infection rates were so high in the first division.  The causes were variably blamed on a variety of causes such as ventilation, "miasma", overcrowding of the wards, the weather, and the onset of lactation.  Infection was accepted as inevitable and  death unpreventable.
     Semmelweis  was as puzzled as the next as to the cause of the disease.  He tried all the remedies including having women deliver lying in different positions (a postulated cause of infection) to no avail.   As he studied more cases he became aware that there was no correlation between those factors blamed on infection and the infection itself. In 1847 a tragic but seminal event occurred, as important in its impact as was the finding by Pasteur years later of the protective effect of accidentally-inactivated inoculation fluid in his study of chicken cholera.  Professor Jacob Kolletschka, a colleague and friend of Semmelweis was accidentally pricked in the finger during an unrelated autopsy. He died a few days later. His autopsy revealed massive infection with pus and abnormalities in many tissues not unlike that found in women dead of puerperal fever.  Semmelweis correctly deduced that the cause of puerperal fever and the infection of his friend were similar.  They had to be due he reasoned to the introduction into the body of foreign, contaminated matter - cadaver particles.  And it became crystal clear that the modality for infecting the women in labor were the hands of the physicians and students who transferred contaminated particles from one patient to another or cadaver to patient! [To read of Semmelweis' discovery in his own words, Click Here]
     In short order Semmelweis introduced chloride of lime (a disinfectant) into the wards and insisted that no physician or student could touch a patient without first undergoing rigorous hand-washing and scrubbing in the disinfectant. The incident of puerperal fever dropped precipitously (from 17 percent to 1 percent) in the first division and remained low as long as the routine of disinfection was not breached.   Unfortunately, many of the older and influential physicians including Prof. Klein, Semmelweis' superior, placed little stock in Semmelweis' doctrine, belittled his work despite the evidence before them, thus diminishing its impact in hospitals and clinic  across   Austria and Hungary.   In addition. Semmelweis resisted given more than a few lectures on preventing puerperal fever to medical groups. He unexplainably failed to publish his work until 1861, 14 years after his discovery, when he brought forth a large and rambling book "Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers (“Etiology, Understanding and Preventing of Childbed Fever").  The book received adverse criticism.  The preponderance of medical thought still held with the older ideas of the cause of the disease.  This rejection led Semmelweis to attack those authorities who opposed his teaching and undoubtedly did not help his cause.   It required the passing of the old guard to fully accept the doctrine of Semmelweis, namely the requirement for asepsis in the hospital ward.   Ironically Semmelweis following a nervous breakdown died in a mental institution with an infection not unlike that of puerperal fever
      Joseph Lister, meanwhile, in England, assiduously building on the germ theory of Pasteur, widely published his research.  He was making medical history by introducing asepsis into the surgery.  Ironically, the doctrine of Semmelweis first became known to Lister and Pasteur the same year that Semmelweis died.  It has been noted by Nuland in his wonderful review of Semmelweis' career ("The Doctor's Plague", W.W. Norton & Co. New York, 2003) that if Semmelweis had availed himself of the microscope to examine the pus and exudates of infected women he might have predated Pasteur in promulgating the germ theory of disease.  Lord Lister reviewing Semmelweis' work stated  “I think with the greatest admiration of him and his achievement and it fills me with joy that at last he is given the respect due to him.” (Enc. Britannica, 2003 ed.)  [copyright DVC, Jan. 2004]