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* Author for correspondence: P. Jadraque, Department of Epidemiology, Hospital General de La Palma, 38710 Breña Alta Canarias, Spain. (Email: [email protected])
INTRODUCTION
In the late 18th and early 19th centuries, vast numbers of postpartum women died from a disease known as puerperal fever or childbed fever. In some maternity facilities, over a period of several years, mortality from this disease averaged more than twenty percent of all admitted patients [1]. In the maternity facilities of Vienna's main hospital, the Allgemeines Krankenhaus (AKH), the overall mortality rate was relatively favourable – about 7–10% 1 ; however, there were about five times as many deaths in one part of the facility, called the First Division, as in another part, called the Second Division [2].
Ignác Fülöp Semmelweis is famous for dramatically reducing puerperal mortality in the First Division of the AKH. At the time, Semmelweis was Assistant to Johannes Klein who was Professor of Obstetrics in the First Division. Soon after being appointed, Semmelweis realized that, unlike the (female) student midwives in the Second Division, who did not conduct autopsies, (male) student obstetricians in the First Division regularly came to the obstetrical wards with hands reeking of decaying remains from the autopsies they were conducting in the morgue. He originally hypothesized that puerperal fever was caused by the cadaveric particles which could be identified by its smell – later he extended the cause to every decaying organic matter. Sometime in the middle of May 1847 (the exact date is unknown), Semmelweis began requiring all medical personnel to wash, thoroughly, in a chlorine solution, in order to deodorize the hands, before examining patients or delivering babies. Almost immediately, mortality in the First Division fell to about the same rate as was maintained in the Second Division [2].
Today, Semmelweis's views seem unquestionably correct. We now understand that decaying organic matter contains pathogenic flora and that washing with a chlorine solution can help disinfect the hands. Also, the deaths to admissions ratios at the AKH from the time it opened (1784) through the time Semmelweis supervised the use of chlorine washings (1849) are consistent with Semmelweis's statements. These ratios are shown in Fig. 1 below as slopes of the (straight, not drawn) lines that bind points. A horizontal line...