Puerperal fever, or "childbed fever", is the term generally used to describe a nosocomial infection following childbirth. It is defined by fever > 38.4°C for two consecutive days in the nine days following childbirth. The fever can be accompanied by abdominal and/or uterine tenderness, pelvic abscess, wound infection, septic pelvic thrombophlebitis, pulmonary atelectasis (the collapse of the small airways of the lung) and other serious conditions. (1)
Puerperal fever is usually caused by Streptococcus pyogenes, a group A b-hemolytic streptococcus, although other organisms have been found to cause similar infections. Strep pyogenes can also cause sore throat, scarlet fever, osteomyelitis and skin infections. (2) Group A streptococci are gram-positive, have a rigid cell wall (like other gram -positive organisms), and are heat- and acid-resistant due the presence of the M protein on the fimbria-like appendages and on the surface of the cell. (2),(3). Useful tests for identifying Strep pyogenes are blood agar culture (for positive hemolysis), bacitracin sensitivity, and catalase negative (H2O2). (4)
Puerperal Fever, which is relatively rare today, has been identified as the "scourge of European hospitals in the 1800's" and was thought to be responsible for the death of as many as 1 out of every 5 new mothers, if not more. (5) The disease was not thought to be contagious. In 1842, Oliver Wendell Holmes, Professor of Anatomy & Physiology at Harvard (9), became aware of another doctor and medical student who cut themselves during an autopsy of a puerperal fever victim; they both became ill and the student died. Holmes started to research this and in 1843, presented a paper on his findings which basically denounced medical doctors for infecting their patients by carrying the disease from one patient to another. His findings were either ignored or not welcomed.(5)
During the same time in Austria, Iganz Semmelweis, an obstetrician and surgeon, noticed that the mortality rate from Puerperal Fever was drastically higher in the teaching hospital than it was in the hospital training midwives. When a colleague cut himself during an autopsy and died from a disease that looked very much like the one killing the new mothers, Semmelweis began to examine the cause of the disease (7). He concluded that the male doctors were transferring the disease from the autopsy rooms to the birthing rooms and ordered all doctors and students to wash their hands in a chlorine solution before attending a laboring mother (7). Within a few months of instituting these practices, the mortality rate fell from 18 percent to 2.45 percent. (8). This news was not welcomed and the controversy continued until the end of the century. There was little agreement that the disease was contagious even after Holmes and Semmelweis' findings became known. Indeed, in 1845, a Dr. Waddy published a lengthy treatise on Puerperal Fever in the Lancet and not once is there mention of what might cause the disease. (10). It wasn't until Lister's findings in 1867 on antisepsis (11) and Pasteur's later work demonstrating that Puerperal Fever was usually caused by Streptococcus that practices really started to change. (9) Unbelievably, according to the 1995 Journal of Hospital Infections, handwashing still remains ineffective and sporadic among practitioners in all health care settings. (6)
(1) No author. University of Iowa Family Practice Handbook, 3rd Edition. http://www.vh.org/Providers/ClinRef/FPHandbook/Chapter08/32-8.html
(2) Tortora, Funke, and Case. "Microbiology, An Introduction", 6th edition. 1998, p.604,
(3) Joklik, Willett, Amos. "Zinsser Microbiology", 18th ed., p. 464-471.
(4) Hudson, Barbara K. and Sherwood, Linda, "Explorations in Microbiology", Prentice-Hall, 1997.
(5) Powell, Alvin. The Harvard University Gazette, "Defeating Infection". 09/18/1997. URL: http://www.news.harvard.edu/gazette/1997/09.18/DefeatingInfect.html
(6) No author. "Dr. Greene's House Calls". URL: http://www.drgreene.com/961230.asp
(7) No author. Compton's Encyclopedia Online. URL: http://www.optonline.com/comptons/ceo/04307_A.html
(8) Senfelder, Leopold. The Catholic Encyclopedia. 1999 URL: http://www.newadvent.org/cathen/13712a.htm
(9) Carr, Ian, M.D. "Dying to Have a Baby - The History of Childbirth". University of Manitoba. URL: http://www.umanitoba.ca/outreach/manitoba_womens_health/hist1b.htm
(10) Waddy. "On Puerperal Fever," Lancet 1 (June 14, 18450 671-675. URL: http://wsrv.clas.virginia.edu/~wwc2r/vicstudies/1845_L1.waddy.html
(11) No author. "A Century of Obstetrics". The University of Pennsylvania Health Care System. URL: http://www.obgyn.upenn.edu/History/puerp.html