Childbed Fever

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Ignaz Semmelweis Scientific approach to the mystery of Childbed Fever The scientific method of research is defined as a careful, disciplined, logical search for knowledge about any and all aspects of the universe, obtained by examination of the best available evidence and always subject to correction and improvement upon discovery of better evidence.

The five steps of the scientific method are: 1. Observation: observe some aspect of the universe.

2. Hypothesis: tentative description of the observation or a working assumption, if tentative description is consistent it then becomes a theory 3. Prediction: based upon the hypothesis 4. Test: test the prediction or further observation and modify you hypothesis if needed 5. Repeat steps 3 and 4 until there are no discrepancies between the hypothesis/theory and experiment and observation.

Ignaz Semmelweis in studying childbed fever used the scientific method of research in 1847.

Semmelweis noticed that between 600 and 800 women who had died each year from childbed fever had died in Division 1 of the Vienne General Hospital.

He also noted that the number of deaths in Division II was one-tenth as many. That was Semmelweiss' initial observation. Semmelweiss also made the following observations: 1. when the hospital experienced violent epidemic of childbed fever no such epidemic was seen in the city of Vienna 2. home deliveries had a low mortality rates 3. homeless mother too poor to go to the hospital failed to contact childbed fever after self-delivering in back alleys of the city 4. did not find any relationship between weather and the number of women dying from childbed fever 5. if the delivery was especially traumatic the mother had a greater chance of coming down with childbed fever 6. observed a professor slice his finger during an autopsy who a few days later became very ill with sepsis (blood poisoning) Based upon all that he had observed Semmelweis hypothesized that the cause of the death of the Professor and childbed fever was "cadaver particles." Semmelweis argued that the cadaver particles, though invisible but susceptible to smell, were transmitted to the female patient when the doctors when they delivered babies after performing an autopsy.

Semmelweis predicted that if the doctors washed there hands to the point where they could not smell the cadaver particles that they would not transmit them to the pregnant female and the pregnant female would not develop childbed fever. Based upon that prediction Semmelweis instituted a strict policy that everyone was to wash their hands until their skin was slippery and the smell of cadaver was gone. This test of Semmelweis prediction was successful. In the first year mortality rates dropped from 18.3 % to 1.2% in division 1 and division 1.2 % had a rate of 1.3%. Semmelweis did not publish his finding at that time.

Semmelweis repeated his hypothesis in 1850 at St. Rochus Hospital in Pest where he had similar results. Again, Semmelweis did not publish his finding. Dr. Oliver Wendell Holmes in 1843 returned to the US after studying in Pairs. Holmes argued that "the disease known as puerperal fever is so far contagious at to be frequently carried from patient to patient by physicians or nurses." Whenever sanitary precautions were taken the number of childbed fever cases decreased. However after Semmelweis left Vienna the hand washes stopped and the mortality rates from childbed fever rose again into the teens.

Semmelweis in 1850 he presented his theory on childbed fever at the Viennese Medical Society. The lecture and debate went well but Semmelweis still did not write it up for publication. Had Semmelweis published at this time I believe that his findings would have been lauded. In 1860 Semmelweis did finally publish his finding in a work titled, The Etiology, Concept, and Prophylaxis of Childbed Fever. Apparently the book was poorly written, presented large amounts of unprocessed data, made sweeping conclusions in indigestible prose.

The medical community was unwilling to accept Semmelweis hypothesis for several reasons but I believe that the most important reason was that the cause of the transmission of the cadaver to the patient was the doctor. Doctor are suppose to heal not endanger. Semmelweis was from Hungary and believed that that played a role in his theories not being accepted. Another area of concern was the lack of information on what exactly the midwives did that was different in division II that was different from division I. In addition there were other doctors in the filed that had working hypothesis of the cause of childbed fever. One such theory was the miasmatic theory, being caused by a noxious condition of the atmosphere. Other theories centered on microbes causing childbed fever.

Holmes' theories I believe were more widely accepted and put into practice because he published as he worked. That allowed for others to follow his written lead and do the same. Holmes also well known, the sons of a Harvard divine. Holmes reputation grew and several others repeated his work. Thus in the end giving Semmelweis the credit he deserved for his early work on childbed fever.