In the mid-1800s, hospitals were a very dangerous place for a birthing woman. Some may say they still are today. Prior to the recognition of hygiene practices like handwashing and sterilizing medical instruments, women who gave birth in the hospital commonly fell victim to a significant and deadly complication of childbirth known as puerperal fever.

You probably have never heard of puerperal fever, but in the 19th century, some hospital’s rates were as high as 30%.

Also known as childbed fever, puerperal fever is a serious infection that can occur in the female reproductive tract following childbirth or miscarriage–especially fatal in the pre-antibiotic era. Characterized by fever, abdominal pain, uterine tenderness, and other symptoms of infection, puerperal fever can be caused by various bacteria, including Streptococcus pyogenes (group A streptococcus) and other pathogens.

The 19th century marked the medicalization of childbirth, where childbirth increasingly came under the purview of the medical profession. The shift away from the traditional home birth with midwives, to modern medical facilities managed by trained physicians, however, was met with the unforeseen medical complication. You guessed it: puerperal fever.

The problem occurred both in the Americas and throughout Europe, but it would be a Hungarian physician, Ignaz Semmelweis, who made an important observation that would change the course of history. He astutely observed a stark contrast in mortality rates between the maternity ward attended by medical students and doctors and the one managed by midwives in the hospital where he worked, Vienna General Hospital. He formulated a hypothesis that the doctors and students might unwittingly transmit infectious agents from cadavers they dissected to the women they examined.

In 1847, Semmelweis boldly enforced a mandatory handwashing protocol with a chlorinated lime solution for all medical personnel before patient examinations. Astonishingly, this simple intervention drastically reduced the mortality rate in the doctor’s ward, plummeting from 18% to a mere 2%.

Despite the evidence that handwashing prior to patient examinations had contributed to a dramatic reduction in puerperal fever, Semmelweis encountered vehement resistance from the medical establishment, where many practitioners were reluctant to accept their role in disease transmission and recoiled at the suggestion of handwashing.

He was eventually dismissed from his position at the Vienna General Hospital in 1849. This dismissal came as a significant blow to his career and reputation. 

Following his dismissal, Semmelweis faced severe mental health challenges, possibly from a syphilis infection he acquired during his research into infectious disease. He struggled with depression and was committed to a mental institution in Vienna.

Ignaz Semmelweis tragically died in the mental institution on August 13, 1865, at the age of 47. The circumstances of his death are both mysterious and heartbreaking. He succumbed to a wound infection, possibly resulting from a physical altercation with staff at the institution.

Beyond his work on puerperal fever, Semmelweis made notable contributions to comprehending diseases such as cholera, typhus and syphilis, passionately advocating for the paramount importance of cleanliness and hygiene in disease prevention.

It was only posthumously that Semmelweis’s pioneering insights on handwashing and infection control gained widespread acceptance.

The story of Ignaz Semmelweis stands as a reminder that truth is often met with opposition, especially when it questions a reigning, predominant belief system. The medicalization of health has been predominated by a paternalism that is blinded to its own bias, beliefs, and ego.

Rather than the docile compliance of conformity, we must practice reason, which is the ability to think for oneself, to question what one is told, and to seek out the truth.

Further reading critical of the practice of medicine:

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