On the Causes of the Endemic Puerperal Fever of Vienna

Abstract

TaE author of the following remarks having had his attention painfully called to two or three unfortunate cases of puerperal fever, prior to his visit to the Continent, had subsequently an opportunity, in walking the hospitals of Paris and Vienna, of obtaining some more extended information relative to the causes of this disease. Believing that the facts he has observed are sufficiently important, he ventures to call to them the attention of the profession. These remarks, however, must be regarded as applying especially to Vienna, although it is believed that similar causes are brought into operation in other countries, and might as effectively be combated.A short explanation of the manner in which labours are conducted in the Vienna Hospital, and the system of clinical instruction carried on, is a necessary prelude to a clear understanding of the question.There are three lying-in departments in the general hospital. The first, a secret department, to which strangers are not admitted, and which, therefore requires no further comment. The remaining two are open to medical investigation. For the sake of clearness, we shall speak of one of these as thefirst division, and of the other as the seconddivision.The first division is for the instruction of medical men and midwives. The second division for midwives exclusively.

Suppressed anti-inflammatory heat shock response in high-risk COVID-19 patients: lessons from basic research (inclusive bats), light on conceivable therapies

“…Proper RCTs can answer these relevant issues. Perhaps allowing patients to elaborate a natural and own resolution of inflammation by having high core temperature, instead of trying to avoid it with antipyretics, would be a measure as simple and positive as handwashing heralded by Dr Ignaz Philipp Semmelweis at the end of May 1847 in Vienna in order to eliminate the poisonous ‘ subter ungues’ cadaveric matter [ 227 ]. This may also suggest that the perceived Gordian knot (an intractable problem that may be solved by ‘thinking outside the box’) of allowing COVID-19 patients to develop inflammation, but resolve it by the HSR without having cytokine storm, especially those bearing chronic inflammatory diseases, may be about to be untied.…”

Ignaz Philipp Semmelweis (1818–1865): herald of hygienic medicine

“…As a public institution that predominantly served Vienna's poor, the General Hospital offered physicians and medical students many learning opportunities throughout the 19th century and had a strong emphasis on the teaching of pathological anatomy 4 . Each morning, under the instruction of Professor Klein, doctors and medical students in the obstetric department performed dissections in the hospital morgues before attending the clinic.…”

“…Now known to be caused by staphylococcal or streptococcal septicaemia, 6 it was attributed in the 19th century to unhealthy miasmas arising from the mixture of blood, pus and excrement that filled the air of these overcrowded wards 7 . The first signs of the infection — fever, tachycardia and diarrhoea — developed soon after labour, followed by a broad range of sepsis‐related symptoms, including uterine or perineal pain, peritonitis, pleural effusion, pericarditis, seizures, and violet macules on the limbs 4 . Death was often drawn out and painful.…”

La investigación antigua de la fiebre puerperal: galimatías científico y objeto de reflexión

“…Entre 1700 y finales de 1800, en el cuerpo médico todo fue galimatías sobre la fiebre puerperal. En el Departamento de Maternidad del Hospital General de Viena que era el centro de obstetricia más grande de Europa en la primera mitad del siglo XIX, donde se atendían unos seis mil partos al año (6), en promedio fallecían 13% a 17% de las parturientas (7,8), y hasta el 90% o más durante las epidemias en París (9) o en Leipzig (5). Estando la ciencia médica en aprietos, Ignaz Philipp Semmelweis había arrojado luz sobre su modo de transmisión (10), y los obstetras quedaron señalados "como instrumentos de la muerte" a menos que se lavaran las manos en una solución de hipoclorito de sodio después de realizar las necropsias de las parturientas fallecidas por fiebre puerperal y antes de hacer nuevas exploraciones vaginales en mujeres en trabajo de parto (2).…”