SCI : Childbed Fever - Case Notes

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Author - Elaine Butler - Summer 1998

Background

Teaching Notes I anticipate that the case will require two periods of a MWF class and 1 to 2 periods of a TR class.

At the beginning of the first class the students are given Handout 1 (WORD97, WORD95, MacWORD5.1, WordPerfect for Windows 5.x, Rich Text Format). This gives them background information and the observations that Semmelweis made on the differences in patient care and environment in the two wards. They split into their groups and have 15 - 20 minutes to formulate hypotheses, using Semmelweis’s observations, that would explain the difference in mortality rates between the two wards. They should also devise a test for their hypothesis.

The rest of the class period is used to discuss, and reach consensus on, their hypotheses and tests. Semmelweis discovered that all of the hypotheses were false e.g. changing the delivery position of the patients had no effect on mortality rates.

At the beginning of the second class the students are given handout 2 (WORD97, WORD95, MacWORD5.1, WordPerfect for Windows 5.x, Rich Text Format) which quotes from Semmelweis’s original paper. He describes his depression at being unable to explain the cause of childbed fever and his need to travel and rejuvenate himself. On his return he hears of the death of a colleague from symptoms similar to those of childbed fever.

The students are asked to develop another hypothesis based on this new information and describe how they would test it.

Semmelweis’s hypothesis was that childbed fever was caused by ‘cadaverous particles’ (actually the bacterium Streptococcus pyogenes; bear in mind that this was in the time before the germ theory of disease was formulated) which were transmitted from the bodies used for autopsy to the patients in Ward 1 by doctors performing patient examinations immediately after doing autopsies. The midwives in Ward 2 did not perform autopsies, hence the lower incidence of the disease in this ward.

As the paper tells, Semmelweis introduced a protocol by which all doctors were required to wash their hands in chlorina liquida, a strong disinfectant, before doing patient examinations. The results were dramatic; in the seven months after introduction of the protocol the mortality rate in Ward 1 fell below that in Ward 2.

Despite Semmelweis’s success, his findings and new techniques were not accepted by the other doctors. Their hostility was so great that Semmelweis eventually resigned his position. He died in 1865 in an insane asylum.

Discussion at the end of the second period could include the role of serendipity in Semmelweis’s discovery (serendipitous for him but not for Kolletschka!), functions and dysfunctions of authority (ridicule of his colleagues) and perhaps a wrap up with how Semmelweis’s approach to the childbed fever problem mirrors the scientific method.