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| Mary Woolstonecraft, author of the Vindication of the Rights of Women fell victim to Childbed fever in 1797 having given birth to her daughter Mary Shelly the author of Frankenstein |
The discovery of antibiotics has transformed all of our lives but it was found quite by accident when Professor Alexander Fleming discovered that one of the plates which had previously been coated with staphyloccus bacteria had mould on it in 1928. The mould was penicillium notatum but it was not used on a human being until 1941 when an Oxford doctor, Charles Fletcher, tried it on a patient dying from an infected wound. The patient unfortunately died, not because the drug did not work but simply because Fletcher did not have enough to kill all the bacteria. Having proved its effectiveness in reducing bacterial infection in people the drug went into production and was available to treat patients from the end of World War II. In 1945 Fleming, and the US drug company that manufactured the new ‘Wonder Drug’ Chain and Florey were awarded the Nobel Prize for Medicine.
Staphylococcus has many strains and causes a wide variety of diseases in humans and animals. About 20% people are long-term carriers of staphyloccus aureus on the skin or in the nostrils and it lurks quite inertly in the healthy lower reproductive tract of women. It can cause a range of illnesses, from minor skin infections, such as pimples, impetigo, boils, cellulitis, folliculitis, carbuncles, scalded skin syndrome, and abscesses, to life-threatening diseases such as pneumonia, meningitis, osteomyelitis, endocarditis, toxic shock syndrome, bacteremia, and sepsis. It is still one of the five most common causes of hospital-acquired infections. When it gets into the bloodstream your chances of surviving without antibiotics is about 20% for a healthy adult for the frail and the very young it is much lower so it is not surprising that many people in the past died of what we consider to be relatively minor illnesses e.g.:infected wounds, rotten teeth, septic throats, leg ulcers and abscesses.
Puerperal or childbed fever was a common infection in the past. It is an infection of the uterus and surrounding tissues. Infection can be caused by a number of factors: premature rupture of membranes, vaginal examinations, manual removal of the placenta, and prolonged labour. In chapter II of 'Feavers and Acute Diseases in Women in Childbed' Nicholas Culpepper discusses puerperal fever (though not by this name) and attributes it to the “…stoppage of the afterflux… or the foul humours that were gathered at the time of being with child and stirred in travel” i.e. labour. In addition to this, getting up too soon after childbirth, too rapid a delivery, changes in the weather, strong drink, spices, metastasizing milk, and obstructed perspiration were all suggested as possible causes but the most popular was that it arose from poisons in the atmosphere or miasma.
The epidemic of childbed fever that struck the city of Aberdeen, Scotland, between December 1789 and March 1792 was unusual. It occurred not in the dirty, crowded and ill-ventilated wards of lying-in hospitals, but throughout the city and surrounding villages. Alexander Gordon, physician to the Aberdeen Dispensary found that "this disease seized such women only as were visited or delivered by a practitioner or taken care of by a nurse who had previously attended patients affected by the disease." He admitted, "I myself was the means of carrying the infection to a great number of women." He went on to recommend in his report of 1795 that, "Nurses and physicians who have attended patients afflicted with the puerperal fever ought carefully to wash themselves and get their apparel properly fumigated before it be put on again." Unfortunately his advice was rejected by the medical establishment of the time, he died a broken man a few years later and the carnage in the the lying-in wards continued unabated.
One famous victim of puerperal fever was Mary Wollstonecraft, mother of Frankenstein author Mary Shelley. In 1797 she gave birth to her daughter Mary with the assistance of a midwife but then a doctor was called to help remove the placenta. He came quickly and with unwashed hands removed it. Wollstonecraft died a painful but typical death a week later. Today, as I know myself these infections are treated with antibiotics. Antibiotics saved my life twice in childbirth so I am very grateful that I was born after their discovery.
In the 1790s, Gordon stressed that the disease was spread from one patient to another. In 1842, Thomas Watson recommended that physicians and birth attendants wash their hands and use chlorine between patients. In 1847, Ignaz Semmelweis reduced the rate of fever in his obstetric ward by ordering hand washing, but the idea was still rejected by the medical industry at large and it was not until the late 1850s when the work of Louis Pasteur and Robert Koch provided convincing evidence of what we now call 'germ theory' that the idea of human transmission of infection started to be accepted. Indeed in 1880 the miasma theory was still competing with the germ theory of disease. Eventually, a "golden era" of bacteriology ensued, in which the theory quickly led to the identification of the actual organisms that cause many diseases.
Antibiotics are precious and we should use them wisely. If we look at what life was like before we had them I am sure we would not take them for granted.
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References:
Porter Ian A. Alexander Gordon MD of Aberdeen 1752-1799. University of Aberdeen:Oliver and Boyd (Edinburgh), 1958.
Gordon, Alexander. A Treatise on the Epidemic of Puerperal Fever of Aberdeen.London:GG and J Robinson,1795.
https://en.wikipedia.org/wiki/Germ_theory_of_disease (01.05.2016)
A Directory of Midwives or a Guide for Women” by Nicholas Culpepper (London, 1681).
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