historical mortality rates of puerperal fever historical mortality rates of puerperal fever historically, puerperal fever was a devastating disease. it affected women within the first three days after childbirth and progressed rapidly, causing acute symptoms of severe abdominal pain, fever and debility. vienna general hospital in 1784. semmelweis worked at the maternity clinic. copper engraving by josef & peter schafer the most common infection causing puerperal fever is genital tract sepsis caused by contaminated medical equipment or unhygienic medical staff who contaminate the mother's genital tract during the delivery. other types of infection that can lead to sepsis after childbirth include urinary tract infection, breast infection (mastitis) and respiratory tract infection (more common after anaesthesia due to lesions in the trachea). puerperal fever is now rare in the west due to improved hygiene during delivery, and the few infections that do occur are usually treatable with antibiotics. the work of dr. ignaz semmelweis dr. ignaz semmelweis worked at the vienna general hospital's maternity clinic on a 3-year contract from 1846–1849. there, as elsewhere in european and north american hospitals, puerperal fever, or childbed fever, was rampant, sometimes climbing to 40 percent of admitted patients. he was disturbed by these mortality rates, and eventually developed a theory of infection, in which he theorized that decaying matter on the hands of doctors, who had recently conducted autopsies, was brought into contact with the genitals of birthgiving women during the medical examinations at the maternity clinic. he proposed a radical hand washing theory using chlorinated lime, now a known disinfectant. at the time however, the germ theory of infection had not been developed and semmelweis' ideas ran contrary to key medical beliefs and practices. his ideas were rejected and ridiculed. quite unusually, his contract was not renewed, effectively expelling him from the medical community in vienna. he died as an outcast in a mental institution. puerperal fever – a modern disease an 1841 account of epidemic childbed fever states that insofar as existing historical documents permit one to judge, childbed fever is a modern disease. the cases reported by hippocrates that are generally identified as such are not puerperal fever. there are only examples of bilious fever, then common, which among maternity patients was no different from its appearance among non-maternity patients or men; hippocrates himself never identified it as a separate and distinguishable disease. hospital hôtel-dieu de paris hôtel dieu in paris, about ad 1500. the priest on the right is issuing the last sacraments, while a nun administers to the patient on the left. patients often slept two, three and even four to a bed we encounter the first, as yet unclear indication of childbed fever in the second half of the 17th century at the hôtel-dieu in paris. phillipe peu relates that mortality among the newly delivered was very great and greater in certain seasons than others. the year 1664 was particularly devastating. another account states that the lower abdominal infection, la fièvre puerpérale, had raged every winter since 1774 among the maternity patients of the hôtel-dieu, and that often as many as 7 of every 12 patients suffered from it. the maternity clinic at würzburg for the relatively small maternity clinic at würzburg in germany, franz kiwisch von rotterau reported 27 deaths from 102 patients (26.5%) cared for during one year, much higher than the viennese hospital. semmelweis explained this from the need in small hospitals to use every patient as teaching material. in contrast, "in vienna there is such an excess of teaching material that hundreds of individuals are not used for teaching and thus are not infected". inconsistencies in data there are various inconsistencies in the datasets reported by semmelweis and provided below. inconsistencies exist for instance in reported yearly rates, and monthly rates (if aggregated to yearly basis). one of the causes may be that semmelweis used different sources. he points out several times that actual mortality rates were higher than reported ones, because during childbed fever epidemics, the maternity ward was overwhelmed with dying women, who were then transferred to the general hospital, and therefore not registered at the maternity ward, when dying. some women were also released from the maternity ward, either healthy or not so healthy, only to be readmitted to the general hospital when symptoms appeared or worsened.