5 - HOW THE CHANGE BEGAN: THE STORY OF SEPSIS

Summary

The contagiousness of childbed fever was first recognised by Alexander Gordon in Aberdeen in 1795. Epidemics occurred in cities, rural communities and lying-in hospitals. In the USA Oliver Wendell Holmes caused uproar by saying doctors were carriers of disease. In 1848 Semmelweis reduced the death rate in Vienna’s maternity hospital by introducing handwashing but was not recognised until later. In the 1870s panic took hold in England. Midwives were charged with homicide and the hospital death rate in London was 2.6%. In Europe Billroth described the streptococcus and Pasteur showed that it caused puerperal sepsis. In Britain Listerian asepsis transformed surgery and reduced the death rate in lying-in hospitals. In the 1930s Colebrook worked on aseptic maternity practice. In Germany Domagk discovered prontosil and in 1936 Colebrook demonstrated its life-saving effects. Fleming discovered penicillin and Florey and Chain turned it into an antibiotic. Maternal mortality fell rapidly. By 1982-4 antibiotics had abolished deaths from puerperal sepsis but by 2006-8 sepsis was again the leading cause of Direct death and the Reports emphasised the need for constant vigilance.