d midwifery students and those attended by physicians and medical students (22). Puerperal fever, an infection normally associated with childbirth, was rampant in the hospital. Death rates among women attended by midwives were about 2 3 per cent and among those attended by medical staff, two to five times that rate. When one of his medical colleagues died after being inadvertently stuck with a sharp instrument being used for dissection of a woman who had died of PF, Semmelweis realized that whatever was causing PF was transmitted by contact with autopsy material. Semmelweis' contribution was the belated realization that the discrepancy between the rates of PF among women attended by midwives and physicians was explained by the fact that only physicians performed post mortem examinations. Semmelweis thus required all students and physicians to soak their hands in chlorinated lime after autopsies, before examining antepartal patients. Within a few months after enforcement of this practice, the PF deaths among women attended by medical staff had fallen to levels comparable to those of women attended by midwives (19).
Earlier than Semmelweis, Dr. Charles White had markedly reduced the rates of PF by disinfecting wards with chlorine gas and chloride of lime (1). Yet, what made Semmelweis' findings unique were his recognition that the agent or cause of PF was being directly transmitted from one individual to another on the hands, and the concept of one necessary cause for the disease. It is important that Semmelweis focus the attention and blame away from previous 'causes' of such infections - those of miasma or foul air, and toward a specific real cause of contamination which could be thwarted. While he was incorrect in thinking that the cause was only related to dead or decomposing matter, as he later discovered when PF was clearly propagated from a living patient with a uterine infection to the women in surrounding beds, Semm...