Historical Review
Alexander Gordon, puerperal sepsis, and modern theories of infection control—Semmelweis in perspective

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Summary

Ignaz Semmelweis, a Hungarian doctor who practised in 19th century Vienna, is widely believed to be the father of modern infection control. He earned this accolade when he showed that puerperal sepsis was contagious and that it could be prevented with adequate hand hygiene. In fact, such ideas had circulated in the medical world for at least a century before Semmelweis' work. Moreover, it is well documented that Alexander Gordon, an obstetrician working in Aberdeen, UK, was the first to prove the contagious nature of puerperal sepsis. He also advocated the need for good hygiene for its prevention in a thesis published in 1795. This work described an epidemic of puerperal sepsis that began in Aberdeen in 1789. Gordon's thesis was reprinted three times in Edinburgh, Philadelphia, and London over the next 55 years, suggesting that Semmelweis (1847) could well have known of his work. Like Semmelweis, Gordon was persecuted for his findings.

Introduction

Ignaz Semmelweis is commonly accepted as the first person to show the contagious nature of child bed (puerperal) fever and to have shown the benefits of improved hygiene in preventing spread of infection from the post mortem to the patient.1 Specifically, in 1846, Semmelweis advocated disinfection of hands of attendants, instruments, and dressings and isolation of infected women. However, it is well documented in several texts that others preceded him in this momentous work.2, 3, 4, 5 Most famously Oliver Wendell Holmes published a pamphlet Puerperal Fever as a Private Pestilence in 1855 and The Contagiousness of Puerperal Fever in 1843,6 3 years before Semmelweis. It was not until 1861 that Semmelweis wrote Die Aetilogie, der Begriff und die Prophylaxis des Kindbettfiebers (the aetiology, concept, and prophylaxis of childbed fever).7 This was 66 years after Alexander Gordon of Aberdeen published his observations on an epidemic of puerperal sepsis that started in Aberdeen in 1789 in A Treatise on the Epidemic Puerperal Fever of Aberdeen8 in which he showed the contagiousness of puerperal fever and advised disinfection of the hands and clothes of doctors and midwives.

In fact, Hippocratic writings give a clear description of puerperal fever5 and the term is first recorded in 1716 by Edward Strother.5 In 1751, John Burton9 suggested the disease might be contagious, although just before this in 1746 was the first complete account of an epidemic at the Hotel Dieu, Paris.5 In 1772, John Leake10 thought it to be a contagion and the next year Charles White11 pleaded for cleanliness of surroundings for women who had recently delivered. In 1790, Joseph Clarke recommended isolating patients and disinfecting wards.12 But it is to Alexander Gordon that the plaudits should really go for conclusively showing the contagious nature of puerperal fever and also how to prevent it.

So this short review will, not for the first time, attempt to set the record straight, following in the footsteps of Lea (1910),2 Thoms (1928),3 Colebrook (1956),4 and Porter (1959),5 all of whom unequivocally supported Gordon's claim. Gordon's rightful place as a pioneer of British medicine and modern ideas of infection control has never been acknowledged. Not that everything in Gordon's treatise was correct. His ideas on, for example, blood letting as a treatment were completely wrong and this was realised by many at the time it was published.

Section snippets

Gordon's treatise on child bed fever

Gordon's treatise was published several times over the succeeding half century, with addenda.8, 13, 14 The original 1795 version8 had seven chapters, the first briefly describing the history and symptoms of puerperal fever. The epidemic started in December, 1789 (which coincidentally was the year the Aberdeen Medico-Chirurgical Society was formed), and seems to have been classic in much of its presentation. Importantly, it did not affect a lying-in (maternity) hospital, only a few midwives and

Gordon's treatise in context

Girolamo Fracastoro (1478–1553) was perhaps the first to suggest a modern form of so-called germ theory.16 In 1546 he proposed that epidemic diseases were caused by seminaria (seeds) spreading from one person to another by one of three methods: direct contact, contamination of the environment, or through the air. This challenge of the traditional miasma theory had to await the discovery of the microscope for proof. In 1658 and 1676, respectively, using such microscopes, Athanasius Kircher and

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