disparate conditions—puerperal fever and pathol-
ogist’s pyemia—together.
Semmelweis practiced and taught at Vienna
General Hospital, a major medical mecca of its
time. Its maternity ward was very busy. As was
the custom of the time, women attended by physi-
cians went to one ward and women attended by
midwives went to another ward. In 1847, the year
of Semmelweis’s epiphanic recognition, 20 to 35
percent of women who received care from doctors
during childbirth died within weeks from puer-
peral fever. Only 2 percent of women who
received their childbirth care from midwives met
with similar fate.
Another customary practice of the time was for
doctors to immediately autopsy patients who died,
partly to provide education for student doctors.
After his close friend died of a massive infection
resulting from a wound suffered while conducting
an autopsy, Semmelweis began to observe the pat-
terns of illness in the maternity ward. He soon
concluded that the practice of doctors freely mov-
ing between performing autopsies and attending
to deliveries was the likely cause.
Semmelweis began to cleanse his hands with
chlorinated lime before entering the childbirth
ward and required his students to do the same.
Though the caustic solution left the doctors’ hands
somewhat raw, nearly immediately the infection
rate on their maternity ward dropped to 3 per-
cent—much the same as the rate of infection on
the midwifery ward. Midwives, of course, did not
participate in autopsies. The change was a turning
point in medicine’s approach to childbirth. Within
a decade antisepsis converged with the discovery
of ANESTHESIAto vastly improve the safety and
comfort of childbirth. When England’s Queen Vic-
toria received chloroform anesthesia during child-
birth in 1853, she established a standard of
acceptability for both improvements.
CESAREAN SECTION (surgical childbirth) also
became a reasonable option for difficult deliveries,
allowing doctors to save both mother and baby.
Though ancient Chinese medical texts allude to a
surgical childbirth procedure, cesarean section was
an action of desperation to save the infant, gener-
ally carried out only when it was clear the mother
had no chance of survival or had already died.
Though popular mythology attributes the proce-
dure and its name to the surgical birth of Rome’s
Julius Caesar, most medical historians believe such
a correlation is highly unlikely. More likely is the
derivation of the name from the Latin word
caesones, the term applied to the infants who sur-
vived surgical extraction from their dying or dead
mothers. Historical records document that Julius
Caesar’s mother lived long after her son’s birth.Breakthrough Research and Treatment Advances
The final decades of the 20th century brought piv-
otal advances in reproductive medicine. The first
in vitro fertilization (IVF) baby—“test tube
baby”—was born in England in 1978. Since then
ASSISTED REPRODUCTIVE TECHNOLOGY (ART) has
brought thousands of babies into the world. Today
IVF is the cornerstone of treatment for infertility.
Nearly 45,000 ART babies are born in the United
States each year.
The coupling of advances in diagnostic imaging
procedures and surgical techniques gave birth to
the new subspecialty of fetal surgery, in which
surgeons can operate on the unborn fetus to cor-
rect potentially devastating or fatal birth defects
such as severe SPINA BIFIDA and congenital
diaphragmatic HERNIA (incomplete formation or
absence of the DIAPHRAGM). Technologic advances
have also vastly improved the survivability of pre-
mature (preterm) infants, with some measures
targeting efforts to maintain the pregnancy as long
as possible and others focused on supporting the
still-developing baby after birth.
Among the flurry of advances in pharmaceuti-
cals at the turn of the 21st century, none attracted
quite so much attention or sales as the phosphodi-
esterase (PDE) inhibitor medication to treat EREC-
TILE DYSFUNCTION, sildenafil. The trade name
product Viagra catapulted to record sales, becom-
ing the highest selling DRUGof all time within six
months of its release. Sildenafil was the first con-
venient treatment for physiologically based erec-
tile dysfunction, which affects about 25 million
men in the United States.
The start of the 21st century also marked the
end of a more than 50-year tradition in medical
history when extensive research studies concluded
that routine hormone replacement therapy (HRT)
to treat menopause did not provide the health
benefits widely attributed to it but instead signifi-238 The Reproductive System