Puerperal Fever: A Dreadful Consequence of Childbirth

From the 1600s through the mid-1800s, puerperal fever, or childbed fever as it was more commonly called, affected women with severe and acute symptoms such as abdominal pain and fever. Puerperal was considered to be just a dreaded consequence of childbirth and motherhood. That was because beginning in the seventeenth century “lying-in” hospitals became popular throughout Europe, and these hospitals were rife for infections with their unsterilized instruments, crowded conditions, and unclean practices.

Birth scene ca. 1800. Public domain.

One of the more famous women of the eighteenth century who contracted puerperal fever was Napoleon Bonaparte‘s mother, Letizia. She contracted the illness after Caroline’s birth on 25 March 1782, but fortunately, she recovered and did not die. The feminist Mary Wollstonecraft wasn’t as lucky. She died in 1797 after giving birth to her second daughter, Mary Shelley, author of Frankenstein. Another well-known woman affected by puerperal was Isabella Mary Beeton, author of Mrs. Beeton’s Book of Household Management. She contracted it a day after giving birth to her fourth child and died a week later.

Letizia Ramolino Bonaparte. Author’s collection.

It wasn’t just the famous who died. One medical treatise written by a doctor and lecturer on puerperal fever reported in the mid-eighteenth century:

“The mortality attending the Puerperal Fever, is truly lamentable. In the year 1750, at Paris, none who were seized with it, recovered. In one hospital in London, in the space of two months, thirty-two patients were affected with the disease, and all, except one, fell victims to it. In another hospital, nineteen were seized with it, during the epidemic season, thirteen of whom died. In the Lying-in Ward at Edinburgh, all who were attacked with it, in the epidemic season died.”[1]

Twenty years later, there was little improvement:

“In the year 1770, this fever raged with great violence in several of the London lying-in hospitals. In the Westminster Hospital, between November 1769 and May 1770, of sixty-three women delivered, nineteen had Puerperal Fever, and fourteen died. In the British Lying-in-Hospital, thirty-five died during the year. In another establishment of the same nature in London, of 224 delivered, ten died of Puerperal Fever.”[2]

Doctors had no idea what caused puerperal fever and argued about it. Some maintained that death could be linked to excitability in the body brought on by the childbirth itself. In 1785, Thomas Denman, a doctor of midwifery at London’s College of Physicians and teacher of midwifery in London, cited other reasons:

“It has been represented by some writers, as entirely owing its existence to the undue secretion or subsequent deposition of the milk, and therefore denominated … Some again have considered this disease not as a Fever, but as an inflammation or ulceration of the Uterus, while others have contended that inflammation was wholly confined to the Omentum, the Peritoneum, or the Intestines, and that the Uterus was not in anywise concerned. A contrariety of opinion … was produced by the interpretation of the word Erysipelas, … without any intention to denote a specific kind of inflammation”[3]

Thomas Denman. Courtesy of Wikipedia.

There was the belief that ill-ventilated hospitals with miasma air, might cause it because such air depressed “vital energies,” thereby harming individuals. Temperature or humidity was also thought to play a role as it was reported that one doctor at the lying-in-wards of the Hotel Dieu in Paris made “wholesome” atmospheric changes that proved dramatic. “[M]ortality of one in seven … [changed to] only one in seventy-seven.”[4] Another suggestion was the avoidance of dampness combined with fumigation, cleansing, and ventilation of wards. This was done in Dublin and remarkable reductions in death numbers were reported after 1829, which then bolstered the idea that the disease was somehow affected by the atmosphere.

One doctor stated in 1823, “Great discrepancy of opinion still exists among writers of celebrity, respecting the … treatment of … puerperal.”[4] His suggestion that a wide variety of varying opinions existed also resulted in a wide array of opinions about how to treat it. Remedies ranged from bleeding, purgatives, emetics, mercury, opium, alkalies, fomentations, and blistering to turpentine, alum, and various homeopathic treatments. 

Despite all the disagreements over what puerperal was, what caused it, and how to treat it, doctors generally agreed on its symptoms, which appeared about twenty-four to thirty hours after a woman delivered and seldom appeared later than four days after. The onset of symptoms often included languor, nervous irritability, and a headache behind the eyes, as well as what one doctor described:

“The disease was mostly ushered in by very slight shiverings, or rigors, by oppression at the praecordia, by vomiting, retching, or nausea, and by considerable anxiety of mind. When shiverings or rigors abated, which were often very short, the skin became universally hot and dry, and the thirst urgent. The tongue was much paler than usual, and appeared as if it had been recently rubbed, or dusted with a fine whitish powder … The matter thrown up consisted of the ingesta, mixed with mucus, and and yellow or greenish bile. The pulse was seldom less than 120 in the minute, and mostly rather full, tense, and vibrating, or very small, sharp, or somewhat wirey, when the excitement had fully emerged.”[5]

Puerperal fever generally ran its course in a few days. Doctors reported that for those women who died, soon after their death, the corpse became “livid” and “offensive” in smell and that the abdomen was “immensely distended.”

As conjecture over puerperal fever continued, in 1840, when mid-wives recorded lower incidences of puerperal than did doctors, a Hungarian physician named Ignaz Semmelweis became intrigued and approached the issue methodically. He discovered antiseptic solutions used before delivery reduced the incidence of puerperal. Unfortunately, doctors at the time did not understand germs and were offended that they might cause the problem or that the idea of hand washing would cure it. This was noted by one well-regarded Philadelphia obstetrician, Charles Delucena Meigs who exclaimed, “Doctors are gentlemen, and gentlemen’s hands are clean.”[6]

puerperal fever

Ignaz Semmelweis. Courtesy of Wikipedia.

Prior to Semmelweis’ findings in 1844, other physicians noticed a similar connection to uncleanliness and puerperal. For instance, Thomas Watson, a professor at King’s College Hospital in London wrote in 1842, “Wherever puerperal fever is rife … a practitioner … should use most diligent ablution … to prevent the practitioner [from] becoming a vehicle of contagion and death between one patient and another.”[7] In 1843, Oliver Wendell Holmes formed a similar conclusion. He concluded puerperal was passed from physicians to their patients and from patient to patient because of uncleanliness.

Oliver Wendell Holmes. Courtesy of Wikipedia.

Despite the expanding evidence that uncleanliness was the problem, the medical community criticized Semmelweis, Watson, and Holmes. However, Semmelweis was not deterred. He ordered students and doctors working in his hospital in 1847 to wash their hands with a chlorinated lime, now known to be a disinfectant. They were instructed to do so before starting work and after examining patients. The results were amazing. Incidences of puerperal fever miraculously fell, but ignorant doctors refused to accept his findings. In fact, Semmelweis’s ideas were seen as so outrageous, doctors tortured him until eventually he was committed to a mental institution and died.

References:

  • [1] Gordon, M.D., Alexander, A Treatise on the Epidemic Puerperal Fever of Aberdeen, London, 1795 p. i.
  • [2] Campbell, William, A Treatise on the Epidemic Puerperal Fever, as it Prevailed in Edinburgh in 1821-1822 to which is Added an Appendix, Containing the Essay of … Gordon on the Puerperal Fever of Aberdeen in 1789-1792, p. 13-14. 
  • [3] Denman, Thomas, An Essay on the Puerperal Fever, 1785, p. 1-2.
  • [4] Moore, George, An Enquiry Into the Pathology, Causes, and Treatment of Puerperal Fever, 1836, p. 197
  • [4] Armstrong, John, Facts, Observations and Practical Illustrations, Relative to Puerperal Fever, Scarlet Fever, Pulmonary Consumption, and Measles, 1823, p. 1.
  • [5] Ibid., p. 1-2.
  • [6] Nevins, Michael, Meanderings in New Jersey’s Medical History, 2011, p. 52. 
  • [7] Watson, Thomas, Lectures on the Principles & Practice of Physic, 1871, p. 426.

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