Eighteenth-century obstetricians produced a considerable body of work in which they sought explanations and solutions to the problem of puerperal fever. Mixing common sense with misapprehension, they devised sometimes fanciful, sometimes practicable plans that emphasized cleanliness, the avoidance of overcrowding, controlling the temperature in the lying-in rooms and wards, and ensuring efficient ventilation. They generally stopped short, however, of realizing the contagiousness of puerperal fever and the imperative need for sterile procedures in labor and delivery.
These obstetricians sought to improve air quality in lying-in rooms by prioritizing effective ventilation in an effort to eliminate "putrid effluvia." The belief that something in the air caused fatal putrefaction dated to William Cullen (1710-1790), an Edinburgh physician, who theorized in 1786 that the remote cause of epidemics could be traced to "some matter floating in the atmosphere" (xli).
In 1773, Charles White (1728-1813), a surgeon and man-midwife at the Manchester Public Infirmary, insisted that the lying-in room should be free from all unhealthy elements: "The stools, urine, and foul linen should not be permitted to remain in the apartment" (20). That he should issue this caution demonstrates the poor care a mother-to-be could expect in the eighteenth century. Contemporary practices obviously justified his insistence. White describes contaminated air in confined places such as hospitals, jails, small houses inhabited by many families, and lying-in rooms as the perfect breeding ground for "putrid fevers" (1).
Explaining how to purify the air, White borrowed a fanciful idea from James Lind (1716-1794), a doctor who had proposed the explosion of small quantities of gunpowder to drive out "foul air," claiming that the explosion created an "antiseptic vapor" that eliminated the "putrid effluvia" believed to cause puerperal fever. Although White additionally favored the inhalation of certain substances, such as warm vinegar vapor, he had reservations about fumigating the wards with it since he doubted whether it was as antiseptic "as has been advised by many authors." Instead he found that distillation of vinegar produced quantities of watery steam that worsened the very complaints he was trying to remedy (16). White rejected other air purifiers such as sprinklings of vinegar infused with camphor, tobacco, potassium nitrate, pitch, tar, resinous or aromatic gums, sulphur, or frankincense, finding them unnecessary as long as the room was plentifully supplied with fresh air.
In 1775, the physican William Butter proffered advice consistent with White's. In his words, "every part of [the patient's] habitation should be temperate and airy," and attendants should admit fresh air, albeit "cautiously," by opening a door or window as necessary; the mother should also take moderate post-partum exercise (348). Butter wrinkled his nostrils at lack of hygiene: "There is, in some cases, an offensive smell about the patient, unless the room be kept cool, the linen often changed, and sometimes the whole bedding" (337). However, Butter and others regarded smells as more than merely offensive. He endorsed the "miasma theory," according to which bad or foul air generated putrefaction: "When a peculiar state of the air, a neglect of cleanliness, or other causes conspire to promote a great degree of putrefaction in the bowels, the disease will be very dangerous, and soon end fatally" (342).
As a countermeasure White recommended "keep[ing] the patient in that kind of heat which nearest approaches the standard of health, at the same time promoting a free circulation of air, [so] that those morbific particles and the human effluvia may not stagnate about the patient, but be carried off, and their absorption prevented by an effectual ventilation." He also suggested opening the chamber-door and the windows in warm weather, so that the curtains should not be tight shut, and the chimney should not be blocked up so that "the effluvia may have the liberty of escaping" (11).
- Puerperal Fever: A Question of Definition
- Contrasting Epidemics: Puerperal Fever and Cholera
- Puerperal Fever: Overcrowding and Effluvia
Butter, W. An Account of the Intermittent Puerperal Fevers. London: T. Payne, 1775.
Cullen, W. First lines on the practice of physic. Edinburgh, 1786.
Loudon, I. "Deaths in childbed from the eighteenth century to 1935." Medical History 30 (1986): 1-41.
White, C. The Management of Pregnant and Lying-in Women. London: n.p., 1773.
Wohl, A. S. Endangered Lives: Public Health on Victorian Britain. London: J. M. Dent & Sons, 1984.
Last modified 11 September 2020