Britain’s rapid urbanisation from 1700-1900, the reduction in the number of women having their babies delivered in their own homes, the increase in the numbers being admitted to maternity hospitals, and the growing dominance of male-midwifery created overcrowded hospital lying-in wards which some regarded as a perfect environment for people to infect each other by inhaling "effluvia," that is, aerosolized secretions from one another's bodies.

John Leake (?-1792), a licentiate of the Royal College of Physicians of London and First Physician of the Westminster Lying-in Hospital, outlined a programme for limiting the bad effects of "effluvia," in which he urged those who directed and supervised public lying-in hospitals to limit crowding in the wards. "The wards should not be over-crowded with beds," he wrote, "in order to avoid the danger of breathing air rendered impure by a great number of people confined in a narrow space [...] The different wards should be ventilated by a stream of fresh air passing through them" (173). He observed that women are never subject to puerperal fever "before, but only after delivery, and more particularly during an unhealthy constitution of the atmosphere" (my italics: 88), a point that was consistent with miasma or pythogenic theory, the idea that diseases resulted from exposure to bad or foul air.

Leake and Nathaniel Hulme, FRS (1732 -1807), shared an adherence to the this theory. They believed that emissions from rotting organic matter produced fevers. In A Treatise on The Puerperal Fever Hulme advanced an argument that just as "an absorption of putrid matter" will cause puerperal fever, "the putrid miasms of lying-in hospitals will produce the same effect." From this it is an easy step to supposing that something present only in hospitals caused puerperal fever. This he believed was an airborne contagion. He adduced evidence from a military surgeon, one Doctor Pringle, who had informed him that "foul air, occasioned by one mortified limb, brought on a malignant fever in the military hospital." Hulme also thought that Pringle had proved that "the putrid effluvia exhaling from wounded men brought on a fever, which killed a great many childbed women who lay in the same hospital" (89).

Although Hulme conceded that in the hospitals every attempt was made to keep the air fresh and the patient clean, he insisted that physicians must deal with the relationship between temperature and putrefaction. He included in the causes of "putrid effluvia" the lochial discharge, i.e., the post-delivery vaginal discharge. While attending women in childbed, he noticed "the offensive effluvia" arising from the lochia in a small, close room and was immediately convinced that he had found the cause of puerperal fever. Although the provision of fresh air and moderate to cool temperatures in lying-in hospitals was probably impossible, "the custom of confining lying-in women in an over-heated air, and to a warm regimen, is frequently attended with the most fatal consequences." He catalogued a daunting array of them: extreme irritability, thirst, "frightful apprehensions," tremors, palpitations, loss of sleep, uneasy dreams, premature and hurtful sweats, head pains, pathological lesions, and "fevers of the most dangerous kind" (93).

Incensed by "this baneful method," he heaped irony upon irony as he attacked the way in which accoucheurs treated mothers-to-be:

How careful are the good women to stop up every crevice, keep out every breath of air. How anxious in heaping clothes upon the bed, so that the poor patient can hardly breathe under them. How cautious lest the curtains of the window or bed be withdrawn! How observant in keeping up the great fires in the room! And that the internal state of the patient may correspond with the external, they take care to give her very liberally of warm caudle, with plenty of spices, and all the good cordials they can think of, and these to be swallowed as hot as the mouth and stomach can well bear them! If this be not the readiest way to cause inflammations in the bowels and other viscera, and fevers of the worst tendency, in a person whose blood is already overheated by a swift circulation, during the repeated pangs and throes of labour, I know not which is. (94)

Another physician, Charles White, thought it impossible to keep "the air pure, dry and sweet" while simultaneously adjusting the temperature of the ward to suit everyone’s needs. He also doubted whether any intervention would be effective whenever several women were lying-in in one ward. His solution was quarantine. Each woman should be allowed her own apartment; if that were not possible, any woman who fell ill should be moved immediately into another room, for her safety and that of others. Better still, he added, would be to deliver every woman in a separate room and quarantine her there until the danger from the fever had passed. White’s recommendation -- that supervisors quarantine a woman immediately when she contracts the fever for the sake of others -- implies a recognition of contagiousness, which he cannot fully articulate.

Related Material


Hulme,N. A Treatise on the Puerperal Fever. London: T. Cadell, 1772.

Leake, J. Practical Observations on the Child-Bed Fever. London: J. Walter, 1772.

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 Ltd., 1984.

Last modified 11 September 2020