Childbed Fever: A Documentary History (review)

Loudon’s book includes twenty-two documents on childbed fever. The documents are arranged chronologically—the earliest was published in 1772, and the most recent in 1968. Each item is preceded by an introduction that includes biographical information about the author. Also included are a ten-page glossary, a thirty-seven-page introduction, and a twenty-page annotated bibliography (but no index). All of these editorial materials are clear and useful.

This short volume provides engaging and informative glimpses into two hundred years of evolving medical opinions about childbed fever. It will make interesting reading for anyone who seeks a better understanding of the history of this pernicious and persistent disease.

Since the mid-eighteenth century, a vast literature has accumulated on the topic of childbed fever. One must sympathize with anyone trying to compile a manageable source book on the disease. But compassion aside, Loudon’s volume suffers from serious omissions. First, all the included documents were written by medical personnel. Yet, childbed fever entailed the deaths of hundreds of thousands of young women—mothers, wives, and daughters. Few diseases have had such terrible social consequences. Can this phenomenon be understood, even superficially, if portrayed exclusively from the perspective of the medical profession?

Second, of Loudon’s twenty-two documents, apart from some excerpts from Ignaz Semmelweis’s Aetiology of Childbed Fever and a few pages reporting the famous debate between Louis Pasteur and Jacques-Francois-Édouard Hervieux, all are drawn from Anglo-American sources. Yet, during the 1870s and 1880s, the bacterial etiology of childbed fever was worked out primarily in France and Germany. Neither in the body of the text nor even in the bibliography does Loudon mention the seminal studies by Karl Mayrhofer, Léon Coze and Victor-Timotheé Feltz, Wilhelm Waldeyer, Johannes Orth, Friedrich Daniel von Recklinghausen, and Edwin Klebs. These studies, which guided both Pasteur and Koch, provided the foundation for our modern concept of puerperal infection. They also reveal research on childbed fever as absolutely central in the etiological thinking that dominated late-nineteenth-century medicine. No doubt Joseph Clarke, Robert Gooch, and John Roberton have some antiquarian interest and may have contributed to the general background understanding of childbed fever. However, by the late nineteenth century, their writings were virtually forgotten and their ideas next to irrelevant. This is clear from the only historical account contained in Loudon’s selections, a brief historical survey written in 1904: excepting Pasteur, James Hawley Burtenshaw does not mention one of the authors included in this book; instead, he cites Mayrhofer, Coze and Feltz, Recklinghausen, Waldeyer, and Orth. Loudon might somewhere have hinted that the German and French bacteriologists also had ideas about childbed fever—ideas that even ended up making a difference.