Fever that lasts for more than 24 hours within the first
10 days after a woman has had a baby. Puerperal fever is due to an infection, most
often of the placental site within the uterus. If the infection involves the bloodstream,
it constitutes puerperal sepsis.
P uerperal fever has gone by a number of different names including childbirth
fever, childbed fever and postpartum fever. In Latin a "puerpera" is a woman in
childbirth since "puer" means child and "parere" means to give birth. The puerperium
is the time immediately after the delivery of a baby.
Historical note: Three of the names most closely associated with puerperal
fever are Alexander Gordon, Oliver Wendell Holmes, and Ignaz Philip Semmelweiss.
Dr. Alexander Gordon (1752-1799) in Aberdeen, Scotland was the first to identify
the cause of puerperal fever. In 1795, Gordon wrote: "I will not venture positively
to assert that the Puerperal Fever and Erysipelas are precisely of the same specific
nature... (but) that they are concomitant epidemics I have unquestionable proofs.
For these two epidemics began in Aberdeen at the same time, and afterwards kept
pace together; they arrived at their acme together, and they both ceased at the
same time. After delivery the infectious matter is readily and copiously admitted
by the numerous patulous orifices, which are open to imbibe it, by the separation
of the placenta from the uterus." Gordon added that: "The disease seized such women
only as were visited, or delivered by a practitioner...or nurse who has previously
attended patients afflicted with the disease. It is a disagreeable declaration for
me to mention that I was myself the means of carrying the infection to a great number
of women."
In 1843 Oliver Wendell Holmes (1809-1894), Professor of Anatomy & Physiology
at Harvard, wrote in his celebrated paper entitled "On the Contagiousness of Puerperal
Fever" that: "...if one case of puerperal fever arises in a physician's practice
there is an increased risk of a second, two cases suggest that the physician should
do no obstetrics for at least a month, and three prima facie evidence that he is
the source of the contagion."
The Viennese physician Ignaz Philip Semmelweiss (1818-1862) provided proof of
the cause of puerperal fever. In 1847 he ordered hand washing in chlorinated water
before delivering infants and the mortality from childbed fever declined dramatically.
Semmelweiss wrote that: "Puerperal fever is caused by conveyance to the pregnant
woman of putrid particles derived from living organisms, through the agency of the
examining fingers....... Consequently must I make my confession that God only knows
the number of women whom I have consigned prematurely to the grave."
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