Fever, puerperal

Fever, puerperal: 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.

Puerperal 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.”