My previous post on childbed fever described the widespread belief that childbed fever — what today we call puerperal infections — was mainly caused by breathing foul, noxious air that arrived on the wind, permeated hospital furniture and people’s clothing, or emanated from a woman’s own body. In truth, the 18th-century medical practitioners who tended new mothers after delivery had no clue as to the real cause of this often fatal malady: a bacterial infection of the uterus that can spread to the bloodstream and result in sepsis. Despite their ignorance, 18th-century practitioners used therapies they believed worked to save the lives of desperately ill mothers suspected of having the dreaded fever. Here are some of the treatments they used.
A medical practitioner administers leeches to a woman (Boilly, 1827) (Source: Wellcome Library #L0041637 CC BY 4.0)
Bloodletting
Some physicians favored bloodletting. Dr. John Leake, Physician to the Westminster Lying-In Hospital in London, believed early and copious bleeding was important. He preferred this treatment over every other one he had tried.1
Dr. Charles White, however, cautioned against bloodletting for fear it would weaken a woman who exhibited symptoms of putrefaction; he believed strongly that the “circulating powers” (the bloodstream) should not be weakened, as they were the mechanism by which putrefaction was removed from the body.2 Neither physician specified the method of bleeding: leeches, venesection, wet cupping or scarification. Presumably any or all of these bloodletting strategies were used.
Peruvian bark (Cinchona officinalis) (Source: Wikimedia Commons)
Peruvian Bark
Both Drs. Leake and White advocated the use of Peruvian bark — or simply “the bark” — to reduce fever. Dr. White cited a colleague who had given the preparation to a woman in the amount of one drachm every three hours for twenty-four hours, beginning some two days after her delivery, without adversely affecting the lochial discharge.3 (A drachm is an apothecary weight, described in footnote 1 below; lochial discharges are the normal vaginal discharges that occur after delivery.) Peruvian bark was used in the 18th- and 19-centuries as a febrifuge. (What a great word! It means “a compound that acts to reduce fever.”) Today the bark is perhaps best known for its quinine content, which is important in the treatment of malaria.
Dr. White’s Cure for Puerperal Fever
Dr. White’s book on managing pregnant women contains a long chapter on the cure of puerperal fever. He cleverly divided his treatment regimen into sections, depending on the stage of the disease, and offered advice on what to do … and what not to do. As noted in the previous post most women first presented with a shivering fit, followed by a fever, headache, stomach pains and vomiting. Here is the advice he offered his colleagues on treating the symptoms of childbed fever:4
When the patient is shivering
- apply bags of toasted grains, hot bricks, bottles full of hot water, or warm flannel to the patient’s feet
- give the patient only a little food
- DO NOT give the patient spiritous liquors; ale, wine or wine whey; broths; animal foods; cordials; or aromatic spices that stimulate the body’s heat
When the shivering ends and the hot fit begins
- remove extra clothing and the warm bricks, etc.
- administer an emollient clyster (an enema — see footnote 2 below)
- give the patient weak tea, thin water gruel, or barley water
- reduce the patient’s heat by opening windows or doors to bring in fresh, cold air
If the patient aches in the head, back, or loins
- give her a gentle emetic made of either ipecacuanha or an antimonial preparation such as essence of antimony or James’s powder to cause vomiting — in large doses ipecacuanha works as an emetic — the metalloid antimony affects mainly the mucus lining of the gastrointestinal tract and causes vomiting and purging (Today antimonials are used in the treatment of leishmaniasis, a parasitic disease that affects some 350 million people in 88 countries.)
If the patient vomits frequently
- encourage vomiting, for it is useful in treating putrid fevers
- the importance of promoting vomiting arose from observing that saliva in the mouth absorbed the putrid miasma (which was believed to cause puerperal or childbed fever) — when the saliva was swallowed and then vomited, some of the putrid miasma was removed from the body, thus improving the patient’s health
If the patient is costive (constipated)
- administer an emollient clyster (an enema) to help carry off the “morbid matter”
- any of the following preparations were recommended: cream of tartar, Epsom salts, rhubarb, or castor oil
When the stomach and bowels are empty of their morbific contents (another great word: morbific means “causing disease”)
- give the patient spiritus mindereri or salt of wormwood — spiritus mindereri is a pure, colorless solution with a salty taste that most patients find very disagreeable; it acts as a sedative and helps decrease perspiration in fever states — salt of wormwood was used in this case as a stomach tonic or to prevent recurring episodes of a disease
When the patient was truly sinking — when she was in the last stage of childbed fever and near death — Dr. White advised throwing everything at her: administering strong infusions of Peruvian bark, giving her wine and cordials (which had been withheld up to this point), applying blisters to the abdomen (which he otherwise advised against) and injecting antiseptic solutions into the uterus.5
Did These Therapies Work?
The strength of a woman’s innate immune system had more to do with surviving a case of childbed fever than any of the treatments reported above. Because childbed fever is caused by a bacterial infection, not miasma, the use of external remedies like refreshing stale air, applying blisters to the abdomen and warm bricks to the feet, promoting vomiting, prescribing the bark and other herbal concoctions, and administering an emollient clyster had no chance of knocking out the infection.
These therapies look somewhat silly from today’s high hill, but the truth is that without an understanding of the germ theory of disease, Regency medical practitioners had no way of properly addressing the puerperal infection. Even so, they were doing something right: asking questions, writing down observations, looking for patterns. In truth, they were working as epidemiologists — long before the term had even been invented. (See footnote 3 below.)
And there is something else worth noting: sepsis following delivery remains a problem even today. Roughly one-quarter of the women in the United Kingdom who die within six weeks of delivery die from sepsis.
FOOTNOTES:
1) A drachm is an apothecary weight used in Jane Austen’s day; it is equivalent to 60 grains or 1/8 ounce.
2) An emollient clyster is an enema. The famous Dr. William Buchan, whose popular book Domestic Medicine is often sited in this blog, believed clysters were of greater importance to health than was generally believed. Clysters served to evacuate the contents of the intestines; they could also be used to convey medicines into the GI tract. Opium and Peruvian bark, for instance, could be administered in this fashion when other methods were less attractive. The emollient clyster was formulated in the following manner:
“Take of linseed tea and new milk, each six ounces. Mix them. If fifty or sixty drops of laudanum (opium) be added to this, it will supply the place of the Anodyne Clyster.”6
3) The word “epidemiology” was first used in 1870-1875.
Sources:
1Leake, John. Practical Observations on the Child-bed Fever: and also on the Nature and Treatment of Uterine Hemorrhages, Convulsion, and such other Acute Diseases (London, 1775), p. 11 (PDF p. 16).
2White, Charles. A Treatise on the Management of Pregnant and Lying-In Women (London, 1791), p. 217 (PDF p. 243).
3Ibid., p. 138 (PDF p. 164).
4Ibid., pp. 185-204 (PDF pp. 211-230).
5Ibid., p. 223 (PDF p. 249).
6Buchan, William. Domestic Medicine (Boston, 1811), p. 442.