My previous blog posts examined the supposed causes of childbed fever as they were understood in late 18th-century England, when Jane Austen was a teenager, and also the treatments prescribed to manage the symptoms of this often fatal disease. In reading various books on midwifery and childbed fever published in the late 1700s and early 1800s, I came across one by Dr. Samuel Bard, which was published in 1819 (three years after Austen’s death). It contains this interesting case.1 I thought you might enjoy (well, perhaps, enjoy is too strong a word) reading a first-hand description of a Regency woman’s real-life experience of being treated for childbed fever.
Case 140. A young woman, of a delicate constitution, was delivered on the eighth of August … From an imperfect contraction of the uterus, she lost a considerable quantity of blood, by which she became extremely faint. On the morning of the 10th, she took twenty grains of jalap and three of calomel, which procured ten stools. On the 11th, between one and two o’clock in the morning, she was seized with a violent rigor, immediately succeeded by a severe and continued pain in the abdomen; the belly was distended, excessively tender, and her head was affected with violent pains and throbbing … Sixteen ounces of blood were taken from a large orifice, which, occasioning a great degree of faintness, the orifice was closed … At 8 o’clock, as soon as the faintness had abated, she took half a drachm of jalap. At 9, after an interval of ease of twenty minutes, the pains became rather stronger … but again abated in a short time … Soon after 11, the orifice of the arm was again opened, and four ounces more of blood were taken away; a clyster was injected, a blister applied to the abdomen, and a saline draught, with five drops of antimonial wine, was given every two hours … After the second bleeding, the pain gradually abated, the patient fell asleep, awoke easy, and the pain returned no more … [but] she had no evacuation by the bowels. In the evening, therefore, another clyster was injected, and a stronger opening mixture prescribed, which procured copious evacuations; the diarrhea was kept up for some days, and the patient soon recovered.
She Got the Whole Kit and Caboodle
Dr. Bard threw everything at her. Over the course of two days she received three doses of purgatives and two clysters (enemas) to cleanse her bowels, one emetic to make her vomit, and had 20 ounces of blood abstracted, all while she recovered from childbirth and began her life as a new mother.
On the strength of cases like this one, in which a woman survived a life-threatening bout of childbed fever, medical practitioners during the Regency era embraced a variety of treatments that today seem almost inhumane. Some allowance must be made for their ignorance. After all, most medical practitioners of that time believed that miasma or foul, noxious air caused childbed fever.
Regency Treatments for Childbed Fever
Several of the remedies mentioned in the above case study were described in my previous blog. Bloodletting, purgatives and emetics were popular Regency remedies for treating childbed fever.
- Foremost among the typical treatments for childbed fever was bloodletting. Regency medical practitioners believed in taking blood early and often. Dr. Thomas Denman, who was a leading man-midwife or accoucheur of the early 19th century (he might be considered the leading accoucheur in Jane Austen’s day), believed bleeding with the lancet (from the arm or neck, for example) was preferable to other methods, but he also supported bleeding with leeches or by scarification or cupping.2
- The woman in Case 140 above had sixteen ounces of blood taken in the wee hours of the morning and another four ounces taken later that morning at around 11 o’clock. Altogether 20 ounces of blood were withdrawn. A typical adult body contains about 5 liters of blood or 170 ounces. Women generally have less blood than men. If the patient in Case 140 had about 160 ounces of blood altogether, and 20 ounces were taken through bloodletting, then about 12% of her blood supply was withdrawn over the course of one morning. Think of removing enough blood to fill a Starbucks’ Venti-size latte! And all while the poor woman is feeling wretched in every way.
- It could have been worse. The woman described in Case 141 had 36 ounces or about 20% of her blood removed over the course of an evening. She “speedily recovered.”1
- Jalap is a purgative (also called a cathartic), meaning that it cleanses the bowls. Regency medical practitioners were keen on promoting evacuations, both of the stomach and the bowels.
- Calomel is a form of mercury chloride used as a purgative to evacuate the bowels. Although the toxicity of mercury had been recognized since the Roman era, it was considered a standard medical treatment, even for children, during the Regency era.3
- Dr. Denman recommended an emollient clyster (an enema) to remove any hardened feces remaining in the lower part of the rectum and ensure that the entire GI tract was cleansed. He might have used Dr. Buchan’s formulation of six ounces of linseed tea mixed with six ounces of new milk.4
- Antimonial wine was used as an emetic to promote vomiting.5 The preparation was made by pouring wine or water into cups made of antimony; the solution was allowed to stand overnight and then drunk the next day. This method was eventually abandoned because the results were not constant and the effects could be lethal.
The Real Cause of Childbed Fever
Today we know that puerperal infections of the female reproductive tract occurring after delivery are caused by bacteria, mainly Streptococcus pyogenes, Staphylococcus, and Echerichia coli, among others. Antibiotics are typically prescribed and surgery is sometimes necessary, depending upon the type of infection.6 Clysters, emetics, purgatives and bloodletting will not cure a bacterial infection. Sadly, women still die of puerperal infections every year, even in our world of enlightened medicine.
1Bard, Samuel. Compendium on the Theory and Practice of Midwifery (New York, 1819), pp. 349-350 (PDF pp. 362-363).
2Denman, Thomas. An Introduction to the Practice of Midwifery (Battleborough, VT, 1807), pp. 417, 425 (PDF pp. 456, 464).
3Davis, LE. Unregulated potions still cause mercury poisoning. West J Med. 2000; 173(1): 19.
4Buchan, William. Domestic Medicine (Boston, 1811), p. 442.
5Wilkes, John, Encyclopaedia Londinensis, or, Universal Dictionary of Arts (London: J. Adlard, 1810), Vol. iv, p. 278 (right-hand column, second paragraph).
6Hamilton SM, et al. Pregnancy-related group A Streptococcal infections: temporal relationships between bacterial acquisition, infection onset, clinical findings, and outcome. Clin Infect Dis. 2013; 57(6):870-876.