“A deep, dark and continuous stream of mortality.”—William Farr, 18761

Most medical practitioners in England’s Regency era believed that miasma caused puerperal or childbed fever. The miasma was believed to arrive on foul-smelling air, to emanate from clothing and furniture, or to be given off by a woman’s body itself. It seemed to be cured with emetics that made patients vomit, with purgatives that cleansed their bowels, and with copious bloodletting. It was all medical moonshine, one long “stream of mortality” for decades marching right into the early 19th century.

Today we know puerperal infections are caused by bacteria. Antibiotics are the cure. Sadly, Regency medical practitioners had the wrong tools for managing this often deadly disease. How many Regency women died? A disturbing number of them.

internal-exam-of-a-woman c. 1800 from janeaustensworld.wordpress.com

Internal examination of a possibly pregnant woman, c. 1800 (Jane Austen’s World)

18th-Century Mortality

Good statistical data are lacking on the causes of maternal deaths in the 18th century. Dr. Samuel Bard, President of the college of Physicians and Surgeons at the University of the State of New York, wrote a description of puerperal fever and its sometimes “epidemical” nature. His book notes that in 1761, a small London Lying-in Hospital had thirty-two patients who developed puerperal fever.2 All but one died, a death rate of 97%.

That same year Dr. William Hunter, an anatomist and physician and the most famous accoucheur or man-midwife of the late 18th century, reported an epidemic of the fever across London: three of four women died—a death rate of 75%.2

Dr. John Leake, Physician to the Westminster Lying-in Hospital reported the figures from London’s Bills of Mortality. In 1768-1769 185 women died in childbed; in 1769-1770, 270 died; in 1770-1771, 122 died, leading him to believe the fever constituted an epidemic like cholera. In his opinion the Bills of Mortality underreported the number of deaths from childbed fever because some women’s deaths were classified erroneously under some other cause of death, such as pleurisy or the flux (watery diarrhea).3

In 1774 the Infirmary of Edinburgh experienced an epidemic of the disease in its obstetric ward. Every childbed woman, of whom there were six, contracted the disease and died. This so alarmed the hospital that it shut the ward; cleansed and whitewashed it; and had it fumigated before allowing new obstetric patients. There was no return of the fever.4

Early 19th-Century Mortality

National statistics on maternal mortality did not exist in England before 1838,5 but doctors and man-midwives were concerned about maternal deaths long before the cause of childbed fever was understood. For the period 1847-1850, the number of maternal deaths due to puerperal sepsis was 1.9 per 1000 births.6 The maternal death rate from puerperal sepsis ranged from 1.5 to 2.8 deaths per 1000 births between 1851 and 1935; beginning in 1936 the rate fell dramatically to 0.77 per 1000 births and even less in the years afterward—a stunning achievement!

Moreover it mattered whether a woman gave birth in England’s northern counties versus its southern counties. Even as late as the 1890’s death rates from peurperal fever were higher in the north, as can be seen in the figure below.

Death rates from childbed fever between 1885 and 1894 in England and Wales (Source: Loudon, 1986)

Death rates from childbed fever between 1885 and 1894 in England and Wales, expressed as deaths per 1000 births (Figure 6b)  (Source: Loudon, 1986)

For all of our modern medicines and interventions, about 830 women die every day from causes related to pregnancy and childbirth. That’s about one woman every two minutes.7 The number suggests there is still much work to be done to stop the steady stream of mortality.


1Farr, William, in 39th report of the Registrar General for 1876, 1878, p. 242. Cited in Loudon, Irvine. Deaths in childbed from the eighteenth century to 1935. Med Hist. 1986; 30: 1-41.

2Bard, Samuel. Compendium of the Theory and Practice of Midwifery (New York: 1819), p. 345 (PDF p. 358).

3Leake, John. Practical Observations on the Child-Bed Fever. (London, 1775), p. 28 (PDF p. 33)

4Bard, pp. 344-345 (PDF pp. 357-358).

5Loudon I. Deaths in childbed from the eighteenth century to 1935. Medical History. 1986;30:1-41.

6Ibid., p. 32 (Figure 6b).

7World Health Organization. Trends in Maternal Mortality: 1990-2015, available at the United Nations Population Fund website.