Book Review

Comparative/World

Although not a new disease, puerperal fever, a severe, extraordinarily painful, and often fatal peritonitis of postpartum women, acquired a new visibility with the development of lying-in hospitals in late eighteenth and early nineteenth-century Europe. It was a good deal rarer in fact than in the imaginations of novelists, for whom it has been a deus ex machina of inestimable value. Even in bad situations, the mortality rate over time was usually well less than one percent of deliveries, far lower than typical infant mortality rates. But cases were not evenly distributed in space or time. Often they came as epidemics, affecting a single town, hospital building, or the practice of a particular midwife. What in retrospect has seemed clear evidence of contagion has led to a prominent place for the disease in popular histories of the germ theory, which focus on the heroic struggles of the Hungarian obstetrician Ignaz Semmelweis against the callous stupidity of the staff at Vienna's huge Allegemeines Krankenhaus or the exceptional clarity of mind of that elite Bostonian, Oliver Wendell Holmes.

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Following his magisterial work, Death in Childbirth (1992), Irvine Loudon here offers an interpretation of the response to the disease that is better informed both by pathological theories of the past and by modern knowledge of the Group A Streptococcus, the causal agent of the disease. The work opens with the 1797 death of Mary Wollstonecraft Godwin, following the birth of a daughter who would later write Frankenstein (1819), and takes the story through the appearance, in the mid-1930s, of the sulfa drugs that could finally cure the disease. A final chapter examines the epidemiology of infection by this variety of streptococcus, which is associated with erysipelas and necrotizing fasciitis when it infects other parts of body.

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