Iatrogenic epidemics of puerperal fever in the 18th and 19th centuries.

The epidemics of puerperal fever in the 18th and 19th centuries began soon after the creation of Lying-in hospitals in the mid-18th century. The primary purpose of these hospitals was to provide physicians with training in obstetrics in general and in forceps deliveries in particular. The first reports describing epidemics of puerperal fever, its contagiousness and control were made by British physicians in the latter half of the 18th century. Alexander Gordon provided epidemiological evidence of contagion in 1792, and Oliver Wendell Holmes in the USA reviewed these reports in his paper on outbreaks of puerperal fever around Boston in 1843. Ignaz Semmelweis in Vienna, unaware of previous work on this disease, re-discovered the actions required to control the contagion in 1847, but published his paper much later in 1861. A few enlightened doctors struggled to prove that puerperal fever was contagious and could be spread by doctors and midwives. Their peers and colleagues predominantly displayed apathy and ignorance until forced to act by the weight of evidence. However, it was the multitude of parturient women who paid the ultimate price for these iatrogenic epidemics.