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Postpartum infections
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<h2 id="signs-and-symptoms">Signs and symptoms</h2> <p>Signs and symptoms usually include a <a href="/facts/Fever/waVxR2Ac">fever</a> greater than 38.0 °C (100.4 °F), chills, low abdominal pain, and possibly bad-smelling vaginal discharge.<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a> It usually occurs after the first 24 hours and within the first ten days following delivery.<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> </p> <h2 id="causes">Causes</h2> <p>After childbirth, the <a href="/facts/Female_reproductive_system/9ebPetXh">female genital tract</a> has a large bare surface, which is prone to infection. Infection may be limited to the cavity and wall of the <a href="/facts/Uterus/LIrApMXs">uterus</a>, or it may spread beyond to cause <a href="/facts/Septicaemia/n52bkffJ">septicaemia</a> (blood poisoning) or other illnesses, especially when resistance has been lowered by long labour or severe bleeding. Puerperal infection is most common on the raw surface of the interior of the uterus after separation of the <a href="/facts/Placenta/7XUoks1b">placenta</a> (afterbirth), but <a href="/facts/Pathogenic/axMXtV1M">pathogenic</a> organisms may also affect <a href="/facts/Lacerations/snv0h3Gj">lacerations</a> of any part of the genital tract. By whatever portal, they can invade the <a href="/facts/Bloodstream/WXwudzzc">bloodstream</a> and <a href="/facts/Lymph_system/yw5QLgMT">lymph system</a> to cause <a href="/facts/Sepsis/n52bkffJ">sepsis</a>, <a href="/facts/Cellulitis/hCIm7nzQ">cellulitis</a> (inflammation of connective tissue), and pelvic or generalized <a href="/facts/Peritonitis/pWjYb4MB">peritonitis</a> (inflammation of the abdominal lining). The severity of the illness depends on the <a href="/facts/Virulence/TYmX1Fa6">virulence</a> of the infecting organism, the resistance of the invaded tissues, and the general health of the woman. Organisms commonly producing this infection are <i><a href="/facts/Streptococcus_pyogenes/qrkSpDz1">Streptococcus pyogenes</a></i>; <a href="/facts/Staphylococci/maRQMH6E">staphylococci</a> (inhabitants of the skin and of <a href="/facts/Pimples/WrBWl7Nl">pimples</a>, <a href="/facts/Carbuncles/HI0yKqJ9">carbuncles</a>, and many other <a href="/facts/Pustular/BW3TH8kb">pustular</a> eruptions); the <a href="/facts/Peptostreptococcus/R0r7yIC4">anaerobic streptococci</a>, which flourish in devitalized tissues such as may be present after long and injurious labour and unskilled instrumental delivery; <i><a href="/facts/Escherichia_coli/nR4Gvl56">Escherichia coli</a></i><a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a> and <i><a href="/facts/Clostridium_perfringens/hhfqd8Sm">Clostridium perfringens</a></i> (inhabitants of the lower bowel); and <i><a href="/facts/Clostridium_tetani/RzFNBHds">Clostridium tetani</a></i>.<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a> </p> <h3>Risk factors</h3> <p>Causes (listed in order of decreasing frequency) include: <a href="/facts/Endometritis/DX431N3D">endometritis</a>, <a href="/facts/Urinary_tract_infection/4NwY9tL0">urinary tract infection</a>, <a href="/facts/Pneumonia/Jw0KquTA">pneumonia</a>/<a href="/facts/Atelectasis/BWcvjfma">atelectasis</a>, <a href="/facts/Wound_infection/182XrncP">wound infection</a>, and <a href="/facts/Septic_pelvic_thrombophlebitis/c4hsRg0T">septic pelvic thrombophlebitis</a>. Septic risk factors for each condition are listed in order of the <a href="/facts/Postpartum/abLj2JtY">postpartum</a> day (PPD) on which the condition generally occurs. </p> <ul><li>PPD 0: <a href="/facts/Atelectasis/BWcvjfma">atelectasis</a> risk factors include <a href="/facts/General_anesthesia/bv3Yzcz7">general anesthesia</a>, <a href="/facts/Cigarette_smoking/obI4MYne">cigarette smoking</a>, and <a href="/facts/Obstructive_lung_disease/gchqdBYT">obstructive lung disease</a>.</li> <li>PPD 1–2: urinary tract infections risk factors include multiple <a href="/facts/Catheterization/ehnH1eF5">catheterization</a> during labor, multiple <a href="/facts/Vaginal_examination/lsRao90L">vaginal examinations</a> during labor, and untreated <a href="/facts/Bacteriuria/KIDQCfJn">bacteriuria</a>.</li> <li>PPD 2–3: endometritis ( the most common cause ) risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and multiple vaginal examinations during labor.</li> <li>PPD 4–5: wound infection risk factors include emergency <a href="/facts/Cesarean_section/GJ623ers">cesarean section</a>, prolonged <a href="/facts/Membrane_rupture/0fPmTBnz">membrane rupture</a>, prolonged labor, and multiple vaginal examinations during labor.</li> <li>PPD 5–6: septic pelvic thrombophlebitis risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and diffuse difficult vaginal childbirth.</li> <li>PPD 7–21: <a href="/facts/Mastitis/yvcmf1yH">mastitis</a> risk factors include nipple trauma from <a href="/facts/Breastfeeding/cdWXyYDX">breastfeeding</a>.</li></ul> <h2 id="diagnosis">Diagnosis</h2> <p>Puerperal fever is diagnosed with: </p> <ul><li>A temperature rise above 38 °C (100.4 °F) maintained over 24 hours or recurring during the period from the end of the first to the end of the 10th day after childbirth or abortion. (ICD-10)</li> <li>Oral temperature of 38 °C (100.4 °F) or more on any two of the first ten days postpartum. (USJCMW)<a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a></li></ul> <p>Puerperal fever (from the Latin <i>puer</i>, <i>male child (boy)</i>), is no longer favored as a diagnostic category. Instead, contemporary terminology specifies:<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a> </p> <ol><li>the specific target of infection: <a href="/facts/Endometritis/DX431N3D">endometritis</a> (inflammation of the inner lining of the uterus), metrophlebitis (inflammation of the veins of the uterus), and <a href="/facts/Peritonitis/pWjYb4MB">peritonitis</a> (inflammation of the membrane lining of the abdomen).</li> <li>the severity of the infection: less serious <a href="/facts/Infection/182XrncP">infection</a> (contained multiplication of microbes) or possibly life-threatening <a href="/facts/Sepsis/n52bkffJ">sepsis</a> (uncontrolled and uncontained multiplication of microbes throughout the blood stream).</li></ol> <p><a href="/facts/Endometritis/DX431N3D">Endometritis</a> is a polymicrobial infection. It frequently includes organisms such as <i><a href="/facts/Ureaplasma/Mhr2zqqg">Ureaplasma</a></i>, <i><a href="/facts/Streptococcus/Fx8lJ0nz">Streptococcus</a></i>, <i><a href="/facts/Mycoplasma/G1T7m3rv">Mycoplasma</a></i>, and <i><a href="/facts/Bacteroides/Ln9hkTdc">Bacteroides</a></i>, and may also include organisms such as <i><a href="/facts/Gardnerella/3gyr7jL7">Gardnerella</a></i>, <i><a href="/facts/Chlamydia_(bacterium)/zbm60vHX">Chlamydia</a></i>, <i><a href="/facts/Lactobacillus/pwoacAbe">Lactobacillus</a></i>, <i><a href="/facts/Escherichia/ehBXfPgT">Escherichia</a></i>, and <i><a href="/facts/Staphylococcus/maRQMH6E">Staphylococcus</a></i>.<a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> </p> <h3>Differential diagnosis</h3> <p>A number of other conditions can cause fevers following delivery including: <a href="/facts/Urinary_tract_infections/4NwY9tL0">urinary tract infections</a>, <a href="/facts/Breast_engorgement/S2gaSa73">breast engorgement</a>, <a href="/facts/Atelectasis/BWcvjfma">atelectasis</a> and surgical incisions, among others.<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a> </p> <h2 id="management">Management</h2> <p>Antibiotics have been used to prevent and treat these infections—however, the misuse of antibiotics is a serious problem for global health.<a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> It is recommended that guidelines be followed that outline when it is appropriate to give antibiotics and which antibiotics are most effective.<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a> </p><p><a href="/facts/Atelectasis/BWcvjfma">Atelectasis</a>: mild to moderate fever, no changes or mild rales on chest <a href="/facts/Auscultation/mmICf6XP">auscultation</a>.<a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a> </p><p>Management: pulmonary exercises, ambulation (deep breathing and walking). </p><p><a href="/facts/Urinary_tract_infection/4NwY9tL0">Urinary tract infection</a>: high fever, malaise, <a href="/facts/Costovertebral_angle_tenderness/B7c8Cczd">costovertebral</a> tenderness, positive urine culture.<a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a> </p><p>Management: antibiotics as per culture sensitivity (cephalosporine). </p><p><a href="/facts/Endometritis/DX431N3D">Endometritis</a>: moderate fever, exquisite uterine tenderness, minimal abdominal findings.<a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a> </p><p>Management: multiple agent IV antibiotics to cover polymicrobial organisms: clindamycin, gentamicin, addition of ampicillin if no response, no cultures are necessary. </p><p><a href="/facts/Wound_infection/182XrncP">Wound infection</a>: persistent spiking fever despite antibiotics, wound <a href="/facts/Erythema/VUsgXRlB">erythema</a> or fluctuance, wound drainage.<a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a> </p><p>Management: antibiotics for cellulitis, open and drain wound, saline-soaked packing twice a day, secondary closure. </p><p><a href="/facts/Septic_pelvic_thrombophlebitis/c4hsRg0T">Septic pelvic thrombophlebitis</a>: persistent wide fever swings despite antibiotics, usually normal abdominal or pelvic exams.<a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a> </p><p>Management: IV heparin for 7–10 days at rates sufficient to prolong the PTT to double the baseline values. </p><p><a href="/facts/Mastitis/yvcmf1yH">Mastitis</a>: unilateral, localized erythema, <a href="/facts/Edema/Q6MI3KdH">edema</a>, tenderness.<a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a> </p><p>Management: antibiotics for cellulitis, open and drain abscess if present. </p> <h2 id="epidemiology">Epidemiology</h2> <p>The number of cases of puerperal sepsis per year shows wide variations among published literature—this may be related to different definitions, recordings etc.<a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a> Globally, bacterial infections are the cause of 10% of <a href="/facts/Maternal_death/UquTVxdf">maternal deaths</a>—this is more common in low income countries but is also a direct cause of maternal deaths in high-income countries.<a class="footnote-ref" id="fnref:45" href="#fn:45"><sup>45</sup></a><a class="footnote-ref" id="fnref:46" href="#fn:46"><sup>46</sup></a> </p><p>In the United States, puerperal infections are believed to occur in between 1% and 8% of all births. About three die from puerperal sepsis for every 100,000 births. The single most important risk factor is <a href="/facts/Caesarean_section/GJ623ers">caesarean section</a>.<a class="footnote-ref" id="fnref:47" href="#fn:47"><sup>47</sup></a> The number of maternal deaths in the United States is about 13 in 100,000. They make up about 11% of pregnancy-related deaths in the United States.<a class="footnote-ref" id="fnref:48" href="#fn:48"><sup>48</sup></a> </p><p>In the United Kingdom from 1985 to 2005, the number of <i>direct</i> deaths associated with genital tract sepsis per 100,000 pregnancies was 0.40–0.85.<a class="footnote-ref" id="fnref:49" href="#fn:49"><sup>49</sup></a> In 2003–2005, genital tract sepsis accounted for 14% of direct causes of maternal death.<a class="footnote-ref" id="fnref:50" href="#fn:50"><sup>50</sup></a> </p><p>Puerperal infections in the 18th and 19th centuries affected, on average, 6 to 9 women in every 1,000 births, killing two to three of them with peritonitis or sepsis. It was the single most common cause of maternal mortality, accounting for about half of all deaths related to <a href="/facts/Childbirth/KaWFJ4kG">childbirth</a>, and was second only to <a href="/facts/Tuberculosis/ggPyovAl">tuberculosis</a> in killing women of childbearing age. A rough estimate is that about 250,000–500,000 died from puerperal fever in the 18th and 19th centuries in England and Wales alone.<a class="footnote-ref" id="fnref:51" href="#fn:51"><sup>51</sup></a> </p> <h2 id="history">History</h2> <p>Although it had been recognized from as early as the time of the <a href="/facts/Hippocratic_corpus/y2dKVDhE">Hippocratic corpus</a> that women in childbed were prone to fevers, the distinct name "puerperal fever" appears in historical records only from the early 18th century.<a class="footnote-ref" id="fnref:52" href="#fn:52"><sup>52</sup></a> </p><p>The death rate for women giving birth decreased in the 20th century in <a href="/facts/Developed_countries/sqwTSDHm">developed countries</a>. The decline may be partly attributed to improved environmental conditions, better <a href="/facts/Obstetrical/JbYHxtCd">obstetrical</a> care, and the use of <a href="/facts/Antibiotics/sF1kIfxg">antibiotics</a>. Another reason appears to be a lessening of the virulence or invasiveness of Streptococcus pyogenes. That organism is also the cause of <a href="/facts/Scarlet_fever/RFyoPtP9">scarlet fever</a>, which declined over the same period but has seen a rise in the last decade worldwide, especially in Asia, with smaller outbreaks in US and Canada. The UK reported 12,906 cases between September 2015 and April 2016, which is the largest outbreak since 1969.<a class="footnote-ref" id="fnref:53" href="#fn:53"><sup>53</sup></a> </p> <h3>"The Doctor's Plague"</h3> <p>From the 17th century through to the mid-to-late 19th century, the majority of childbed fever cases were caused by the doctors themselves. With no knowledge of <a href="/facts/Microorganism/pysJYcE2">germs</a>, doctors did not believe hand washing was needed.<a class="footnote-ref" id="fnref:54" href="#fn:54"><sup>54</sup></a> </p><p>Hospitals for childbirth became common in the 17th century in many European cities. These "lying-in" hospitals were established at a time when there was no knowledge of <a href="/facts/Antisepsis/ua05WK9M">antisepsis</a> or <a href="/facts/Epidemiology/wgTmxoMA">epidemiology</a>, and women were subjected to crowding, frequent vaginal examinations, and the use of contaminated instruments, dressings, and bedding. It was common for a doctor to deliver one baby after another, without washing his hands or changing clothes between patients. </p><p>The first recorded epidemic of puerperal fever occurred at the <a href="/facts/H%25C3%25B4tel-Dieu_de_Paris/j4acXzJl">Hôtel-Dieu de Paris</a> in 1646. Hospitals throughout Europe and America consistently reported death rates between 20% and 25% of all women giving birth, punctuated by intermittent epidemics with up to 100% fatalities of women giving birth in childbirth wards.<a class="footnote-ref" id="fnref:55" href="#fn:55"><sup>55</sup></a> </p><p>In the early 19th century, <a href="/facts/Ignaz_Semmelweis/LYuM2MBK">Ignaz Semmelweis</a> noticed that women giving birth at home had a much lower incidence of childbed fever than those giving birth in a <a href="/facts/Maternity_ward/KaWFJ4kG">maternity ward</a>. His investigation discovered that washing hands before a delivery with a <a href="/facts/Calcium_hypochlorite/c0el5gJH">calcium hypochlorite</a> solution reduced childbed fever fatalities by 90%.<a class="footnote-ref" id="fnref:56" href="#fn:56"><sup>56</sup></a> His findings were not well received by the medical profession, because they conflicted both with existing medical concepts, and with the image doctors had of themselves.<a class="footnote-ref" id="fnref:57" href="#fn:57"><sup>57</sup></a> The scorn and ridicule of doctors was so extreme that Semmelweis moved from Vienna and, following a breakdown, eventually died in a mental asylum.<a class="footnote-ref" id="fnref:58" href="#fn:58"><sup>58</sup></a> </p><p>Semmelweis was not the only doctor ignored after sounding a warning about the problem. In his <i>Treatise on the Epidemic of Puerperal Fever</i> (1795), ex-naval surgeon and <a href="/facts/Aberdeen/yoH7QeAK">Aberdonian</a> obstetrician <a href="/facts/Alexander_Gordon_(physician)/rfjDmHLW">Alexander Gordon</a> (1752–1799) warned that the disease was transmitted from one case to another by midwives and doctors. Gordon wrote, "It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women."<a class="footnote-ref" id="fnref:59" href="#fn:59"><sup>59</sup></a><a class="footnote-ref" id="fnref:60" href="#fn:60"><sup>60</sup></a> </p><p>In 1842, <a href="/facts/Sir_Thomas_Watson%2c_1st_Baronet/DofHXb1q">Thomas Watson</a> (1792–1882), a professor of medicine at <a href="/facts/King%2527s_College_Hospital/6wv9JoC7">King's College Hospital</a>, London, wrote: "Wherever puerperal fever is rife, or when a practitioner has attended any one instance of it, he should use most diligent <a href="/facts/Hygiene/zH17q0L0">ablution</a>." Watson recommended <a href="/facts/Handwashing/BTgUfoRo">handwashing</a> with <a href="/facts/Chlorine/y27UwYBM">chlorine</a> solution and changes of clothing for obstetric attendants "to prevent the practitioner becoming a vehicle of contagion and death between one patient and another."<a class="footnote-ref" id="fnref:61" href="#fn:61"><sup>61</sup></a><a class="footnote-ref" id="fnref:62" href="#fn:62"><sup>62</sup></a> </p> <h3>Hygienic measures</h3> <p>In 1843, <a href="/facts/Oliver_Wendell_Holmes_Sr./wWKINHoX">Oliver Wendell Holmes Sr.</a> published <i>The Contagiousness of Puerperal Fever</i> and controversially concluded that puerperal fever was frequently carried from patient to patient by physicians and nurses. He suggested that clean clothing and avoidance of autopsies by those aiding birth would prevent the spread of the disease.<a class="footnote-ref" id="fnref:63" href="#fn:63"><sup>63</sup></a><a class="footnote-ref" id="fnref:64" href="#fn:64"><sup>64</sup></a> Holmes quoted Dr. James Blundell as stating, "... in my own family, I had rather that those I esteemed the most should be delivered unaided, in a stable, by the mangerside, than that they should receive the best help, in the fairest apartment, but exposed to the vapors of this pitiless disease."<a class="footnote-ref" id="fnref:65" href="#fn:65"><sup>65</sup></a> </p><p>Holmes' conclusions were ridiculed by many contemporaries, including <a href="/facts/Charles_Delucena_Meigs/aG6H44sK">Charles Delucena Meigs</a>, a well-known obstetrician, who stated, "Doctors are gentlemen, and gentlemen's hands are clean."<a class="footnote-ref" id="fnref:66" href="#fn:66"><sup>66</sup></a> Richard Gordon states that Holmes' exhortations "outraged obstetricians, particularly in Philadelphia".<a class="footnote-ref" id="fnref:67" href="#fn:67"><sup>67</sup></a> In those days, "surgeons operated in blood-stiffened frock coats—the stiffer the coat, the prouder the busy surgeon", "pus was as inseparable from surgery as blood", and "cleanliness was next to prudishness". He quotes <a href="/facts/Sir_Frederick_Treves%2c_1st_Baronet/cJI9evlK">Sir Frederick Treves</a> on that era: "There was no object in being clean. Indeed, cleanliness was out of place. It was considered to be finicking and affected. An executioner might as well manicure his nails before chopping off a head."<a class="footnote-ref" id="fnref:68" href="#fn:68"><sup>68</sup></a><a class="footnote-ref" id="fnref:69" href="#fn:69"><sup>69</sup></a> </p><p>In 1844, <a href="/facts/Ignaz_Semmelweis/LYuM2MBK">Ignaz Semmelweis</a> was appointed assistant lecturer in the First Obstetric Division of the <a href="/facts/Vienna_General_Hospital/aU8zP43R">Vienna General Hospital</a> (Allgemeines Krankenhaus), where medical students received their training. Working without knowledge of Holmes' essay, Semmelweis noticed his ward's 16% mortality rate from fever was substantially higher than the 2% mortality rate in the Second Division, where midwifery students were trained. Semmelweis also noticed that puerperal fever was rare in women who gave birth before arriving at the hospital. Semmelweis noted that doctors in the First Division performed autopsies each morning on women who had died the previous day, but the midwives were not required or allowed to perform such autopsies. He made the connection between autopsies and puerperal fever after a colleague, <a href="/facts/Jakob_Kolletschka/c5qj5w8V">Jakob Kolletschka</a>, died of sepsis after accidentally cutting his hand while performing an autopsy. </p><p>Semmelweis began experimenting with various cleansing agents and, from May 1847, ordered all doctors and students working in the First Division to wash their hands in chlorinated lime solution before starting ward work and later ordered this before each vaginal examination. The mortality rate from puerperal fever in the division fell from 18% in May 1847 to less than 3% in June–November of the same year.<a class="footnote-ref" id="fnref:70" href="#fn:70"><sup>70</sup></a> While his results were extraordinary, he was treated with skepticism and ridicule (see <a href="/facts/Contemporary_reaction_to_Ignaz_Semmelweis/7FhCrjHP">Response to Semmelweis</a>). </p><p>He did the same work in St. Rochus hospital in <a href="/facts/Pest%2c_Hungary/pfeyP837">Pest, Hungary</a>, and published his findings in 1860, but his discovery was again ignored.<a class="footnote-ref" id="fnref:71" href="#fn:71"><sup>71</sup></a> </p><p>In 1935, <a href="/facts/Leonard_Colebrook/xSBMu1Sg">Leonard Colebrook</a> showed <a href="/facts/Prontosil/qb42up4x">Prontosil</a> was effective against <a href="/facts/Haemolysis/1WpVYHkP">haemolytic</a> <a href="/facts/Streptococcus/Fx8lJ0nz">streptococcus</a> and hence a cure for puerperal fever.<a class="footnote-ref" id="fnref:72" href="#fn:72"><sup>72</sup></a><a class="footnote-ref" id="fnref:73" href="#fn:73"><sup>73</sup></a> </p> <h3>Notable cases</h3> <p class="note">See also: <a href="/facts/List_of_women_who_died_in_childbirth/CcaneLLa">List of women who died in childbirth</a></p> <p>Elite status was no protection against postpartum infections, as the deaths of several English queens attest. <a href="/facts/Elizabeth_of_York/c1gBXRWD">Elizabeth of York</a>, queen consort of <a href="/facts/Henry_VII_of_England/dhSlzq5b">Henry VII</a>, died of puerperal fever one week after giving birth to a daughter, who also died. Her son <a href="/facts/Henry_VIII/LFgGAjh0">Henry VIII</a> had two wives who died this way, <a href="/facts/Jane_Seymour/7eM4dlcI">Jane Seymour</a> and <a href="/facts/Catherine_Parr/EW9YxrA8">Catherine Parr</a>.<a class="footnote-ref" id="fnref:74" href="#fn:74"><sup>74</sup></a> </p><p>Suzanne Barnard, mother of philosopher <a href="/facts/Jean-Jacques_Rousseau/yfvWByCj">Jean-Jacques Rousseau</a>, contracted childbed fever after giving birth to him and died nine days later. Her infant son was also in perilous health following the birth; the adult Rousseau later wrote that "I came into the world with so few signs of life that little hope was entertained of preserving me". He was nursed back to health by an aunt.<a class="footnote-ref" id="fnref:75" href="#fn:75"><sup>75</sup></a> French natural philosopher <a href="/facts/%25C3%2589milie_du_Ch%25C3%25A2telet/F6Uty0PA">Émilie du Châtelet</a> died in 1749. <a href="/facts/Mary_Wollstonecraft/oKNkF8LM">Mary Wollstonecraft</a>, author of <i><a href="/facts/Vindication_of_the_Rights_of_Woman/DvcyA4t9">Vindication of the Rights of Woman</a></i>, died ten days after giving birth to <a href="/facts/Mary_Shelley/Pen5dCkU">her second daughter</a>, who grew up to write <i><a href="/facts/Frankenstein/15QDt2dI">Frankenstein</a></i>. Other notables include African-American poet <a href="/facts/Phillis_Wheatley/YceIvtbs">Phillis Wheatley</a> (1784), British housekeeping authority <a href="/facts/Isabella_Beeton/64tU48Dn">Isabella Beeton</a> (1865),<a class="footnote-ref" id="fnref:76" href="#fn:76"><sup>76</sup></a><a class="footnote-ref" id="fnref:77" href="#fn:77"><sup>77</sup></a> and American author <a href="/facts/Jean_Webster/xP7DyFld">Jean Webster</a> in 1916 died of puerperal fever. </p><p>In <a href="/facts/Charles_Dickens/B54mQHJs">Charles Dickens</a>' novel <i><a href="/facts/A_Christmas_Carol/hhN8RuH0">A Christmas Carol</a></i>, it is implied that both <a href="/facts/Ebenezer_Scrooge/KHlwl8yb">Scrooge's</a> mother and younger sister perished from this condition, explaining the character's animosity towards his nephew Fred and also his poor relationship with his own father. </p> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/Postpartum_confinement/H7VyhPHR">Postpartum confinement</a>, a traditional practice after childbirth</li></ul> <h2 id="further-reading">Further reading</h2> <ul><li>Chaim W, Burstein E (August 2003). "Postpartum infection treatments: a review". <i>Expert Opinion on Pharmacotherapy</i> (review). 4 (8): 1297–313. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.1517%2F14656566.4.8.1297">10.1517/14656566.4.8.1297</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/12877638">12877638</a>. <a href="/facts/S2CID_(identifier)/ldJsHa2Y">S2CID</a> <a href="https://api.semanticscholar.org/CorpusID:26781321">26781321</a>.</li> <li>French L (August 2003). "Prevention and treatment of postpartum endometritis". <i>Current Women's Health Reports</i> (review). 3 (4): 274–9. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/12844449">12844449</a>.</li> <li>Calhoun BC, Brost B (June 1995). "Emergency management of sudden puerperal fever". <i>Obstetrics and Gynecology Clinics of North America</i> (review). 22 (2): 357–67. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.1016%2FS0889-8545%2821%2900185-6">10.1016/S0889-8545(21)00185-6</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/7651676">7651676</a>.</li></ul> <h2 id="external-links">External links</h2> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>Hiralal Konar (2014). DC Dutta's Textbook of Obstetrics. JP Medical Ltd. p. 432. ISBN 978-93-5152-067-2. Archived from the original on 2015-12-08. <a href="978-93-5152-067-2" target="_blank">978-93-5152-067-2</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>"Cover of Hacker & Moore's Essentials of Obstetrics and Gynecology". Hacker & Moore's essentials of obstetrics and gynecology (6 ed.). Elsevier Canada. 2015. pp. 276–290. ISBN 978-1-4557-7558-3. <a href="978-1-4557-7558-3" target="_blank">978-1-4557-7558-3</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>WHO recommendations for prevention and treatment of maternal peripartum infections (PDF). World Health Organization. 2015. p. 1. ISBN 978-92-4-154936-3. PMID 26598777. Archived (PDF) from the original on 2016-02-07. <a href="978-92-4-154936-3" target="_blank">978-92-4-154936-3</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>WHO recommendations for prevention and treatment of maternal peripartum infections (PDF). World Health Organization. 2015. p. 1. ISBN 978-92-4-154936-3. PMID 26598777. Archived (PDF) from the original on 2016-02-07. <a href="978-92-4-154936-3" target="_blank">978-92-4-154936-3</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> <li id="fn:13"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></p></li> <li id="fn:17"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></p></li> <li id="fn:18"><p>GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577</a> <a href="#fnref:18" class="footnote-back-ref">↩</a></p></li> <li id="fn:19"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:19" class="footnote-back-ref">↩</a></p></li> <li id="fn:20"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:20" class="footnote-back-ref">↩</a></p></li> <li id="fn:21"><p>GBD 2015 Mortality and Causes of Death Collaborators (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388903" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388903</a> <a href="#fnref:21" class="footnote-back-ref">↩</a></p></li> <li id="fn:22"><p>GBD 2013 Mortality and Causes of Death Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–171. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340604" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340604</a> <a href="#fnref:22" class="footnote-back-ref">↩</a></p></li> <li id="fn:23"><p>WHO recommendations for prevention and treatment of maternal peripartum infections (PDF). World Health Organization. 2015. p. 1. ISBN 978-92-4-154936-3. PMID 26598777. Archived (PDF) from the original on 2016-02-07. <a href="978-92-4-154936-3" target="_blank">978-92-4-154936-3</a> <a href="#fnref:23" class="footnote-back-ref">↩</a></p></li> <li id="fn:24"><p>Walvekar V (2005). Manual of perinatal infections. New Delhi: Jaypee Bros. p. 153. ISBN 978-81-8061-472-9. Archived from the original on 2016-03-04. <a href="978-81-8061-472-9" target="_blank">978-81-8061-472-9</a> <a href="#fnref:24" class="footnote-back-ref">↩</a></p></li> <li id="fn:25"><p>Magner LN (1992). A history of medicine. New York: Dekker. pp. 257–258. ISBN 978-0-8247-8673-1. <a href="978-0-8247-8673-1" target="_blank">978-0-8247-8673-1</a> <a href="#fnref:25" class="footnote-back-ref">↩</a></p></li> <li id="fn:26"><p>Anderson BL (April 2014). "Puerperal group A streptococcal infection: beyond Semmelweis". Obstetrics and Gynecology. 123 (4): 874–882. doi:10.1097/aog.0000000000000175. PMID 24785617. S2CID 24685091. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:26" class="footnote-back-ref">↩</a></p></li> <li id="fn:27"><p>Ataman AD, Vatanoğlu-Lutz EE, Yıldırım G (2013). "Medicine in stamps-Ignaz Semmelweis and Puerperal Fever". Journal of the Turkish German Gynecological Association. 14 (1): 35–9. doi:10.5152/jtgga.2013.08. PMC 3881728. PMID 24592068. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881728" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881728</a> <a href="#fnref:27" class="footnote-back-ref">↩</a></p></li> <li id="fn:28"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:28" class="footnote-back-ref">↩</a></p></li> <li id="fn:29"><p>Hiralal Konar (2014). DC Dutta's Textbook of Obstetrics. JP Medical Ltd. p. 432. ISBN 978-93-5152-067-2. Archived from the original on 2015-12-08. <a href="978-93-5152-067-2" target="_blank">978-93-5152-067-2</a> <a href="#fnref:29" class="footnote-back-ref">↩</a></p></li> <li id="fn:30"><p>Andy W Wong (2024-03-27). "Postpartum Infections". Medscape. Retrieved 2025-03-14. <a href="https://emedicine.medscape.com/article/796892-overview" target="_blank">https://emedicine.medscape.com/article/796892-overview</a> <a href="#fnref:30" class="footnote-back-ref">↩</a></p></li> <li id="fn:31"><p>Befekadu Tesfaye Oyato (2024-06-20). "Determinants of puerperal sepsis among postpartum women: a case–control study in East Shoa Zone public hospitals, Central Ethiopia". PubMed Central, U.S. National Institutes of Health's National Library of Medicine (NIH/NLM). Retrieved 2025-03-14. <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC11328626/" target="_blank">https://pmc.ncbi.nlm.nih.gov/articles/PMC11328626/</a> <a href="#fnref:31" class="footnote-back-ref">↩</a></p></li> <li id="fn:32"><p>The Global Incidence of Puerperal Sepsis Protocol for a Systematic Review Archived 2008-12-17 at the Wayback Machine <a href="http://www.gfmer.ch/Medical_education_En/PGC_RH_2004/Pdf/Chisembele_Puerperal_sepsis.pdf" target="_blank">http://www.gfmer.ch/Medical_education_En/PGC_RH_2004/Pdf/Chisembele_Puerperal_sepsis.pdf</a> <a href="#fnref:32" class="footnote-back-ref">↩</a></p></li> <li id="fn:33"><p>Carter (2005):98 <a href="#fnref:33" class="footnote-back-ref">↩</a></p></li> <li id="fn:34"><p>Berenson AB (April 1990). "Bacteriologic Findings of Post-Cesarian Endometritis in Adolescents". Obstetrics and Gynecology. 75 (4): 627–629. PMID 2314783. Archived from the original on 2013-11-03. <a href="http://journals.lww.com/greenjournal/abstract/1990/04000/bacteriologic_findings_of_post_cesarean.12.aspx" target="_blank">http://journals.lww.com/greenjournal/abstract/1990/04000/bacteriologic_findings_of_post_cesarean.12.aspx</a> <a href="#fnref:34" class="footnote-back-ref">↩</a></p></li> <li id="fn:35"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:35" class="footnote-back-ref">↩</a></p></li> <li id="fn:36"><p>WHO recommendations for prevention and treatment of maternal peripartum infections (PDF). World Health Organization. 2015. p. 1. ISBN 978-92-4-154936-3. PMID 26598777. Archived (PDF) from the original on 2016-02-07. <a href="978-92-4-154936-3" target="_blank">978-92-4-154936-3</a> <a href="#fnref:36" class="footnote-back-ref">↩</a></p></li> <li id="fn:37"><p>WHO recommendations for prevention and treatment of maternal peripartum infections (PDF). World Health Organization. 2015. p. 1. ISBN 978-92-4-154936-3. PMID 26598777. Archived (PDF) from the original on 2016-02-07. <a href="978-92-4-154936-3" target="_blank">978-92-4-154936-3</a> <a href="#fnref:37" class="footnote-back-ref">↩</a></p></li> <li id="fn:38"><p>"Atelectasis". The Lecturio Medical Concept Library. Retrieved 7 July 2021. <a href="https://www.lecturio.com/concepts/atelectasis/" target="_blank">https://www.lecturio.com/concepts/atelectasis/</a> <a href="#fnref:38" class="footnote-back-ref">↩</a></p></li> <li id="fn:39"><p>"Urinary Tract Infection". Centers for Disease Control and Prevention (CDC). 17 April 2015. Archived from the original on 22 February 2016. Retrieved 7 July 2021. <a href="https://www.cdc.gov/getsmart/community/for-patients/common-illnesses/uti.html" target="_blank">https://www.cdc.gov/getsmart/community/for-patients/common-illnesses/uti.html</a> <a href="#fnref:39" class="footnote-back-ref">↩</a></p></li> <li id="fn:40"><p>Crum CP, Lee KR, Nucci MR (2011). Diagnostic Gynecologic and Obstetric Pathology E-Book. Elsevier Health Sciences. p. 430. ISBN 978-1-4557-0895-6. <a href="978-1-4557-0895-6" target="_blank">978-1-4557-0895-6</a> <a href="#fnref:40" class="footnote-back-ref">↩</a></p></li> <li id="fn:41"><p>Definition of "infection" from several medical dictionaries – Retrieved on 2021-07-07 <a href="http://medical-dictionary.thefreedictionary.com/infection" target="_blank">http://medical-dictionary.thefreedictionary.com/infection</a> <a href="#fnref:41" class="footnote-back-ref">↩</a></p></li> <li id="fn:42"><p>Callaghan T. Blueprint Obstetrics and Gynecology. <a href="#fnref:42" class="footnote-back-ref">↩</a></p></li> <li id="fn:43"><p>Berens PD (December 2015). "Breast Pain: Engorgement, Nipple Pain, and Mastitis". Clinical Obstetrics and Gynecology. 58 (4): 902–14. doi:10.1097/GRF.0000000000000153. PMID 26512442. S2CID 13006527. <a href="https://semanticscholar.org/paper/a3f96251efd59a92f82ed618dda1fea955027fbe" target="_blank">https://semanticscholar.org/paper/a3f96251efd59a92f82ed618dda1fea955027fbe</a> <a href="#fnref:43" class="footnote-back-ref">↩</a></p></li> <li id="fn:44"><p>The Global Incidence of Puerperal Sepsis Protocol for a Systematic Review Archived 2008-12-17 at the Wayback Machine <a href="http://www.gfmer.ch/Medical_education_En/PGC_RH_2004/Pdf/Chisembele_Puerperal_sepsis.pdf" target="_blank">http://www.gfmer.ch/Medical_education_En/PGC_RH_2004/Pdf/Chisembele_Puerperal_sepsis.pdf</a> <a href="#fnref:44" class="footnote-back-ref">↩</a></p></li> <li id="fn:45"><p>WHO recommendations for prevention and treatment of maternal peripartum infections (PDF). World Health Organization. 2015. p. 1. ISBN 978-92-4-154936-3. PMID 26598777. Archived (PDF) from the original on 2016-02-07. <a href="978-92-4-154936-3" target="_blank">978-92-4-154936-3</a> <a href="#fnref:45" class="footnote-back-ref">↩</a></p></li> <li id="fn:46"><p>"WHO recommendations for prevention and treatment of maternal peripartum infections" (PDF). Archived (PDF) from the original on 2016-03-06. <a href="http://apps.who.int/iris/bitstream/10665/186171/1/9789241549363_eng.pdf?ua=1" target="_blank">http://apps.who.int/iris/bitstream/10665/186171/1/9789241549363_eng.pdf?ua=1</a> <a href="#fnref:46" class="footnote-back-ref">↩</a></p></li> <li id="fn:47"><p>Carter KC, Carter BR (2005). Childbed fever. A scientific biography of Ignaz Semmelweis. Transaction Publishers. p. 100. ISBN 978-1-4128-0467-7. <a href="978-1-4128-0467-7" target="_blank">978-1-4128-0467-7</a> <a href="#fnref:47" class="footnote-back-ref">↩</a></p></li> <li id="fn:48"><p>"37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8. <a href="978-0-07-179893-8" target="_blank">978-0-07-179893-8</a> <a href="#fnref:48" class="footnote-back-ref">↩</a></p></li> <li id="fn:49"><p>Lewis G, ed. (2007). Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer – 2003–2005. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. CEMACH. p. 97. ISBN 978-0-9533536-8-2.[permanent dead link] <a href="978-0-9533536-8-2" target="_blank">978-0-9533536-8-2</a> <a href="#fnref:49" class="footnote-back-ref">↩</a></p></li> <li id="fn:50"><p>CEMACH: Saving Mothers' Lives 2003–2005 Archived 2008-05-21 at the Wayback Machine <a href="http://www.cemach.org.uk/Publications/CEMACH-Publications/Maternal-and-Perinatal-Health.aspx" target="_blank">http://www.cemach.org.uk/Publications/CEMACH-Publications/Maternal-and-Perinatal-Health.aspx</a> <a href="#fnref:50" class="footnote-back-ref">↩</a></p></li> <li id="fn:51"><p>Loudon I (9 March 2000). The Tragedy of Childbed Fever (PDF). Oxford University Press, USA. p. 6. ISBN 978-0-19-820499-2. Archived from the original (PDF) on 11 February 2012. <a href="978-0-19-820499-2" target="_blank">978-0-19-820499-2</a> <a href="#fnref:51" class="footnote-back-ref">↩</a></p></li> <li id="fn:52"><p>The debate about when this term first emerged is presented by Irvine Loudon, The tragedy of childbed fever, Oxford University Press, 2000, p. 8. <a href="#fnref:52" class="footnote-back-ref">↩</a></p></li> <li id="fn:53"><p>Basetti S, Hodgson J, Rawson TM, Majeed A (2017-08-11). "Scarlet fever: a guide for general practitioners". London Journal of Primary Care. 9 (5): 77–79. doi:10.1080/17571472.2017.1365677. ISSN 1757-1472. PMC 5649319. PMID 29081840. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649319" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649319</a> <a href="#fnref:53" class="footnote-back-ref">↩</a></p></li> <li id="fn:54"><p>Rebecca Davis (2015-01-12). "The doctor who championed hand-washing and saved women's lives". National Public Radio. Retrieved 2025-03-14. <a href="https://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives" target="_blank">https://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives</a> <a href="#fnref:54" class="footnote-back-ref">↩</a></p></li> <li id="fn:55"><p>Loudon I. "Deaths in childbed from the eighteenth century to 1935". Med History 1986; 30: 1–41 <a href="#fnref:55" class="footnote-back-ref">↩</a></p></li> <li id="fn:56"><p>Caplan CE (1995). "The Childbed Fever Mystery and the Meaning of Medical Journalism". McGill Journal of Medicine. 1 (1). Archived from the original on 2012-07-07. <a href="https://web.archive.org/web/20120707205101/http://www.med.mcgill.ca/mjm/issues/v01n01/fever.html" target="_blank">https://web.archive.org/web/20120707205101/http://www.med.mcgill.ca/mjm/issues/v01n01/fever.html</a> <a href="#fnref:56" class="footnote-back-ref">↩</a></p></li> <li id="fn:57"><p>Wyklicky H, Skopec M (1983). "Ignaz Philipp Semmelweis, the prophet of bacteriology". Infect Control. 4 (5): 367–370. doi:10.1017/S0195941700059762. PMID 6354955. S2CID 25830725. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:57" class="footnote-back-ref">↩</a></p></li> <li id="fn:58"><p>De Costa CM (Nov 2002). ""The contagiousness of childbed fever": a short history of puerperal sepsis and its treatment". The Medical Journal of Australia. 177 (11–12): 668–671. doi:10.5694/j.1326-5377.2002.tb05004.x. PMID 12463995. S2CID 12164328. Archived from the original on 2006-12-03. <a href="http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.html" target="_blank">http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.html</a> <a href="#fnref:58" class="footnote-back-ref">↩</a></p></li> <li id="fn:59"><p>Gordon A (1795). A Treatise on the Epidemic Puerperal Fever of Aberdeen. London, England: G.G. and J. Robinson. pp. 63–64. On p. 63, Gordon recognized that puerperal fever was infectious: "But this disease seized such women only, as were visited, or delivered, by a practitioner, or taken care of by a nurse, who had previously attended patients affected with the disease. In short, I had evident proofs of its infectious nature, and that the infection was as readily communicated as that of smallpox, or measles, and operated more speedily than any other infection, with which I am acquainted." From p. 64: "It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women." <a href="https://archive.org/details/treatiseonepidem00gord" target="_blank">https://archive.org/details/treatiseonepidem00gord</a> <a href="#fnref:59" class="footnote-back-ref">↩</a></p></li> <li id="fn:60"><p>"Treatise on the Epidemic of Puerperal Fever". www.general-anaesthesia.com. Archived from the original on July 20, 2008. Retrieved September 15, 2011. <a href="https://web.archive.org/web/20080720005441/http://www.general-anaesthesia.com/images/ignaz-semmelweis.html" target="_blank">https://web.archive.org/web/20080720005441/http://www.general-anaesthesia.com/images/ignaz-semmelweis.html</a> <a href="#fnref:60" class="footnote-back-ref">↩</a></p></li> <li id="fn:61"><p>Watson (February 18, 1842). "Lectures on the principles and practice of physic: Diseases of the abdomen". The London Medical Gazette. 29: 801–808. From p. 806: "Whenever puerperal fever is rife, or when a practitioner has attended any one example of it, he should use most diligent ablution; he should even wash his hands with some disinfecting fluid, a weak solution of chlorine for instance: he should avoid going in the same dress to any other of his midwifery patients: in short, he should take all those precautions which, when the danger is understood, common sense will suggest, against his clothes or his body becoming a vehicle of contagion and death between one patient and another." <a href="https://babel.hathitrust.org/cgi/pt?id=mdp.39015018029671&view=1up&seq=811" target="_blank">https://babel.hathitrust.org/cgi/pt?id=mdp.39015018029671&view=1up&seq=811</a> <a href="#fnref:61" class="footnote-back-ref">↩</a></p></li> <li id="fn:62"><p>The Medical Journal of Australia."The contagiousness of childbed fever: a short history of puerperal sepsis and its treatment" Archived 2006-12-03 at the Wayback Machine <a href="http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.html#i1067496" target="_blank">http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.html#i1067496</a> <a href="#fnref:62" class="footnote-back-ref">↩</a></p></li> <li id="fn:63"><p>Holmes OW (1842–1843). "On the contagiousness of puerperal fever". The New England Quarterly Journal of Medicine. 1: 503–530. <a href="https://babel.hathitrust.org/cgi/pt?id=mdp.39015059415961&view=1up&seq=513" target="_blank">https://babel.hathitrust.org/cgi/pt?id=mdp.39015059415961&view=1up&seq=513</a> <a href="#fnref:63" class="footnote-back-ref">↩</a></p></li> <li id="fn:64"><p>Oliver Wendell Holmes: The Contagiousness of Puerperal Fever Archived 2007-02-03 at the Wayback Machine <a href="http://www.bartleby.com/38/5/1.html" target="_blank">http://www.bartleby.com/38/5/1.html</a> <a href="#fnref:64" class="footnote-back-ref">↩</a></p></li> <li id="fn:65"><p>(Holmes, 1842–1843), p. 510. <a href="https://babel.hathitrust.org/cgi/pt?id=mdp.39015059415961&view=1up&seq=520" target="_blank">https://babel.hathitrust.org/cgi/pt?id=mdp.39015059415961&view=1up&seq=520</a> <a href="#fnref:65" class="footnote-back-ref">↩</a></p></li> <li id="fn:66"><p>Meigs CD (1854). On the Nature, Signs, and Treatment of Childbed Fevers: In a Series of Letters Addressed to the Students of His Class. Philadelphia, Pennsylvania: Blanchard and Lea. p. 104. From p. 104: Speaking of a physician in Philadelphia, Pennsylvania, Meigs said: "He is a gentlemen who is scrupulously careful of his personal appearance, … But a gentleman's hands are clean." <a href="https://archive.org/details/onnaturesignstre1854meig" target="_blank">https://archive.org/details/onnaturesignstre1854meig</a> <a href="#fnref:66" class="footnote-back-ref">↩</a></p></li> <li id="fn:67"><p>Gordon R (1983). "Disastrous Motherhood: Tales from the Vienna Wards". Great Medical Disasters. London: Hutchinson & Co. pp. 43–46 [43]. <a href="/wiki/Richard_Gordon_(English_author)" target="_blank">/wiki/Richard_Gordon_(English_author)</a> <a href="#fnref:67" class="footnote-back-ref">↩</a></p></li> <li id="fn:68"><p>Treves F (1923). "Ch. 2: The Old Receiving Room". The Elephant Man and Other Reminiscences. London, England: Cassell and Company, Ltd. pp. 56–57. <a href="https://archive.org/details/elephantmanother00trevuoft" target="_blank">https://archive.org/details/elephantmanother00trevuoft</a> <a href="#fnref:68" class="footnote-back-ref">↩</a></p></li> <li id="fn:69"><p>Gordon, Richard (1983) p. 44 <a href="#fnref:69" class="footnote-back-ref">↩</a></p></li> <li id="fn:70"><p>Raju TN (1999). "Ignác Semmelweis and the etiology of fetal and neonatal sepsis". Journal of Perinatology. 19 (4): 307–310. doi:10.1038/sj.jp.7200155. PMID 10685244. S2CID 29047987. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:70" class="footnote-back-ref">↩</a></p></li> <li id="fn:71"><p>Christa Colyer."Childbed fever: a nineteenth-century mystery," Archived 2009-04-16 at the Wayback Machine National Center for Case Study Teaching in Science, December 8, 1999 (revised October 27, 2003). <a href="http://www.sciencecases.org/childbed_fever/childbed_fever.asp" target="_blank">http://www.sciencecases.org/childbed_fever/childbed_fever.asp</a> <a href="#fnref:71" class="footnote-back-ref">↩</a></p></li> <li id="fn:72"><p>Colebrook, L; Kenny, M (June 6, 1936). "Treatment of Human Puerperal Infections, and of Experimental Infections in Mice, with Prontosil".Lancet 227(1): 1279–1286. <a href="#fnref:72" class="footnote-back-ref">↩</a></p></li> <li id="fn:73"><p>Sue Bale, Vanessa Jones (2006). Wound care nursing. Elsevier Health Sciences. p. 54. ISBN 978-0-7234-3344-6. Retrieved 2009-08-05. <a href="978-0-7234-3344-6" target="_blank">978-0-7234-3344-6</a> <a href="#fnref:73" class="footnote-back-ref">↩</a></p></li> <li id="fn:74"><p>Sophie Campbell (2012-08-14). "Sudeley Castle: the curious life and death of Katherine Parr". The Telegraph. Retrieved 2025-03-14. <a href="https://www.telegraph.co.uk/travel/destinations/europe/united-kingdom/england/cotswolds/articles/Sudeley-Castle-the-curious-life-and-death-of-Katherine-Parr/" target="_blank">https://www.telegraph.co.uk/travel/destinations/europe/united-kingdom/england/cotswolds/articles/Sudeley-Castle-the-curious-life-and-death-of-Katherine-Parr/</a> <a href="#fnref:74" class="footnote-back-ref">↩</a></p></li> <li id="fn:75"><p>Quoted from Will Durant's "The Age of Rousseau".[full citation needed] <a href="/wiki/Will_Durant" target="_blank">/wiki/Will_Durant</a> <a href="#fnref:75" class="footnote-back-ref">↩</a></p></li> <li id="fn:76"><p>Beetham M (2004). "Beeton, Samuel Orchart (1831–1877)". Oxford Dictionary of National Biography (online ed.). Oxford University Press. doi:10.1093/ref:odnb/45481. Retrieved 23 November 2015.{{cite encyclopedia}}: CS1 maint: ref duplicates default (link) (Subscription or UK public library membership required.) <a href="http://www.oxforddnb.com/view/article/45481" target="_blank">http://www.oxforddnb.com/view/article/45481</a> <a href="#fnref:76" class="footnote-back-ref">↩</a></p></li> <li id="fn:77"><p>Hughes K (2006). The Short Life and Long Times of Mrs Beeton. London: HarperCollins Publishers. ISBN 978-0-7524-6122-9. <a href="978-0-7524-6122-9" target="_blank">978-0-7524-6122-9</a> <a href="#fnref:77" class="footnote-back-ref">↩</a></p></li> </ol>