Christine Hallett PhD
Hallett C E (2002) The puerperal fever controversies: a study of 'Enlightenment science' in British medicine, 1760-1850 . School of Nursing, Midwfiery and Health Visiting, University of Manchester
Contact: Dr Christine Hallett, School of Nursing, Midwifery and Social Work, University of Manchester
christine.hallett@manchester.ac.uk
ABSTRACT
Puerperal fever was an important disease in the late eighteenth and early nineteenth centuries, causing numerous deaths and sometimes occurring in an epidemic form. Physicians, surgeons and men-midwives recognised that they did not understand its nature. During the period 1760 to 1850 repeated attempts were made to determine it aetiology and natural history and to propose a successful treatment. These endeavours took place alongside the emergence of ‘man-midwifery’ as a discipline which developed into ‘obstetric medicine’, and can be seen as part of a process of knowledge construction. This process is studied through an examination of all of those medical treatises which were published in Britain between 1760 and 1850 and which deal with the subject of puerperal fever
In debating the nature of puerperal fever, physicians and man-midwives drew upon a complex array of medical and scientific theories. Prominent among these were the humoural and Hippocratic approaches which had long been current in the medical thinking and the more recent ones drawn from the ideas about inflammation and putrefaction. Writers also made use of an amalgam of newer scientific ideas and perspectives such as vitalism, Brunonianism and certain eighteenth-century chemical theories. The Enlightenment emphasis on the ordering of knowledge found its way into their complex nosologies of puerperal fever and they also debated the extent to which the disease might be contagious. The methods they adopted were part of a self-conscious drive to mark out their approaches as rigorous. They presented their empirical data – particularly their dissections – in great detail and can be seen to have drawn upon experimental and numerical methods.
This thesis examines the process of knowledge construction as it relates to one disease – puerperal fever – during the period from 1760 to 1850. It does so through the lens of Thomas S. Kuhn’s ‘paradigm theory’.¹ The complex web of knowledge created by the men midwives of the late eighteenth and early nineteenth centuries is seen as a ‘pre-consensus phase’ in the history of this disease. The work of the eighteenth- and early –nineteenth-century physicians can be seen as a series of attempts to reach consensus by a group of individuals who were beginning to see themselves as part of a community of shared knowledge. Ideas about puerperal fever never attained the level of consensus necessary to mark them out as a ‘paradigm’. Rather, this period was characterised by both co-operation and disputatious controversy. Among the later works on puerperal fever were those such as the 1839 treatise of Robert Ferguson which can be interpreted as attempts at paradigm formulation.² Nevertheless, no final, clear consensus was reached and the period from 1760 to 1850 can be seen as a ‘pre-paradigm’ phase in the history of puerperal fever.
¹ Kuhn, Thomas S. The Structure of Scientific Revolutions (Chicago, 1996 edition) passim
² Ferguson, R. 1839. Essays on the most important diseases of women. London. passim
