Title page of Dr Alexander Gordon’s manuscript of 'A Treatise on the Epidemic Puerperal Fever of Aberdeen'. Published in 1795, it was more than fifty years before the principles it contained were independently discovered by others and put into practice.What is Puerperal Fever?

Puerperal fever is a bacterial infection which appears within three or four days of delivery and can consist of a shivering fit followed by fever; milk and lochia (post-birth bleeding) disappearing or diminishing; pain, tenderness and swelling in the abdomen; pain in the back, hips and legs and vomiting and diarrhoea.

First described by the Greek physician Hippocrates (c460 BC - 370 BC), it was a major cause of death amongst women in the immediate aftermath of childbirth. Many doctors felt it to be incurable and the mortality rate was incredibly high, in epidemic years it may have been as high as twenty percent of women who delivered.

The epidemic of Puerperal Fever between 1789 and 1792

The severe epidemic of fever which occurred in the town in these years was thought by the inhabitants to be caused by a local fever known as ‘the weed’ for which bleeding was contra-indicated. Puerperal fever was a disease previously unknown in Aberdeen but Alexander Gordon had seen it in London and he kept detailed notes on each case. These enabled him to prove that puerperal fever was a contagious disease which was transferred between women by a shared doctor or midwife. He was also the first to postulate a clear link with erysipelas, a skin disease commonly known as St Anthony’s fire; a theory that would only be proved a century later.

Gordon believed that he cured many of his patients with a combination of heavy bleeding and purging. He then advocated a preventative strategy which consisted of burning the patient’s clothing and bedlinen and insisting that midwives and doctors carefully washed themselves, changed their clothing and had infected clothing fumigated.

Unfortunately, the women of Aberdeen found his methods of treatment and prevention abhorrent. The belief that the fever was due to ‘the weed’ persisted and many believed his treatment had actually caused deaths. Members of the medical profession were indignant at the suggestion that they had spread the disease and that they had been named in his treatise.

In modern times, antiseptic conditions and antibiotics make it a rare and treatable disease, but in the 18th century, there was no agreement amongst the medical profession on what it was, what caused it or even what it was called. This severely hampered research into the disease and it was not until the late 19th century that the main conclusions in Alexander Gordon’s treatise were accepted and acted upon. Had it gained the attention and respect it deserved when it was published, countless numbers of women across the world who died from puerperal fever might have been saved.

It was this meticulous note-taking that allowed Gordon to draw the conclusion that the fever was transmitted from patient to patient by the attending doctor or midwife, and to predict which women would fall ill by knowing who attended their labour.

Illustration of various positions of the Child in the Womb from “The Birth of Mankind otherwise called The Woman’s Book” by Eucharius Rösslin (4th edition, London 1654). This was the first printed book on midwifery and it formed the basis of textbooks on the subject until the 17th century. Doctors and Midwives would often try to turn a child manually and this was one way that puerperal fever was introduced into a woman’s body.Who was Alexander Gordon?

Alexander Gordon was born near Peterculter on the outskirts of modern Aberdeen in 1752 and studied at Marischal College in Aberdeen before embarking on his medical studies in Aberdeen, Edinburgh and possibly Leyden.

He entered the Royal Navy as a surgeon’s mate in 1780 and became full surgeon in 1782. In 1785, Gordon left to study midwifery in the school founded by fellow Aberdeen graduate, Thomas Denman, and his colleague, William Osborne, in London. The following year, he moved back to Aberdeen to become the first purpose-trained midwife there and physician to the Dispensary. A committed and public spirited man, he also offered training for medical students and midwives, served as a manager for Aberdeen Infirmary and had a large private practice.

Gordon was recalled to active duty in the Royal Navy in the 1795 but was invalided out in August 1799. He returned to his brother’s farm in Aberdeenshire and died two months later.

This manuscript has been catalogued with funding from the Wellcome Institute’s ‘Research Resources in Medical History’ scheme. It is part of an ongoing project to catalogue the pre-1860 medical collections belonging to the University of Aberdeen. To find out more about this project, please see here, and to search the University Archive catalogue, please search the catalogues here