Poverty and ignorance: puerperal fever in the Amsterdamse Binnengasthuis in 1845

: The 1845 annual report of the maternity ward of the Amsterdam Binnengasthuis gives an insight into the obstetric knowledge and developments at that time, with emphasis on puerperal fever. Since the introduction of clinical training of medical students in 1828, maternal mortality had risen from 2.6% to 9.0%. In the year reviewed, 1845, maternal mortality was 8.6%. The report concerns 395 indigent and malnourished women. Rickets was frequent. Delivery, presentation of the children, complications, operative deliveries and outcome of the children are described. Perinatal mortality was 12.5%. In the original text, an impressive epidemic of puerperal fever in the first 4 months of the year is described. It also gives us an authentic insight into the views on the dissemination of puerperal fever, both the 'epidemic' (influence of cold weather etc.) and the 'contagionistic' view (dissemination by miasmata: evaporations from the diseased women). C.B. Tilanus Sr. (professor of obstetrics), reacted tepidly to Semmelweis' discoveries.