A favoured approach among medical historians at the end of the twentieth century was the study of a particular disease. Notable among contributions to the genre were Quetel's History of Syphilis (1990), and Arrizabalaga, Henderson, and French's The Great Pox. The French Disease in Western Europe (1997). Prior to this, biographies of particular physicians or scientists - often written in a congratulatory style - had been more in vogue. Alongside the shift to a more "disease-centred" history there was a greater emphasis on the social history of medicine and an increasing focus on the patient's experience, as in works such as Pomata's Contracting a Cure (1998) and Gentilcore's Healers and Healing in Early Modern Italy (1998). Among the "disease-centred" histories Irvine Loudon's The Tragedy of Childbed Fever offers a valuable contribution to the study of both of obstetric medicine and germ theory.

Although it maintains a narrow focus upon one aspect of puerperal fever looking at the ways in which mainstream medical theory explained the disease and does not incorporate a strong emphasis on social or cultural elements, Loudon's book offers an important contribution to the history of disease. The book appears, upon first reading, to be overly Whiggish in approach, focusing on the emergence of germ theory in the history of puerperal fever perhaps to the detriment of other important areas, such as medical theories not relating to contagion. Loudon's purpose in writing this work appears not, however, to have been to cast light upon how puerperal fever was understood at a time when it was prevalent, but rather to step back and take full advantage of his own medical background, and the benefit of hindsight to give an overview of the disease from a modern medical perspective using modern scientific and epidemiological approaches. On these terms, The Tragedy of Childbed Fever is an admirable piece of work, meticulous in its empiricism, clearly structured, and lucid.

Loudon's avowed purpose is to survey the approximately two hundred years during which puerperal fever was widespread in Western Europe. He opens his book with an engaging and moving account of the death of Mary Wollstonecraft. Revealing his modern medical hand, he follows with an overview of the state of modern pathological and epidemiological knowledge about puerperal fever. He goes on to present a chronological overview of his subject, beginning in the mid-eighteenth century, tracing both the incidence and prevalence of the disease, and the emergence of medical ideas and theories, mostly those relating to contagion and - from the later nineteenth century onwards - germ theory. He chooses to emphasize the contributions of certain individual medical men. Whole chapters are devoted to Alexander Gordon, who is credited with being the first person to fully appreciate the fact that puerperal fever could be conveyed from patient to patient on the hands of the midwife or surgeon, to Ignaz Semmelweis, who is said to have been the first individual to insist that all practitioners must wash their hands before having contact with women in childbed, and Joseph Lister, who first introduced antisepsis into surgical practice. Space is also give to discussion of the work of Oliver Wendell Holmes, who wrote on the communicability of puerperal fever, Rebecca Lancefield, who identified the serotypes of the streptococcus involved, and Leonard Colebrook, discoverer of the first successful antibacterial treatment, the sulphonamides. London's emphasis is clear. His work traces the emergence, refinement and consequences of germ theory in obstetric practice.

London's other main emphasis - the epidemiological - is given voice in chapters on "Epidemic Puerperal Fever in Towns" (chapter four), "Puerperal Fever and the Lying-in Hospitals" (chapter five), "Puerperal Fever in the Early Twentieth Century" (chapter ten), and, perhaps most importantly, in the closing chapter, "The Epidemiology of Puerperal Fever" (chapter twelve). These chapters are notable for their lucidity and the value of the empirical data they present. There could, however, have been a greater emphasis on the limitations of epidemiological data which originated during a time prior to modern definitions and approaches, and which are patchy in their availability.

Loudon's book will appeal to medical historians, those studying history at both graduate and post-graduate level, students of medicine, nursing and midwifery, and those already in obstetric practice. Its breadth of appeal is largely due to the accessibility of Loudon's writing style and the focus on both medical and historical aspects of his subject. In an era in which much medical history writing is rather arcane and inaccessible, and in which medical texts invariably give only a passing glance to the history of their subject matter, Loudon's work, as always, provides a valuable bridge between two disciplines which are otherwise, all too often, poles apart.

The University of Manchester Christine Hallett

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