Puerperal Fever (7)
Squish. Squish. With every step, filthy muck clung to my shoes.
“I told you we should have taken the carriage,” Ertia muttered behind me, her face scrunched up in clear displeasure.
Her complaint was perfectly reasonable. Had we ridden in a carriage along clean roads, we could have avoided this mess entirely. But this was my first outing since leaving the lord’s castle. I needed to see the true state of this territory with my own eyes.
The moment I stepped out of the castle and entered the residential district where people actually lived, one word echoed in my mind: filth.
Countless piles of waste littered the paths. It was no mystery why the Black Death had spread so easily. In an environment this unsanitary, it would have been stranger if an epidemic hadn’t broken out.
The Black Death originally spread through bodily fluids. In other words, urine, excrement, and similar filth could all transmit it. Worse, the plague bacteria lived in the fleas and rats that thrived on this waste. The situation was dire.
“Just as I expected.”
“If you expected this, then why didn’t we come by carriage like I suggested!”
Ertia kept trying to wipe the muck that had splattered onto her iron armor, clearly unhappy with how grimy it had become. As a noble, simply walking through a place like this seemed to be stressing her out.
I didn’t particularly enjoy watching a female throw a tantrum, but since I could feel the same disgusting sensation of mud seeping into my own shoes, I let it slide. I could understand exactly how irritated she must be.
“This is the place.”
“Please, enter.”
After wandering through the residential area, we stopped in front of a relatively decent-looking house. Today I wasn’t just here to inspect the streets. I also needed to verify the cause of puerperal fever.
Since we had already sent word ahead, we opened the door without waiting for permission.
“You’ve arrived.”
“Haa… haa…”
The midwife greeted us while the mother-to-be panted heavily.
“The labor pains have begun. The birth should start any moment now.”
“Good.”
Ertia answered in my place. True to her noble upbringing, she looked down at the elderly woman with her arms crossed and spoke without a hint of politeness. From the moment we left the castle, speaking was her job. After all, as a mere Breeder, I ranked lower than a commoner. In this strict class-based society, even commoners looked down on me. It was far easier to let Ertia or Elisa take the lead from the start. That was exactly why I had brought her along.
“Ahk—!”
“That’s it! The baby’s coming!”
Squelch. Squelch!
As the birth finally began, the midwife immediately started washing her hands in the hot water she had prepared beforehand. It wasn’t perfectly sterile, but it would at least offer some protection against bacterial infection.
“Push harder!!”
“Aaaack!!”
“Good, just a little more! I can see the head!!”
The midwife firmly held the mother’s legs to prevent her from straining her thighs too hard and crushing the baby’s head, all while shouting constant encouragement.
“Uwaaaaang—!!”
The birth ended safely.
“How was it? Did you notice anything strange?”
There was nothing more to see here, so Ertia and I headed toward the next house.
“No.”
As expected from an experienced midwife, the preparations had been excellent. Wearing the cleanest clothes available and repeatedly washing her hands with hot water was particularly good. If my prediction was correct, the real problem would appear in the next house.
“Hello.”
The moment we entered the next house, a sight that made me frown greeted me. A white gown crusted with layers of dried blood. Just as I had expected.
The doctors of this world, ignorant of bacteria and viruses, treated the blood on their gowns like badges of honor—just like the physicians from my old world. They assisted in births and performed surgeries without even bothering to clean it off. This included the midwives who helped with deliveries.
Traits
Medical Arts LV 2
Cooking LV 3
Administration LV 1
Midwifery LV 22
“I pride myself on being the best midwife in this entire territory! Haha!”
The doctor laughed while still wearing that filthy gown, completely unaware of what I was thinking. The fact that his midwifery level was ridiculously high while his actual medical skill remained low only made my blood boil more.
Can’t be helped.
It might have been greedy of me to expect a high level in medical arts. Even the doctors of the medieval period in my old world had received the finest education available. This world was different. While medical texts existed, there were no proper institutions to teach or train professionals. Creating such institutions would require either heightened civic awareness or heavy investment from the wealthy—and neither was likely.
Civic awareness? This place was essentially medieval. One look at the filth dumped openly in the streets made it clear how unrealistic that hope was.
Investment from nobles or the rich? It was far more reliable to donate huge sums to the temple and receive divine healing than to waste money on medicine. After all, if priests could save people on the brink of death, surely they could cure minor illnesses. Because of that mindset, medical arts had barely advanced at all.
Even the existing medical books were riddled with errors, and there were only a handful of them. I had assumed the lord’s castle simply didn’t keep them in stock, but it turned out that five three-hundred-page volumes represented the entirety of medical literature in this world.
In a situation like this, it was only natural that the doctors’ skills were poor. Nobles could simply receive healing from priests, so they saw no need to study medicine themselves. Commoners couldn’t afford the exorbitantly priced books, so they had no way to learn either.
Perhaps that was why most doctors were self-taught. And since the majority couldn’t even write properly, they never recorded their experiences for others.
“Uwaaaaang—!!”
Still, thanks to the doctor’s high midwifery level, the birth itself ended safely.
“What a handsome baby boy!”
The problem was the way he picked up the newborn with unwashed hands while still wearing that blood-stained gown and handed the infant directly to the mother.
“……”
But there was little I could do about it right now.
“Is something wrong?”
“Yes… there’s a problem. That mother will soon die from puerperal fever.”
Puerperal fever was a bacterial infection caused by unsanitary conditions during childbirth. Midwives had learned through experience to prepare hot water and frequently wash their hands to rinse away as many contaminants as possible. Doctors, however, did not. Just like the one we had just seen, they assisted births wearing gowns caked in blood from previous deliveries, their hands still covered in dried amniotic fluid.
In such conditions, bacterial infection was inevitable. A mother with strong immunity might overcome it, but most would die from the resulting fever.
The reports that had reached our department confirmed this pattern. As elderly midwives died from the Black Death, the number of deaths from puerperal fever had risen sharply. Having witnessed it myself, it was clear these were cases of doctor-induced bacterial infection.
It couldn’t be helped. Without any concept of bacteria or viruses, the doctors had no way of knowing what they were doing wrong.
Fortunately, I did know. I returned briefly to the lord’s office to address the issue, then headed straight for the department room.
“Miss Elisa. Gather every doctor in the territory. Instruct them that they must wear clean clothes and wash their hands thoroughly with hot water before assisting in any birth or performing surgery.”
“Understood.”
“Also tell them that if they are caught walking around in blood-stained gowns again, they will face severe punishment.”
“Wouldn’t that be too forceful? There might be backlash.”
Back in the department room, I gave Elisa urgent instructions. She nodded but immediately pointed out the potential issue. As expected, she was sharp.
I had rushed because even in the brief time I hesitated, countless mothers would continue dying from puerperal fever.
“Explain that puerperal fever is caused by gowns contaminated with other patients’ amniotic fluid or blood. Show them this report and demonstrate how many more cases occur when doctors or midwives with certain habits assist in births.”
I wasn’t sure if the doctors could even read the report properly, but I handed over the document I had prepared to Elisa.
“Indeed… when you compare it like this, the difference is enormous. I’ll gather the doctors and speak with them immediately.”
After finishing my instructions to Elisa, I turned to leave again.
“Where are you going now?”
“To see the person who created the single most necessary item in this territory right now.”
“Who?”
“The alchemist, Helen Wagner.”
Ertia tilted her head, clearly confused about why an alchemist was needed.
“What are you planning to make?”
“Soap.”
“Soap? But there’s already plenty of it in the lord’s castle!”
As Ertia said, the castle had more than enough soap. But that was only from the perspective of those inside the castle. For the entire territory, the amount was pathetically small. Soap was a luxury item—difficult to produce and expensive. Commoners could only afford to use it on truly special occasions, such as their wedding night or someone’s birthday.
That was going to change. I intended to make sure every household had at least one bar of soap, available for daily use. And the alchemist Helen Wagner we were about to visit was the very person who had manufactured the sodium hydroxide that made it possible.