Placental malaria in nineteenth-century Scotland

In the early 19th century, the Scottish obstetrician James Young Simpson (1811-1870), using an archived placental sample, very probably described for the first time, a case of malaria pigmentation. The sample, taken at 4 months gestation, would have resulted from an abortive pregnancy or maternal death. Black pigmentation of tissues had been previously described, but not in the placenta, although a possible association of morbidity with malaria infection in pregnant women had been considered, even by Hippocrates. This paper outlines the observations he made in what was the first academic review of placental pathology, which were presented in 1835 at his inaugural lecture as President of the Royal Edinburgh Medical Society. The background context of malaria in Scotland in the early 19th century is reviewed, as is the historic importance of Simpson's paper in first pioneering an understanding of placental inflammation and infection. Unknowingly, he was observing the consequences of one of the most important pregnancy infections to affect maternal and child health.