The Rh-negative gene is a well-known cause of perinatal mortality. In this article, we analyze the possible role of Rh disease in perinatal mortality and stillbirths in a particular historical setting: the Skellefteå region in northern Sweden between 1860 and 1900. The data used for the study cover 23,067 children born to 4,943 women. The exact impact is not possible to establish using historical data, but the typical pattern of the disease allows us to make estimations. The expected levels based on knowledge of blood group distribution, the risk of sensitization from Rh incompatability, and the risk of perinatal mortality in births by sensitized mothers are compared with the observed levels. The results show that Rh disease was important for perinatal mortality and clustering of deaths within families.