Holmes on the contagiousness of puerperal fever

At a meeting of the Boston Society for Medical Improvement in 1842, members heard of several fatal cases of puerperal fever, among them the death of a physician, Dr Whitney of Newton, from a wound he received during the autopsy of a woman who had died of the disease. Oliver Wendell Holmes (1809 to 1894), who had taken his Harvard MD in 1836 and taught anatomy, was not an obstetrician, but he set out to learn what the published record showed.

On 13 February 1843 he read his findings to the Society, crediting earlier British writers including Charles White, Alexander Gordon, James Blundell, Edward Rigby and Thomas Watson. He gathered series of cases in which the fever clustered around particular physicians, midwives and nurses, reported over half a century and in widely separated places. The essay was printed in the New England Quarterly Journal of Medicine and Surgery in April 1843, but that journal never had a large circulation and ceased after a year.

Holmes closed with eight rules. A physician who might attend births should take no active part in autopsies of women dead of puerperal fever; if present, he should wash thoroughly, change every article of dress and let 24 hours or more pass before attending a delivery, with similar care after cases of erysipelas. After one case in his practice he should treat his next patient in labor as at risk. After two close together, he would do well to give up obstetric practice for at least a month, and three or more connected cases were prima facie evidence that he carried the contagion. The time had come, he wrote, when a private pestilence around a single physician should be looked on not as a misfortune but as a crime.

Two leading Philadelphia obstetricians, Charles Meigs and Hugh Hodge, attacked the idea; in 1852 Hodge urged his students to put aside any dread that they could carry such a poison to women in childbirth. Holmes answered in 1855 by reprinting the essay unaltered as Puerperal Fever as a Private Pestilence. In a later preface to his collected Medical Essays he wrote that the case had long since been decided in favor of his views.