Oliver Wendell Holmes and Child Bed Fever

If Oliver Wendell Holmes Senior is remembered at all today, it is primarily as a poet and author, and as the father of Supreme Court jurist Oliver Wendell Holmes, Junior.  This does him an injustice as he was by profession a physician and medical reformer, who, before the discovery of the germ theory, fought consistently for better hygiene in medical treatment.  He helped revolutionize the training of physicians in this country and can be considered as one of the founding fathers of modern medicine in the United States.

In 1843 he wrote a prescient article on puerperal fever, child bed fever, that great killer of mothers who had given birth.  Caused by bacterial infection, it was often spread by physicians from pregnant mother to pregnant mother, due to the failure to follow basic hygiene procedures by the physicians.  Holmes was not the first man to suggest that doctors helped spread the disease, but his was the most extensive look at the problem along with practical suggestions for its remedy:

1. A physician holding himself in readiness to attend cases of midwifery should never take any active part in the post-mortem examination of cases of puerperal fever.

2. If a physician is present at such autopsies, he should use thorough ablution, change every article of dress, and allow twenty-four hours or more to elapse before attending to any case of midwifery. It may be well to extend the same caution to cases of simple peritonitis.

3. Similar precautions should be taken after the autopsy or surgical treatment of cases of erysipelas, if the physician is obliged to unite such offices with his obstetrical duties, which is in the highest degree inexpedient.

4. On the occurrence of a single case of puerperal fever in his practice, the physician is bound to consider the next female he attends in labor, unless some weeks at least have elapsed, as in danger of being infected by him, and it is his duty to take every precaution to diminish her risk of disease and death.

5. If within a short period two cases of puerperal fever happen close to each other, in the practice of the same physician, the disease not existing or prevailing in the neighborhood, he would do wisely to relinquish his obstetrical practice for at least one month, and endeavor to free himself by every available means from any noxious influence he may carry about with him.

6. The occurrence of three or more closely connected cases, in the practice of one individual, no others existing in the neighborhood, and no other sufficient cause being alleged for the coincidence, is primâ facie evidence that he is the vehicle of contagion.

7. It is the duty of the physician to take every precaution that the disease shall not be introduced by nurses or other assistants, by making proper inquiries concerning them, and giving timely warning of every suspected source of danger.

8. Whatever indulgence may be granted to those who have heretofore been the ignorant causes of so much misery, the time has come when the existence of a private pestilence in the sphere of a single physician should be looked upon, not as a misfortune, but a crime; and in the knowledge of such occurrences the duties of the practitioner to his profession should give way to his paramount obligations to society. 

Go here to read the entire article.  The nineteenth century was a time of pioneers in the United States, and Holmes was as much a pioneer as those who headed West.

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