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.

Published in: on July 22, 2013 at 5:30 am  Comments (14)  


  1. Ahhh, you walk in one of my favorite fields. History of medicine is its own fascination. Florence Nightingale believed in the Miasmatic theory of disease (roughly bad air). She and the nurses she trained dropped the mortality rate in military hospitals in the Crimean War as I recall from greater than 40% down to 4 % simply by letting in ‘good’ air, sunshine and hygiene.
    One of my favorite people because he used the brain God gave him to figure out that women in Clinic One (training doctors) had a huge death rate over Clinic Two (training nurse midwives) and that almost no women died who had a “street birth”. Ignaz Semmelweis came up with handwashing and his statistics proved his theory, but the wise doctors said it was too much work added to their busy day to wash their hands when coming from cadaver studies and autopsy to deliver babies. Idiots. Semmelweis literally had a nervous breakdown – most suspect over this issue and died in asylum in Vienna.
    Hand washing remains one of the best walls against disease. We teach it on the mission field aggressively and in orphanages too.
    I did not know OWH Sr. fought this same fight.
    Enjoyable reading.
    In Christ,
    Dennis McCutcheon

    • It has always surprised me Dennis that it took such a very long time for physicians to understand that simple cleanliness would aid in a patients recovery. Leaving aside any germ theory one would think that simple trial and error would have quickly revealed that fact. Perhaps it is a tribute to how difficult it was for anyone to stay very clean in the absence of a ready source of running water.

      • The fact is that trial and error itself had begun relatively late. The very medical profession only became a profession, with schools and respectability, between the seventeenth and the eighteenth centuries, and the accumulation of data only began in earnest with the invention of scientific drawing by Vesalius and his colleagues – Leonardo being an invaluable precedent – and the beginnings of experimentation and dissection in the seventeenth century. You have to remember that until the seventeenth century, nobody actually knew what the brains and the heart did. And the connection between medicine and social and economic condition is a nineteenth-century discovery.

        Semmelweiss was an unlucky exception. In general, when a connection between various things could be established, reform tended to be swift and thorough. When it was shown that certain wells in London were associated with the spread of cholera, cholera was not only got rid of in those neighbourhoods, but the practice of having clean waters supplies quickly spread across Europe and America.

      • “The fact is that trial and error itself had begun relatively late.”

        Quite correct. An additional problem is that too many classical texts relied upon by well educated physicians were often quite erroneous: the whole use of bleeding as a remedy and the balancing of bodily humors. Less study of the classics and more hard thinking based on practical experience would have greatly aided the advance of medicine. It is heartbreaking that some of the important advances, doctors maintaining a standard of cleanliness between seeing patients for example, were so simple to implement.

      • Ah, bleeding… I am reminded of one of the saddest and most unnecessary tragedies in Italian history. Count Camillo Benso of Cavour, the prime minister of King Victor Emmanuel, was both the political genius who did more than anyone else to unify Italy on his and his royal master’s terms, and a brilliant administrator who, before the wars of 1859 and 1860, had propelled Victor Emmanuel’s kingdom into the nineteenth century, covering it with railways and canals and establishing free trade and prosperous industries and advanced agriculture. “Another of his fathom they have none”,and without him it is impossible to see how Italy could have been freed or broken from its appallingly backward state. And yet the Count, in spite of his close study of French and English realities and of his brilliantly practical nature, was still a son of Italy, a country that had practically missed the early nineteenth century, and some of his inherited notions had not been reached even by his eager studies of modernity. And so, when – at the height of his success, in the summer of 1861, with the country unified under his leadership – he fell seriously ill, he resorted to the remedies of his youth and demanded to be bled. Nobody would say no to the most powerful man in Italy, even when they should have – and death came quickly. Every historian agrees that the loss of his leadership at such a moment was a catastrophe as bad as a lost war.

      • “Every historian agrees that the loss of his leadership at such a moment was a catastrophe as bad as a lost war.”

        Agreed Fabio. Bleeding as a nostrum had amazing staying power. George Washington in 1799 was bled heavily in the ten hours prior to his death. I suspect that he would have died in any case, but the bleeding probably hastened his death.

  2. This was absolutely fascinating to read. I had never heard the term “Child Bed Fever,” although, of course I knew the high mortality rates among women following delivery. I didn’t know Oliver Wendell Holmes had been such a pioneer in the development of physician standards in patient care. It’s very easy to forget that this wasn’t “ancient” history, but not really that many years ago. Thank you.

    • It is interesting to contemplate how many of us would not be here without modern medicine Debra. I probably would not as I developed pneumonia as a child and had to receive penicillin. The three kids of my wife and I were all delivered by C-section. It is dreadful to contemplate life without modern medicine, but that is what almost all of humanity had to do until the day before yesterday in historical terms.

      • I am a medical missionary. Citizen’s in the USA and Europe, Japan live in a medical bubble. It is dreadfully sad to watch politician’s dismantling that bubble almost daily. Much of the rest of the world lives in a two tiered system – what the wealthy get and what the working class gets. Let me say up front I am NOT a Marxist idiot. This will happen in the US by degrees as government takes over. The rich will pay for the best and get it or travel to get it.
        I am always amazed at how important “public health” issues are. Control of sewage that the US takes for granted probably saves more lives than all the doctors in your community added together. The issue of cleanliness (hands and bodies) that we value would literally save lives even today in the rural areas I serve. Cane workers live shortened lives due to the chemicals they use – simple rebreathing devices, suits, washing hands would add years to life… but no they die young leaving children fatherless in a society that has no social services. these kids become fodder for gangs… I could go on and on, diarrhea in children under five kills some but it also effects brain development and ultimately I believe can be shown to effect GDP of a nation as this generation takes the reigns of government and business.
        Thank GOD for the USA. It has led the world in medical/public health development. We are generous, but not necessarily bright in how we have shared those resources. Now we are watching the destruction on that once great resource as socialism creeps in.
        In Christ,
        Dennis McCutcheon

      • “Control of sewage that the US takes for granted probably saves more lives than all the doctors in your community added together.”

        Agreed. That and potable water. A lack of both made many early nineteenth century cities, as the urban populations began to swell, death traps.

        When medicine is “free”, you tend to get what you pay for.


  3. Actually, nobody in Britain believes that the NHS is free. We understand perfectly well that it is paid from our taxes. You must not imagine you are the only intelligent people on the face of the Earth, you know.

  4. Fabio I will take on that comment for Don. The intelligent and the payers wholly understand that government (what ever degree of socialism) healthcare is not free. BUT having worked in the healthcare field directly for over 30 years and living through the changes…many of the participants and benefactors of the government tit most certainly believe it is free and furthermore believe it is their entitlement. That is the reality of it. We will have riots of a major degree here when finally the system collapses on itself as it must eventually.
    I truly enjoy your comments and additions to this blog site.
    In Christ,
    Dennis McCutcheon

    • I don’t know where you work. Here we know that the NHS is paid with the sweat of our labour. That is the reason why it is important to us.

  5. Career started in the Navy 1970, West Virginia, North Carolina and now missionary in Guatemala. I believe we have a different culture. If you are poor here you are a victim (not all but many) of the system and the system owe’s you therefore a living. National system in Guatemala is a horse of a different color. Full of corruption and greed. One of the undersecretaries of the health system was caught taking equivalent of almost half million US dollars. Offered to give a fourth of it back but only if he kept his job… He is still working the last I heard. The native Mayan are the hardest hit – last to be seen, in some places if over 50 y/o they are NOT seen, they are given a prescription but the hospital and local pharmacies often don’t have the medicine and or the patient doesn’t have the money with which to pay. A true exercise in futility – Catholic and Evangelical Christian ministries struggle to fill this black hole and especially with the collapse of our economy. We are adding 2 people to welfare roles to every job added and the liberals call that a recovery…. only the mentally ill could agree… just my opinion… smile.

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