The Contagiousness of Puerperal Fever

Author: Oliver Wendell Holmes Sr.  | Date: 1843

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O. W. Holmes 1843

Matricide Indicted!


In collecting, enforcing, and adding to the evidence accumulated upon this most serious subject, I would not be understood to imply that there exists a doubt in the mind of any well-informed member of the medical profession as to the fact that puerperal fever is sometimes communicated from one person to another, both directly and indirectly. In the present state of our knowledge upon this point I should consider such doubts merely as proof that the sceptic had either not examined the evidence, or, having examined it, refused to accept its plain and unavoidable consequences. I should be sorry to think . . . that it was a case of "oblique vision." No negative facts, no opposing opinions, be they what they may, or whose they may, can form any answer to the series of cases now within the reach of all who choose to explore the records of medical science.

The practical point to be illustrated is the following: The disease known as Puerperal Fever is so far contagious as to be frequently carried pore patient to patient by physicians and nurses.

Dr. Lee makes the following statement: "In the last two weeks of September, 1827, five fatal cases of uterine inflammation came under our observation. All the individuals so attacked had been attended in labor by the same midwife, and no example of a febrile or inflammatory disease of a serious nature occurred during that period among the other patients of the Westminster General Dispensary, who had been attended by the other midwives belonging to that institution."

The recurrence of long series of cases like those I have cited, reported by those most interested to disbelieve in contagion, scattered along through an interval of half a century, might have been thought sufficient to satisfy the minds of all inquirers that here was something more than a singular coincidence. But if, on a more extended observation, it should be found that the same ominous groups of cases clustering about individual practitioners were observed in a remote country, at different times, and in widely separated regions, it would seem incredible that any should be found too prejudiced or indolent to accept the solemn truth knelled into their ears by the funeral bells from both sides of the ocean,—the plain conclusion that the physician and the disease entered, hand in hand, into the chamber of the unsuspecting patient.

That such series of cases have been observed in this country, and in this neighborhood, I proceed to show.

Certainly nothing can be more open and explicit than the account given by Dr. Peirson of Salem, of the cases seen by him. In the first nineteen days of January, 1829, he had five consecutive cases of puerperal fever, every patient he attended being attacked, and the three first cases proving fatal. In March of the same year he had two moderate cases, in June, another case, and in July, another, which proved fatal.

"Up to this period," he remarks, "I am not informed that a single case had occurred in the practice of any other physician."

At a meeting of the College of Physicians [of Philadelphia] Dr. West mentioned a fact related to him by Dr. Samuel Jackson of Northumberland. Seven females, delivered by Dr. Jackson in rapid succession, while prac-rising in Northumberland County, were all attacked with puerperal fever, and five of them died.

"Women," he said, "who had expected me to attend upon them, now becoming alarmed, removed out of my reach, and others seat for a physician residing several miles distant. These women, as well as those attended by midwives, all did well; nor did we hear of any deaths in child-bed within a radius of fifty miles; excepting two, and these I afterwards ascertained to have been caused by other diseases."

He underwent, as he thought, a thorough purification, and still his next patient was attacked with the disease and died. He was led to suspect that the contagion might have been carried in the gloves which he had worn in attendance upon the previous cases. Two months or more after this he had two other cases. He could find nothing to account for these, unless it were the instruments for giving enemata, which had been used in two of the former cases, and were employed by these patients. When the first case occurred, he was attending and dressing a limb, extensively mortified from erysipelas, and went immediately to the accouchement with his clothes and gloves most thoroughly imbued with its effluvia. And here I may mention, that this very Dr. Samuel Jackson of Northumberland is one of Dr. Dewees’s authorities against contagion. [Dr. Holmes quotes from a letter addressed to his friend, Dr. Storer:]

"January 28, 1843.

"The time to which you allude was in 1830. The first case was in February, during a very cold time. She was confined the 4th, and died the 12th. Between the 10th and 28th of this month, I attended six women in labor, all of whom did well except the last, as also two who were confined March 1st and 5th. Mrs. E., confined February 28th, sickened, and died March 8th. The next day, 9th, I inspected the body, and the night after attended a lady, Mrs. B., who sickened, and died 16th. The 10th, I attended another, Mrs. G., who sickened, but recovered. March 16th, I went from Mrs. G.’s room to attend a Mrs. H., who sickened, and died 21st. The 17th, I inspected Mrs. B. On the 19th, I went directly from Mrs. H.’s room to attend another lady, Mrs. G., who also sickened, and died 22d. While Mrs. B. was sick, on 15th, I went directly from her room a few rods, and attended another woman, who was not sick. Up to 20th of this month I wore the same clothes. I now refused to attend any labor, and did not till April 21st, when, having thoroughly cleansed myself, I resumed my practice, and had no more puerperal fever.

"The cases were not confined to a narrow space. The two nearest were half a mile from each other, and half that distance from my residence. The others were from two to three miles apart, and nearly that distance from my residence. There were no other eases in their immediate vicinity which came to my knowledge. The general health of all the women was pretty good, and all the labors as good as common, except the first. This woman, in consequence of my not arriving in season, and the child being half-born at some rime before I arrived, was very much exposed to the cold at the time of confine-merit, and afterwards, being confined in a very open, cold room. Of the six cases you perceive only one recovered." . . .

This long catalogue of melancholy histories assumes a still darker aspect when we remember how kindly nature deals with the parturient female, when she is not immersed in the virulent atmosphere of an impure lying-in hospital, or poisoned in her chamber by the unsuspected breath of contagion. [Holmes charges that "the loss of life occasioned by these institutions completely defeats the objects of their founders."]

In the view of these facts, it does appear a singular coincidence, that one man or woman should have ten, twenty, thirty, or seventy cases of this rare disease following his or her footsteps with the keenness of a beagle, through the streets and lanes of a crowded city, while the scores that cross the same paths on the same errands know it only by name. It is a series of similar coincidences which has led us to consider the dagger, the musket, and certain innocent-looking white powders as having some little claim to be regarded as dangerous.

It is as a lesson rather than as a reproach that I call up the memory of these irreparable errors and wrongs. No tongue can tell the heart-breaking calamity they have caused; they have dosed the eyes just opened upon a new world of love and happiness; they have bowed the strength of manhood into the dust; they have cast the helplessness of infancy into the stranger’s arms, or bequeathed it, with less cruelty, the death of its dying parent. There is no tone deep enough for regret, and no voice loud enough for warning. The woman about to become a mother, or with her new-born infant upon her bosom, should be the object of trembling care and sympathy wherever she bears her tender burden, or stretches her aching limbs. The very outcast of the streets has pity upon her sister in degradation, when the seal of promised maternity is impressed upon her. The remorseless vengeance of the law, brought down upon its victim by a machinery as sure as destiny, is arrested in its fall at a word which reveals her transient claim for mercy. The solemn prayer of liturgy singles out her sorrows from the multiplied trials of life, to plead for her in the hour of peril. God forbid that any member of the profession to which she trusts her life, doubly precious at that eventful period, should hazard it negligently, unadvisedly, or selfishly!

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Chicago: Oliver Wendell Holmes Sr., The Contagiousness of Puerperal Fever, ed. O. W. Holmes in History in the First Person: Eyewitnesses of Great Events: They Saw It Happen, ed. Louis Leo Snyder and Richard B. Morris (Harrisburg, Pa.: Stackpole Co., 1951), Original Sources, accessed July 22, 2024,

MLA: Holmes, Oliver Wendell, Sr. The Contagiousness of Puerperal Fever, edited by O. W. Holmes, in History in the First Person: Eyewitnesses of Great Events: They Saw It Happen, edited by Louis Leo Snyder and Richard B. Morris, Harrisburg, Pa., Stackpole Co., 1951, Original Sources. 22 Jul. 2024.

Harvard: Holmes, OW, The Contagiousness of Puerperal Fever, ed. . cited in 1951, History in the First Person: Eyewitnesses of Great Events: They Saw It Happen, ed. , Stackpole Co., Harrisburg, Pa.. Original Sources, retrieved 22 July 2024, from