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THE CONTAGIOUSNESS OF

PUERPERAL FEVER

BY

OLIVER WENDELL HOLMES

OLIVER WENDELL HOLMES was born in Cambridge, Massachusetts, August 29, 1809, and educated at Phillips Academy, Andover, and Harvard College, After graduation, he entered the Law School, but soon gave up law for medicine. He studied first in Boston, and later spent two years in medical schools in Europe, mainly in Paris. On his return he began to practise in Boston, but in two years he was appointed professor of anatomy at Dartmouth College, a position which he held from 1838 to 1840, when he again took up his Boston practise. It was soon after this, in 1843, that he published his essay on the Contagiousness of Puerperal Fever, his only contribution of high distinction to medical science. From 1847 to 1882 he was Parkman professor of anatomy and physiology in the Harvard Medical School. He died in Boston, October 7, 1894.

In spite of the importance of the paper here printed, Holmes's reputation as a scientist was overshadowed by that won by him as a wit and a man of letters. When he was only twenty-one his "Old Ironsides" brought him into notice; and through his poetry and fiction, and the sparkling talk of the Breakfast Table" series, he took a high place among the most distinguished group of writers that America has yet produced.

THE CONTAGIOUSNESS OF

PUERPERAL FEVER

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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 medica? 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 a 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, with Dr. Rigby, that it was a case of oblique vision"; I should be unwilling to force home the argumentum ad hominem of Dr. Blundell, but I would not consent to make a question of a momentous fact which is no longer to be considered as a subject for trivial discussions, but to be acted upon with silent promptitude. It signifies nothing that wise and experienced practitioners have sometimes doubted the reality of the danger in question; no man has the right to doubt it any longer. 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.

If there are some who conceive that any important end would be answered by recording such opinions, or by collecting the history of all the cases they could find in which no evidence of the influence of contagion existed, I believe they are in error. Suppose a few writers of authority can

Note: This essay appeared first in 1843, in The New England, Quarterly Journal of Medicine, and was reprinted in the “ Medical Essays

"in 1855

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be found to profess a disbelief in contagion,—and they are very few compared with those who think differently, -is it quite clear that they formed their opinions on a view of all the facts, or is it not apparent that they relied mostly on their own solitary experience? Still further, of those whose names are quoted, is it not true that scarcely a single one could, by any possibility, have known the half or the tenth of the facts bearing on the subject which have reached such a frightful amount within the last few years? Again, as to the utility of negative facts, as we may briefly call them,-instances, namely, in which exposure has not been followed by disease,-although, like other truths, they may be worth knowing, I do not see that they are like to shed any important light upon the subject before us. Every such instance requires a good deal of circumstantial explanation before it can be accepted. It is not enough that a practitioner should have had a single case of puerperal fever not followed by others. It must be known whether he attended others while this case was in progress, whether he went directly from one chamber to others, whether he took any, and what, precautions. It is important to know that several women were expesed to infection derived from the patient, so that allowance may be made for want of predisposition. Now, if of negative facts sc sifted there could be accumulated a hundred for every one plain instance of communication here recorded, I trust it need not be said that we are bound to guard and watch over the hundredth tenant of our fold, though the ninety and nine may be sure of escaping the wolf at its entrance. If any one is disposed, then, to take a hundred instances of lives, endangered or sacrificed out of those I have mentioned, and make it reasonably clear that within a similar time and compass ten thousand escaped the same exposure, I shall thank him for his industry, but I must be permitted to hold to my own practical conclusions, and beg him to or at least to examine them also. Children that walk in calico before open fires are not always burned to death; the instances to the contrary may be worth recording; but by no means if they are to be used as arguments against woollen frocks and high fenders.

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