Puerperal Fever As A Private Pestilence

Puerperal Fever As A Private Pestilence is one of Oliver Wendell Holmes Sr.’s major medical writings, written as a follow up to his foundational 1843 paper The Contagiousness of Puerperal Fever. Holmes returned to the puerperal fever question repeatedly across his career, with the 1855 essay being one of the more important later contributions to a debate that he had been one of the earliest American voices to raise.

The puerperal fever problem was one of the most devastating medical issues of the nineteenth century. The disease, now known to be caused by Streptococcus pyogenes bacterial infection introduced into the uterus during childbirth, killed thousands of women across Europe and America in the decades before the germ theory of disease and the antiseptic practices that eventually controlled it became widely accepted. Holmes was one of the earliest American physicians to argue, based on careful observation and statistical analysis, that the disease was being transmitted by physicians themselves, who carried the infection from patient to patient on their hands, instruments, and clothing.

His original 1843 paper had been received with hostility by many of his medical colleagues, who took the implication that they were actively killing their patients personally. The 1855 follow up, which the Puerperal Fever As A Private Pestilence essay represents, returns to the question with additional evidence and additional polemical force. Holmes argues with the particular intensity of someone who has spent more than a decade watching the medical profession refuse to act on evidence that he had laid out clearly and that the accumulating cases had only confirmed. Some of the most pointed passages in the essay are directed at specific physicians whose continued practice he believed was actively harming their patients.

Holmes’s prose in his medical writings is in the formal nineteenth century scientific style but reads more accessibly than much of the medical writing of the period. He had a real gift for the memorable phrase and for the kind of arresting comparison that lets a complicated medical idea land with general readers. The puerperal fever essays show him at his most morally serious and at his most rhetorically effective.

For historians of medicine, Holmes is one of the central American figures of the nineteenth century, and the puerperal fever writings are among his most important contributions. For general readers interested in the development of modern medical thinking, in the slow movement toward germ theory, or in the ethics of medical practice, the essays are essential.