Puerperal Fever, as a Private Pestilence.

Boston: Ticknor & Fields, 1855.

First edition, inscribed presentation copy in the rare cloth binding of “one of the greatest American contributions to medicine” (Grolier).In the early to mid-nineteenth century in Europe and America, thousands of young women died from childbed fever, also known as puerperal fever, a disease rampant in the charity maternity clinics of the time. Women were generally affected within the first three days after childbirth. The disease progressed rapidly and caused acute symptoms of severe abdominal pain, fever, and debility. Therapy usually involved bloodletting, but with or without this treatment the disease was often fatal. Perhaps Jane Seymour, the third wife of England’s King Henry VIII, was the most famous victim of puerperal fever. She died two weeks after giving birth to Henry’s only surviving son, the future Edward VI of England … Born into a family whose ancestors had distinguished themselves in both literature and medicine, Holmes attended Harvard University and also studied at the prestigious medical schools of Paris. After two and a half years, he returned to the United States and received his medical degree from Harvard in 1836. He maintained a small medical practice for 12 years but found that his main interests lay in teaching and research. Hearing of the death of a physician one week after performing a postmortem exam on a woman who had died of puerperal fever, Holmes began a thorough investigation and read a paper on ‘The Contagiousness of Puerperal Fever’ before the Boston Society for Medical Improvement in 1843. Because the paper was published in the New England Quarterly Journal of Medicine and Surgery, a journal with a very small circulation which ceased publication after only one year, it went largely unnoticed until it was republished in 1855 as a booklet entitled Puerperal Fever, as a Private Pestilence. Holmes argued the controversial view that physicians with unwashed hands were responsible for transmitting puerperal fever from patient to patient. Holmes was promptly attacked by the leading Philadelphia obstetrician, Charles D. Meigs, who derided his arguments as the ‘jejeune and fizzenless dreamings’ of a sophomoric writer, and declared that any practitioner who met with epidemic cases of puerperal fever was simply ‘unlucky.’ A few years later, Semmelweis took up the struggle in Europe to persuade other physicians of the contagiousness of puerperal fever … Thanks to the work of Holmes and Semmelweis, the gradual acceptance of sterile procedures, and to a variety of other factors such as improved environmental conditions, better overall obstetrical care, and the availability of antibiotics, puerperal fever has become rare in developed countries” (Lane et al.). “The publishers’ archives record a press-run of only 500 copies, if which 159 were unsold in 1865 and were put in storage. Most copies of this edition seem to have been issued in printed paper wrappers; copies in the publisher's cloth binding are very rare” (Norman). The Norman copy, in original black cloth and also inscribed, sold for $23,000 at part 3 of the Norman sale at Christie’s, 29 October 1998, lot 1129.

Provenance: Dr. William Page (inscribed by Holmes on the original front yellow fly leaf ‘Dr. Page/ from his friend the author’). Page was a friend of Holmes and possibly worked with him. He served as a surgeon during the Civil War, and later was the first physician at the Montezuma Hot Springs in Las Vegas, New Mexico. Page’s wife died of puerperal fever.

During the 1800s, puerperal fever was widespread in Europe and a common cause of maternal death. Holmes began to research puerperal fever in 1842 after watching Walter Channing, an instructor at Harvard Medical School in Boston, Massachusetts, present about thirteen fatal cases of puerperal fever to the Boston Society for Medical Improvement. At the time, Holmes was a practicing physician in Boston. Holmes spent a year researching puerperal fever by going through case reports and other medical literature in Boston.

“On 13 February 1843, Holmes presented his research to the Boston Society for Medical Improvement. In April, he published his research as an essay, ‘The Contagiousness of Puerperal Fever’. According to Holmes, he intended for the essay to alert physicians and various medical staff to the fact that they could spread puerperal fever and that puerperal fever was contagious. At the time of the essay's publication, researchers couldn't explain the cause of the disease and physicians were unaware that they could be in part be responsible for the spread of the disease.

“‘The Contagiousness of Puerperal Fever’ is divided into three untitled parts. In Part I, Holmes presents his overall thesis that puerperal fever is infectious and often spread by physicians. Holmes also analyses previous literature on puerperal fever. In Part II, Holmes provides evidence regarding the contagious nature of puerperal fever. He presents multiple cases in which patients, who were being treated by physicians who had been exposed to puerperal fever, died after giving birth. In his final section, Part III, Holmes outlines eight preventative measures for physicians and other medical staff to follow to prevent the spread of puerperal fever. Throughout his essay, Holmes includes quotations from physicians talking about cases of puerperal fever.

“In Part I of the essay, Holmes discusses his purpose and also highlights the conclusions of previous research done on puerperal fever. He begins Part I by stating that it is important for physicians to consider that puerperal fever could pass from physician to patient, and that the conclusions of his essay could prevent further maternal deaths. Holmes lists the five points of his essay. In his first point, he states that he does not know if all forms of puerperal fever are equally contagious, so he will not address different forms throughout his essay, rather he discusses puerperal fever from a more general perspective. In the next two points, Holmes states that he will not discuss the exact modes of transmission of the disease or the exact causes. He then acknowledges that there are instances of lone cases of puerperal fever that do not end up spreading to other patients. In his final point, Holmes states that many women died of puerperal fever and that physicians and nurses had been blind to the fact that they may carry the disease.

“In Part I of the essay, Holmes discusses the work of Alexander Gordon, a physician who wrote a 1795 book on the infectious nature of puerperal fever titled A Treatise on the Epidemic Puerperal Fever of Aberdeen. Holmes quotes Gordon as saying that he suspected he was carrying the disease to patients and that he could predict which patients would die of puerperal fever based on who attended to them. Holmes uses Gordon’s words as evidence for his thesis of the contagiousness of puerperal fever. He cites work of other physicians including case reports and research papers, and medical cases for which all the patients of specific medical staff died of puerperal fever during a specific span of time. According to Holmes, the deaths of all the patients of one physician indicated that the physician was responsible for spreading the disease.

“In Part II, Holmes outlines numerous cases of puerperal fever as evidence of the link between the spread of puerperal fever and the actions of the physicians in charge of the cases. In this section, Holmes explores cases for which a physician conducted an autopsy on a patient who died of puerperal fever or other bacterial disease and then treated a pregnant woman after completing the autopsy. Holmes then reviews the case report of Charles Warrington, a physician in the United States. Warrington, after assisting in an autopsy of a patient who died of puerperal fever, delivered the infants of three women and attended two other patients. All five patients were diagnosed with puerperal fever and two died. From Warrington’s report, Holmes concludes that autopsies played a role in the spread of puerperal fever. Holmes presents another case of a physician whose patients were dying of puerperal fever. In the case, two nurses who handled the bodies of the dead patients also died of erysipelas, a disease caused by a bacterial infection in the skin. The physician in charge of the cases had wounded himself during an autopsy of an older man who had died suddenly. Holmes argues that the physician had spread the erysipelas to the nurses, and Holmes connects erysipelas with puerperal fever. He argues that the physician had caused the pregnant patients to get puerperal fever because of the spread of the erysipelas.

“Holmes continues Part II of his essay by examining cases of puerperal fever in which the physicians had not performed autopsies prior to attending to patients. He analyzes the cases to show that the spread of puerperal fever occurred drastically and in a specific amount of time. Holmes references a letter written to a colleague of his in which a physician discusses cases of puerperal fever that had occurred in his practice. The physician details how the cases of puerperal fever seemed to be confined to certain periods of time, occurring one after another. Holmes notes that most cases of puerperal fever spread in a short amount of time, and because they were usually confined to specific physicians, those physicians were responsible for spreading the disease.

“In another case Holmes describes in Part II, puerperal fever was directly transferred from physician to patient. The physician, after conducting an examination of the body of a patient who died of puerperal fever, carried pelvic organs in his pocket to the classroom to teach students. He later aided in the delivery of a pregnant woman who died of puerperal fever. The physician also used the same forceps from the delivery the next day on another patient, who later died of puerperal fever. Holmes uses those cases to show a correlation between patient deaths and the actions of physicians. He states that after physicians conduct autopsies, they transfer the disease to the patients. He also concludes that there is a correlation between erysipelas, a bacterial skin infection, and puerperal fever and that puerperal fever may originate from erysipelas.

“In Part III of ‘The Contagiousness of Puerperal Fever,’ Holmes outlines eight measures medical staff should take to prevent the spread of puerperal fever. He first states that the conclusions of his essay are meant to instruct physicians rather than criticize them. Following, Holmes presents his recommendations. He first recommends that physicians who plan on attending to pregnant women should not take part in autopsies on patients who died of puerperal fever. He then states that if they do attend an autopsy, they should properly clean themselves and wait a full day before attending to pregnant patients. Next, Holmes outlines what medical staff should do with singular cases of puerperal fever, emphasizing that physicians and staff must take precautions to prevent the spread of the disease. He does not specify the precautions, but mentions that a physician should let some time pass after attending to a patient with puerperal fever before attending to another patient. Holmes argues that if more than one patient of a physician’s is diagnosed with puerperal fever, that physician should let a month pass before returning to practice. He goes on to state that if a physician has three closely connected puerperal fever cases, then that physician should be regarded as the reason for the spread of the disease. Finally, Holmes declares that widespread cases of puerperal fever under any physician should not be seen as a misfortune but as crime.

“According to historian of science Lois Magner, Holmes’s essay was not well received by the medical community in the 1840s. Obstetricians, including Charles D. Meigs, a physician of obstetrics and professor at Jefferson Medical College in Philadelphia, Pennsylvania, contended that Holmes’s argument was flawed and referred to him as a sophomoric writer. At the time, many physicians said that widespread cases of puerperal fever were a result of misfortune and not the physicians’ fault. Many obstetricians dismissed Holmes’s work because he was not an obstetrician. In addition, the New England Quarterly Journal of Medicine and Surgery, in which Holmes published his essay, reached few doctors and stopped publishing new issues a year after the publication of Holmes’s essay. Because of the criticism and lack of reach, Holmes published another version of his essay in 1855 that included an additional introduction, in which he highlighted how his initial essay impacted the medical community. The second version of the essay, titled Puerperal Fever as a Private Pestilence, also presented additional cases as evidence.

“Despite the criticism Holmes’s work received and its lack of reach, some physicians followed Holmes’s recommendations. In 1852, James Copeland, a physician at Queen Charlotte’s Lying-in Hospital in London, England, affirmed Holmes’s conclusion in his book, A Dictionary of Practical Medicine. Holmes’s work on puerperal fever was supported by the work of Ignaz Semmelweis, a physician at the Vienna General Hospital in Vienna, Austria, who in 1847 made similar conclusions as Holmes, but also suggested that physicians properly wash their hands prior to and following attending patients.

“‘The Contagiousness of Puerperal Fever’ was the one of the first compilations of evidence arguing that puerperal fever was an infectious disease that could be passed from physician to patient. Holmes’ and Semmelweis’ work on the infectious nature of puerperal fever enabled researchers to prevent and later cure puerperal fever, and the disease became almost non-existent by 1960 in many parts of the world” (Embryo Project).

“Oliver Wendell Holmes was born on 29 August 1809 in Cambridge, Massachusetts. He received his early education in Cambridge, followed by four years at Phillips Academy in Andover. Then entering Harvard in 1829, he studied law for a year before turning to medicine and becoming apprenticed to Dr. James Jackson, who became his counsellor and friend. In 1833 he interrupted his studies in Boston to travel to Paris, at that time the Mecca of medical research and education. There he studied under the great Pierre Louis, who became his beloved teacher, and under others including Velpeau and the surgeons Dupuytren and Larrey. He also travelled widely, visiting Holland, Switzerland, Italy, and England. Returning to the United States in December 1835, he received the Harvard degree of MD in 1836 and entered practice. In 1839 the University of Maryland offered him the chair of surgery in Baltimore, but he declined. He was too much of a Bostonian. The following year he married Amelia Lee Jackson, the daughter of Charles Jackson who was a justice of the Massachusetts Supreme Court. From this marriage there were three children: an elder son and namesake who became a justice of the United States Supreme Court, a daughter, and a younger son who became a Boston lawyer. In 1837 Holmes was appointed to the staff of the Boston Dispensary. During his early years after qualification he also taught physiology and pathology at the Tremont Street Medical College and, with Dr Bigelow, edited the American edition of Marshall Hall’s textbook The theory and practice of medicine. In 1846 Holmes was appointed physician to the Massachusetts General Hospital, and the following year was elected first Parkman professor of anatomy and physiology at Harvard, a position he held for the next 35 years, although physiology was separated from his chair in 1871. He also became dean of the Harvard medical faculty between 1847 and 1853. Holmes was a brilliant conversationalist and became a member of the Saturday Club which included among its select membership Emerson, Hawthorne, Whittier, Longfellow, Lowell, and Motley. Holmes retired from active teaching in 1882. Harvard awarded him the degree of LLD and made him professor emeritus. Four years later he revisited Europe for the first time since 1830, calling on Pasteur in Paris and receiving honorary degrees from the Universities of Oxford, Cambridge, and Edinburgh. After his wife died in 1888, he went to live first with his widowed daughter, and when she in turn died in 1889, then with his son Mr Justice Holmes. It was at this time that he presented his personal collection of 1000 volumes to the Boston Medical Library, of which he had been president for 13 years. He wrote: ‘These books were very dear to me as they stood on my shelves. A twig from some one of my nerves ran to every one of them’” (Dunn).

BAL 8768; Garrison-Morton 6276; Grolier Medicine 72c; Osler 2989A; Waller 4852; Norman 1089; cf. PMM 316 (1843 journal issue). Dunn, ‘Oliver Wendell Holmes (1809–1894) and his essay on puerperal fever,’ Archives of disease in childhood. Fetal and neonatal edition 92 (2007), pp. F325–F327. Lane et al., ‘Oliver Wendell Holmes (1809–1894) and Ignaz Philipp Semmelweis (1818–1865): Preventing the Transmission of Puerperal Fever,’ American Journal of Public Health 100 (2010), pp. 1008–1009.

8vo (237 x 148 mm), pp. [ii, blank], [1-5], 6-60, [2, blank]. Original blind-stamped vertically ribbed cloth, title in gilt on front cover. Exceptionally fine and unrestored copy.

Item #5338

Price: $48,500.00

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