Oliver Wendell Holmes: Poetry Oliver Wendell Holmes Sr.

Medical training

Having given up on the study of law, Holmes switched to medicine. After leaving his childhood home in Cambridge during the autumn of 1830, he moved into a boardinghouse in Boston to attend the city's medical college. At that time, students studied only five subjects: medicine, anatomy and surgery, obstetrics, chemistry and materia medica.[35] Holmes became a student of James Jackson, a physician and the father of a friend, and worked part-time as a chemist in the hospital dispensary. Dismayed by the "painful and repulsive aspects" of primitive medical treatment of the time—which included practices such as bloodletting and blistering—Holmes responded favorably to his mentor's teachings, which emphasized close observation of the patient and humane approaches.[36] Despite his lack of free time, he was able to continue writing. He wrote two essays during this time which detailed life as seen from his boardinghouse's breakfast table. These essays, which would evolve into one of Holmes's most popular works, were published in November 1831 and February 1832 in The New-England Magazine under the title "The Autocrat of the Breakfast-Table".[37]

In 1833, Holmes traveled to Paris to further his medical studies. Recent and radical reorganization of the city's hospital system had made medical training there highly advanced for the time.[38] At twenty-three years old, Holmes was one of the first Americans trained in the new "clinical" method being advanced at the famed École de Médecine.[39] Since the lectures were taught entirely in French, he engaged a private language tutor. Although far from home, he stayed connected to his family and friends through letters and visitors (such as Ralph Waldo Emerson). He quickly acclimated to his new surroundings. While writing to his father, he stated, "I love to talk French, to eat French, to drink French every now and then."[40]

At the hospital of La Pitié, he studied under internal pathologist Pierre Charles Alexandre Louis, who demonstrated the ineffectiveness of bloodletting, which had been a mainstay of medical practice since antiquity.[41][42] Louis was one of the fathers of the méthode expectante, a therapeutic doctrine that states the physician's role is to do everything possible to aid nature in the process of disease recovery, and to do nothing to hinder this natural process.[43] Upon his return to Boston, Holmes became one of the country's leading proponents of the méthode expectante. Holmes was awarded his Doctor of Medicine degree from Harvard in 1836; he wrote his dissertation on acute pericarditis.[44] His first collection of poetry was published later that year, but Holmes, ready to begin his medical career, wrote it off as a one-time event. In the book's introduction, he mused: "Already engaged in other duties, it has been with some effort that I have found time to adjust my own mantle; and I now willingly retire to more quiet labors, which, if less exciting, are more certain to be acknowledged as useful and received with gratitude".[45]

Medical reformer

After graduation, Holmes quickly became a fixture in the local medical scene by joining the Massachusetts Medical Society, the Boston Medical Society, and the Boston Society for Medical Improvement—an organization composed of young, Paris-trained doctors.[46] He also gained a greater reputation after winning Harvard Medical School's prestigious Boylston Prize, for which he submitted a paper on the benefits of using the stethoscope, a device with which many American doctors were not familiar.[47]

In 1837, Holmes was appointed to the Boston Dispensary, where he was shocked by the poor hygienic conditions.[48] That year he competed for and won both of the Boylston essay prizes. Wishing to concentrate on research and teaching, he, along with three of his peers, established the Tremont Medical School—which would later merge with Harvard Medical School[49]—above an apothecary shop at 35 Tremont Row in Boston. There, he lectured on pathology, taught the use of microscopes, and supervised dissections of cadavers.[50] He often criticized traditional medical practices and once quipped that if all contemporary medicine was tossed into the sea "it would be all the better for mankind—and all the worse for the fishes".[51] For the next ten years, he maintained a small and irregular private medical practice, but spent much of his time teaching. He served on the faculty of Dartmouth Medical School from 1838 to 1840,[52] where he was appointed professor of anatomy and physiology. For fourteen weeks each fall, during these years, he traveled to Hanover, New Hampshire, to lecture.[53] He was elected a Fellow of the American Academy of Arts and Sciences in 1838.[54]

After Holmes resigned his professorship at Dartmouth, he composed a series of three lectures dedicated to exposing medical fallacies, or "quackeries". Adopting a more serious tone than his previous lectures, he took great pains to reveal the false reasoning and misrepresentation of evidence that marked subjects such as "Astrology and Alchemy", his first lecture, and "Medical Delusions of the Past", his second.[55] He deemed homeopathy, the subject of his third lecture, "the pretended science" that was a "mingled mass of perverse ingenuity, of tinsel erudition, of imbecile credulity, and of artful misrepresentation, too often mingled in practice".[56] In 1842, he published the essay "Homeopathy and Its Kindred Delusions"[57] in which he again denounced the practice.

In 1846, Holmes coined the word anaesthesia. In a letter to dentist William T. G. Morton, the first practitioner to publicly demonstrate the use of ether during surgery, he wrote:

Everybody wants to have a hand in a great discovery. All I will do is to give a hint or two as to names—or the name—to be applied to the state produced and the agent. The state should, I think, be called "Anaesthesia." This signifies insensibility—more particularly ... to objects of touch.[58]

Holmes predicted his new term "will be repeated by the tongues of every civilized race of mankind."[59]

Study of childbed fever

In 1842 Holmes attended a lecture by Walter Channing to the Boston Society for Medical Improvement about puerperal fever, or "childbed fever", a disease which at the time was a significant cause of mortality of women after delivering children. Becoming interested in the subject, Holmes spent a year going through case reports and other medical literature on the subject to ascertain the cause and possible prevention of the condition. In 1843, he presented his research to the society, which he then published as a paper "The Contagiousness of Puerperal Fever" in the short-lived publication New England Quarterly Journal of Medicine and Surgery.[61] The essay argued—contrary to popular belief at the time, which predated germ theory of disease—that the cause of puerperal fever, a deadly infection contracted by women during or shortly after childbirth, stems from patient-to-patient contact via their physicians.[62] He believed that bed sheets, washcloths and articles of clothing were of particular concern in this regard.[63] Holmes gathered a large collection of evidence for this theory, including stories of doctors who had become ill and died after performing autopsies on patients who had likewise been infected.[64] In concluding his case, he insisted that a physician in whose practice even one case of puerperal fever had occurred, had a moral obligation to purify his instruments, burn the clothing he had worn while assisting in the fatal delivery, and cease obstetric practice for a period of at least six months.[65]

Though it largely escaped notice when first published, Holmes eventually came under attack by two distinguished professors of obstetrics—Hugh L. Hodge and Charles D. Meigs—who adamantly denied his theory of contagion.[66] In 1855, Holmes published a revised version of the essay in the form of a pamphlet under the new title Puerperal Fever as a Private Pestilence,[67] and discussing additional cases.[61] In a new introduction, in which Holmes directly addressed his opponents, he wrote: "I had rather rescue one mother from being poisoned by her attendant, than claim to have saved forty out of fifty patients to whom I had carried the disease."[68] He added, "I beg to be heard in behalf of the women whose lives are at stake, until some stronger voice shall plead for them."[69]

A few years later, Ignaz Semmelweis would reach similar conclusions in Vienna, where his introduction of prophylaxis (handwashing in chlorine solution before assisting at delivery) would considerably lower the puerperal mortality rate, and the then-controversial work is now considered a landmark in germ theory of disease.[28]

Teaching and lecturing

In 1847, Holmes was hired as Parkman Professor of Anatomy and Physiology at Harvard Medical School, where he served as dean until 1853 and taught until 1882.[70] Soon after his appointment, Holmes was criticized by the all-male student body for considering granting admission to a woman named Harriot Kezia Hunt.[71] Facing opposition from not only students but also university overseers and other faculty members, she was asked to withdraw her application.[72] Harvard Medical School would not admit a woman until 1945.[73] Holmes's training in Paris led him to teach his students the importance of anatomico-pathological basis of disease, and that "no doctrine of prayer or special providence is to be his excuse for not looking straight at secondary causes."[74] Students were fond of Holmes, to whom they referred as "Uncle Oliver". One teaching assistant recalled:

He enters [the classroom] and is greeted by a mighty shout and stamp of applause. Then silence, and there begins a charming hour of description, analysis, anecdote, harmless pun, which clothes the dry bones with poetic imagery, enlivens a hard and fatiguing day with humor, and brightens to the tired listener the details for difficult though interesting study.[59]