Oliver Wendell Holmes’ 1836 doctorate dissertation and his journey in medicine

Abstract

Oliver Wendell Holmes’ 1836 hand written doctorate dissertation on acute pericarditis was discovered in the archives of the Boston Medical Library 101 years after it was successfully defended. It was then printed as an unabridged monograph with an explanation of its provenance. The dissertation has received little scrutiny since then. Holmes gathered materials for the scholarly work while he was a third and fourth year student at Ecole de Medecine in Paris. His mentor, Pierre-Charles-Alexandre- Louis insisted on the meticulous gathering and recording of every patient’s history and findings. Each category of data was given a weighted numerical value of diagnostic importance and the information was placed in a registry. Holmes became a disciple of Louis in gathering data by direct observation and measuring outcomes in a “statistical” fashion. Holmes dissertation on acute pericarditis describes the state of knowledge about the illness in the 1830s. When Holmes and other students who had studied in Paris returned to the United States, they helped turn American Medicine from opinion and strong personal bias toward scientific objectivity. Oliver Wendell Holmes eventually became both a professor of anatomy/physiology and a dean at Harvard Medical School. He is recognized as a leader in medicine and a popular author in America and beyond. In his late and infirmed years, Holmes questioned the wisdom of his unswerving advocacy for the scientific underpinnings of medicine. In retrospect he had overlooked the importance of also advocating that each patient be approached with comforting compassion.

Keywords: Acute pericarditis; Medical statistics; Childbed fever; Harvard medical school; Pierre-Charles-Alexandre- Louis

Core tip: Oliver Wendell Holmes' 1836 Doctorate Dissertation on Acute Pericarditis has received little scrutiny since its publication 100 years after it was successfully defended at Harvard Medical School. The state of knowledge about pericarditis in the mid eighteen hundreds was unusually sound considering the inability to study tissue with microscopy. However treatment was a matter of opposing expert opinions and the fashion of the day in Paris was to disparage professors who disagreed. Paris was a mecca for students. Cadavers were plentiful for study. Lectures and clinics were free.