when a practitioner has attended any one instance of it, he should use most diligent ablution." watson recommended handwashing with chlorine solution and changes of clothing for obstetric attendants "to prevent the practitioner becoming a vehicle of contagion and death between one patient and another." hygienic measures ignaz semmelweis, discoverer of some of the causes of puerperal fever in 1843, oliver wendell holmes sr. published the contagiousness of puerperal fever and controversially concluded that puerperal fever was frequently carried from patient to patient by physicians and nurses; he suggested that clean clothing and avoidance of autopsies by those aiding birth would prevent the spread of puerperal fever. holmes quoted dr. james blundell as stating, "... in my own family, i had rather that those i esteemed the most should be delivered unaided, in a stable, by the mangerside, than that they should receive the best help, in the fairest apartment, but exposed to the vapors of this pitiless disease." holmes' conclusions were ridiculed by many contemporaries, including charles delucena meigs, a well-known obstetrician, who stated, "doctors are gentlemen, and gentlemen's hands are clean." richard gordon states that holmes' exhortations "outraged obstetricians, particularly in philadelphia". in those days, "surgeons operated in blood-stiffened frock coats—the stiffer the coat, the prouder the busy surgeon", "pus was as inseparable from surgery as blood", and "cleanliness was next to prudishness". he quotes sir frederick treves on that era: "there was no object in being clean. indeed, cleanliness was out of place. it was considered to be finicking and affected. an executioner might as well manicure his nails before chopping off a head". in 1844, ignaz semmelweis was appointed assistant lecturer in the first obstetric division of the vienna general hospital (allgemeines krankenhaus), where medical students received their training. working without knowledge of holmes' essay, semmelweis noticed his ward's 16% mortality rate from fever was substantially higher than the 2% mortality rate in the second division, where midwifery students were trained. semmelweis also noticed that puerperal fever was rare in women who gave birth before arriving at the hospital. semmelweis noted that doctors in first division performed autopsies each morning on women who had died the previous day, but the midwives were not required or allowed to perform such autopsies. he made the connection between autopsies and puerperal fever after a colleague, jakob kolletschka, died of sepsis after accidentally cutting his hand while performing an autopsy. semmelweis began experimenting with various cleansing agents and, from may 1847, ordered all doctors and students working in the first division wash their hands in chlorinated lime solution before starting ward work, and later before each vaginal examination. the mortality rate from puerperal fever in the division fell from 18% in may 1847 to less than 3% in june–november of the same year. while his results were extraordinary, he was treated with skepticism and ridicule (see response to semmelweis). he did the same work in st. rochus hospital in pest, hungary, and published his findings in 1860, but his discovery was again ignored. in 1935, leonard colebrook showed prontosil was effective against haemolytic streptococcus and hence a cure for puerperal fever. notable cases elite status was no protection against postpartum infections, as the deaths of several english queens attest. elizabeth of york, queen consort of henry vii, died of puerperal fever one week after giving birth to a daughter, who also died. her son henry viii had two wives who died this way, jane seymour and catherine parr. suzanne barnard, mother of philosopher jean-jacques rousseau, contracted childbed fever after giving birth to him and died nine days later. her infant son was also in perilous health following the birth; the adult rousseau later wrote that "i came into the world with so few signs of life that little hope was entertained of preserving me". he was nursed back to health by an aunt. french natural philosopher émilie du châtelet died in 1749. mary wollstonecraft, author of vindication of the rights of woman, died ten days after giving birth to her second daughter, who grew up to write frankenstein. other notables include african-american poet phillis wheatley (1784), british housekeeping authority isabella beeton, and american author jean webster in 1916 died of puerperal fever. in charles dickens' novel a christmas carol, it is implied that both scrooge's mother and younger sister perished from this condition, explaining the character's animosity towards his nephew fred and also his poor relationship with his own father.