The hospital finally opened in 1865. Under the direction of Dr. William Goodell, it admitted pregnant women 16 days before their due date, offering clean clothes, good meals, and two baths per week. The Retreat had a deserved reputation for a low infection rate and mortality. Throughout the world, maternal mortality was dreadful, in large part due to infection, until the latter half of the 19th century. For example, in 1854 an outbreak of childbed fever closed the maternity hospital at Pennsylvania Hospital on Spruce Street. In 1843 Oliver Wendell Holmes Sr., the father of the future US Supreme Court justice, published his monograph The Contagiousness of Puerperal Fever. In it he suggested that physicians themselves were transferring the infection between patients, and recommended avoiding assistance at childbirth immediately after performing an autopsy. In 1847, Ignaz Semmelweis, a Hungarian obstetrician, noted that women who delivered at home or in a hospital with midwives had a much lower risk of infection than mothers delivering in a hospital with physicians and medical students. He recommended, in addition to Holmes' advice, that doctors wash their hands in a bleach solution before assisting in deliveries. At this time germ theory was not generally known. The notion that doctors might be spreading disease did not sit well with doctors, and attention to the advice of Holmes and Semmelweis was not widespread until the 1860s, when Louis Pasteur showed a biologic mechanism for transmission of infectious disease via germs, and Joseph Lister showed a way to make instruments and procedures more antiseptic via using carbolic acid sprays. The Preston Retreat had regulations that prevented the training of medical students there, which may have been one reason for the lower infection rate. Another reason may be favorable patient selection, since patients required "testimonials" before admission, and those without presumably went to the Blockley Almshouse in West Philadelphia, which opened its massive new facility in 1835 (the future Philadelphia General Hospital, and then the site of CHOP). Physician Joseph Price, who figures prominently in our article on the Garretson Hospital, wrote an article in 1889 documenting 500 deliveries at the Preston Retreat without a single case of septicemia or death. In fact, there were 600 deliveries between two deaths, both of those deaths due to eclampsia (seizures due to high blood pressure in pregnancy) in women with underlying kidney disease. An impressive record in the 19th century!