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Part II.
Part II.
I must call the attention of the inquirer most particularly to the
Quarterly Report above referred to, and the letters of Dr. Meigs and Dr.
Rutter, to be found in the "Medical Examiner." Whatever impression they may
produce upon his mind, I trust they will at least convince him that there is
some reason for looking into this apparently uninviting subject.
At a meeting of the College of Physicians just mentioned Dr. Warrington
stated that a few days after assisting at an autopsy of puerperal peritonitis,
in which he laded out the contents of the abdominal cavity with his hands, he
was called upon to deliver three women in rapid succession. All of these women
were attacked with different forms of what is commonly called puerperal fever.
Soon after these he saw two other patients, both on the same day, with the
same disease. Of these five patients, two died.
At the same meeting Dr. West mentioned a fact related to him by Dr.
Samuel Jackson, of Northumberland. Seven females, delivered by Dr. Jackson
in rapid succession, while practising in Northumberland County, were all
attacked with puerperal fever, and five of them died. "Women," he said, "who
had expected me to attend upon them, now becoming alarmed, removed out of my
reach, and others sent for a physician residing several miles distant. These
women, as well as those attended by midwives, all did well; nor did we hear of
any deaths in child-bed within a radius of fifty miles, excepting two, and
these I afterwards ascertained to have been caused by other diseases." He
underwent, as he thought, a thorough purification, and still his next patient
was attacked with the disease and died. He was led to suspect that the
contagion might have been carried in the gloves which he had worn in
attendance upon the previous cases. Two months or more after this he had two
other cases. He could find nothing to account for these unless it were the
instruments for giving enemata, which had been used in two of the former cases
and were employed by these patients. When the first case occurred, he was
attending and dressing a limb extensively mortified from erysipelas, and went
immediately to the accouchement with his clothes and gloves most thoroughly
imbued with its effluvia. And here I may mention that this very Dr. Samuel
Jackson, of Northumberland, is one of Dr. Dewees` authorities against
contagion.
The three following statements are now for the first time given to the
public. All of the cases referred to occurred within this State, and two of
the three series in Boston and its immediate vicinity.
I. The first is a series of cases which took place during the last spring
in a town at some distance from this neighborhood. A physician of that town,
Dr. C., had the following consecutive cases:
No. 1, delivered March 20, died March 24.
" 2, " April 9, " April 14.
" 3, " " 10, " " 14.
" 4, " " 11, " " 18.
" 5, " " 27, " May 3.
" 6, " " 28, had some symptoms, recovered.
" 7, " May 8, had some symptoms, also recovered.
These were the only cases attended by this physician during the period
referred to. "They were all attended by him until their termination, with the
exception of the patient No. 6, who fell into the hands of another physician
on the 2d of May (Dr. C. left town for a few days at this time.) Dr. C.
attended cases immediately before and after the above-named periods, none of
which, however, presented any peculiar symptoms of the disease."
About the 1st of July he attended another patient in a neighboring
village, who died two or three days after delivery.
The first patient, it is stated, was delivered on the 20th of March. "On
the 19th Dr. C. made the autopsy of a man who had died suddenly, sick only
forty-eight hours` had oedema of the thigh and gangrene extending from a
little above the ankle into the cavity of the abdomen." Dr. C. wounded himself
very slightly in the right hand during the autopsy. The hand was quite painful
the night following, during his attendance on the patient No. 1. He did not
see this patient after the 20th, being confined to the house, and very sick
from the wound just mentioned, from this time until the 3d of April
Several cases of erysipelas occurred in the house where the autopsy
mentioned above took place, soon after the examination. There were also many
cases of erysipelas in town at the time of the fatal puerperal cases which
have been mentioned.
The nurse who laid out the body of the patient No. 3 was taken on the
evening of the same day with sore throat and erysipelas, and died in ten days
from the first attack.
The nurse who laid out the body of the patient No. 4 was taken on the
day following with symptoms like those of this patient, and died in a week,
without any external marks of erysipelas.
"No other cases of similar character with those of Dr. C. occurred in the
practice of any of the physicians in the town or vicinity at the time. Deaths
following confinement have occurred in the practice of other physicians during
the past year, but they were not cases of puerperal fever. No post-mortem
examinations were held in any of these puerperal cases."
Some additional statements in this letter are deserving of insertion:
"A physician attended a woman in the immediate neighborhood of the cases
numbered 2, 3, and 4. This patient was confined the morning of March 1st, and
died on the night of March 7th. It is doubtful whether this should be
considered a case of puerperal fever. She had suffered from canker,
indigestion, and diarrhoea for a year previous to her delivery. Her complaints
were much aggravated for two or three months previous to delivery; she had
become greatly emaciated, and weakened to such an extent that it had not been
expected that she would long survive her confinement, if indeed she reached
that period. Her labor was easy enough; she flowed a good deal, seemed
exceedingly prostrated, had ringing in her ears, and other symptoms of
exhaustion; the pulse was quick and small. On the second and third day there
was some tenderness and tumefaction of the abdomen, which increased somewhat
on the fourth and fifth. He had cases in midwifery before and after this,
which presented nothing peculiar."
It is also mentioned in the same letter that another physician had a
case during the last summer and another last fall, both of which recovered.
Another gentleman reports a case last December, a second case five weeks,
and another three weeks, since. All these recovered. A case also occurred very
recently in the practice of a physician in the village where the eighth
patient of Dr. C. resides, which proved fatal. "This patient had some patches
of erysipelas on the legs and arms. The same physician has delivered three
cases since, which have all done well. There have been no other cases in this
town or its vicinity recently. There have been some few cases of erysipelas."
It deserves notice that the partner of Dr. C., who attended the autopsy of the
man above mentioned and took an active part in it, who also suffered very
slightly from a prick under the thumb-nail received during the examination,
had twelve cases of midwifery between March 26th and April 12th all of which
did well, and presented no peculiar symptoms. It should also be stated that
during these seventeen days he was in attendance on all the cases of
erysipelas in the house where the autopsy had been performed. I owe these
facts to the prompt kindness of a gentleman whose intelligence and character
are sufficient guaranty for their accuracy.
The two following letters were addressed to my friend Dr. Storer by the
gentleman in whose practice the cases of puerperal fever occurred. His name
renders it unnecessary to refer more particularly to these gentlemen, who on
their part have manifested the most perfect freedom and courtesy in affording
these accounts of their painful experience.
"January 28, 1843.
II. . . . "The time to which you allude was in 1830. The first case was
in February, during a very cold time. She was confined the 4th, and died the
12th. Between the 10th and 28th of this month I attended six women in labor,
all of whom did well except the last, as also two who were confined March 1st
and 5th. Mrs. E., confined February 28th, sickened, and died March 8th. The
next day, 9th, I inspected the body, and the night after attended a lady, Mrs.
B., who sickened, and died 16th. The 10th, I attended another, Mrs. G., who
sickened, but recovered. March 16th I went from Mrs. G.`s room to attend a
Mrs. H., who sickened, and died 21st. The 17th, I inspected Mrs. B. On 19th,
I went directly from Mrs. H.`s room to attend another lady, Mrs. G., who also
sickened, and died 22d. While Mrs. B. was sick, on 15th, I went directly from
her room a few rods, and attended another woman, who was not sick. Up to 20th
of this month I wore the same clothes. I now refused to attend any labor, and
did not till April 21st, when, having thoroughly cleansed myself, I resumed
my practice, and had no more puerperal fever.
"The cases were not confined to a narrow space. The two nearest were half
a mile from each other, and half that distance from my residence. The others
were from two to three miles apart, and nearly that distance from my
residence. There were no other cases in their immediate vicinity which came to
my knowledge. The general health of all the women was pretty good, and all the
labors as good as common, except the first. This woman, in consequence of my
not arriving in season, and the child being half-born some time before I
arrived, was very much exposed to the cold at the time of confinement, and
afterwards, being confined in a very open, cold room. Of the six cases, you
perceive only one recovered.
"In the winter of 1817 two of my patients had puerperal fever, one very
badly, the other not so badly. Both recovered. One other had swelled leg or
phlegmasia dolens, and one or two others did not recover as well as usual.
"In the summer of 1835 another disastrous period occurred in my practice.
July 1st I attended a lady in labor, who was afterwards quite ill and
feverish; but at the time I did not consider her case a decided puerperal
fever. On 8th I attended one who did well. On 12th, one who was seriously
sick. This was also an equivocal case, apparently arising from constipation
and irritation of the rectum. These women were ten miles apart and five from
my residence. On 15th and 20th, two who did well. On 25th I attended another.
This was a severe labor, and followed by unequivocal puerperal fever, or
peritonitis. She recovered. August 2d and 3d, in about twenty-four hours, I
attended four persons. Two of them did very well; one was attacked with some
of the common symptoms, which, however, subsided in a day or two, and the
other had decided puerperal fever, but recovered. This woman resided five
miles from me. Up to this time I wore the same coat. All my other clothes had
frequently been changed. On 6th, I attended two women, one of whom was not
sick at all; but the other, Mrs. L., was afterwards taken ill. On 10th, I
attended a lady, who did very well. I had previously changed all my clothes,
and had no garment on which had been in a puerperal room. On 12th, I was
called to Mrs. S., in labor. While she was ill, I left her to visit Mrs. L.,
one of the ladies who was confined on 6th. Mrs. L. had been more unwell than
usual, but I had not considered her case anything more than common till this
visit. I had on a surtout at this visit, which, on my return to Mrs. S., I
left in another room. Mrs. S. was delivered on 13th with forceps. These women
both died of decided puerperal fever.
"While I attended these women in their fevers I changed my clothes, and
washed my hands in a solution of chloride of lime after each visit. I attended
seven women in labor during this period, all of whom recovered without
sickness.
"In my practice I have had several single cases of puerperal fever, some
of whom have died and some have recovered. Until the year 1830 I had no
suspicion that the disease could be communicated from one patient to another
by a nurse or midwife; but I now think the foregoing facts strongly favor that
idea. I was so much convinced of this fact that I adopted the plan before
related.
"I believe my own health was as good as usual at each of the above
periods. I have no recollection to the contrary.
"I believe I have answered all your questions. I have been more
particular on some points perhaps than necessary; but I thought you could form
your own opinion better than to take mine. In 1830 I wrote to Dr. Channing a
more particular statement of my cases. If I have not answered your questions
sufficiently, perhaps Dr. C. may have my letter to him, and you can find your
answer there."^15
[Footnote 15: In a letter to myself this gentleman also stated, "I do not
recollect that there was any erysipelas or any other disease particularly
prevalent at the time."]
Boston, February 3, 1843.
III. "My dear Sir: I received a note from you last evening requesting me
to answer certain questions therein proposed, touching the cases of puerperal
fever which came under my observation the past summer. It gives me pleasure to
comply with your request, so far as it is in my power so to do, but, owing to
the hurry in preparing for a journey, the notes of the cases I had then taken
were lost or mislaid. The principal facts, however, are too vivid upon my
recollection to be soon forgotten. I think, therefore, that I shall be able to
give you all the information you may require.
"All the cases that occurred in my practice took place between the 7th of
May and the 17th of June, 1842.
"They were not confined to any particular part of the city. The first two
cases were patients residing at the South End, the next was at the extreme
North End, one living in Sea Street and the other in Roxbury. The following
is the order in which they occurred:
"Case 1. - Mrs.___ was confined on the 7th of May, at 5 o`clock, p. m.,
after a natural labor of six hours. At 12 o`clock at night, on the 9th
(thirty-one hours after confinement), she was taken with severe chill,
previous to which she was as comfortable as women usually are under the
circumstances. She died on the 10th.
"Case 2. - Mrs.___ was confined on the 10th of June (four weeks after
Mrs. C.), at 11 a. m., after a natural, but somewhat severe, labor of five
hours. At 7 o`clock, on the morning of the 11th, she had a chill. Died on the
12th.
"Case 3. - Mrs.___, confined on the 14th of June, was comfortable until
the 18th, when symptoms of puerperal fever were manifest. She died on the
20th.
"Case 4. - Mrs.___, confined June 17th, at 5 o`clock, a. m., was doing
well until the morning of the 19th. She died on the evening of the 21st.
"Case 5. - Mrs.___ was confined with her fifth child on the 17th of June,
at 6 o`clock in the evening. This patient had been attacked with puerperal
fever, at three of her previous confinements, but the disease yielded to
depletion and other remedies without difficulty. This time, I regret to say,
I was not so fortunate. She was not attacked, as were the other patients, with
a chill, but complained of extreme pain in the abdomen, and tenderness on
pressure, almost from the moment of her confinement. In this, as in the other
cases, the disease resisted all remedies, and she died in great distress on
the 22d of the same month. Owing to the extreme heat of the season and my own
indisposition, none of the subjects were examined after death. Dr. Channing,
who was in attendance with me on the three last cases, proposed to have a
post-mortem examination of the subject of case No. 5, but from some cause
which I do not now recollect it was not obtained.
"You wish to know whether I wore the same clothes when attending the
different cases. I cannot positively say, but I should think I did not, as the
weather became warmer after the first two cases; I therefore think it probable
that I made a change of at least a part of my dress. I have had no other case
of puerperal fever in my own practice for three years, save those above
related, and I do not remember to have lost a patient before with this
disease. While absent, last July, I visited two patients sick with puerperal
fever, with a friend of mine in the country. Both of them recovered.
"The cases that I have recorded were not confined to any particular
constitution or temperament, but it seized upon the strong and the weak, the
old and the young-one being over forty years, and the youngest under eighteen
years of age. . . . If the disease is of an erysipelatous nature, as many
suppose, contagionists may perhaps find some ground for their belief in the
fact that, for two weeks previous to my first case of puerperal fever, I had
been attending a severe case of erysipelas, and the infection may have been
conveyed through me to the patient; but, on the other hand, why is not this
the case with other physicians, or with the same physician at all times, for
since my return from the country I have had a more inveterate case of
erysipelas than ever before, and no difficulty whatever has attended any of my
midwifery cases?"
I am assured, on unquestionable authority, that "About three years since,
a gentleman in extensive midwifery business, in a neighboring State, lost in
the course of a few weeks eight patients in child-bed, seven of them being
undoubted cases of puerperal fever. No other physician of the town lost a
single patient of this disease during the same period." And from what I have
heard in conversation with some of our most experienced practitioners, I am
inclined to think many cases of the kind might be brought to light by
extensive inquiry.
This long catalogue of melancholy histories assumes a still darker aspect
when we remember how kindly nature deals with the parturient female, when she
is not immersed in the virulent atmosphere of an impure lying-in hospital, or
poisoned in her chamber by the unsuspected breath of contagion. From all
causes together not more than four deaths in a thousand births and
miscarriages happened in England and Wales during the period embraced by the
first Report of the Registrar-General.^16 In the second Report the mortality
was shown to be about five in one thousand.^17 In the Dublin Lying-in
Hospital, during the seven years of Dr. Collins` mastership, there was one
case of puerperal fever to 178 deliveries, or less than six to the thousand,
and one death from this disease in 278 cases, or between three and four
to the thousand.^18 Yet during this period the disease was endemic in the
hospital, and might have gone on to rival the horrors of the pestilence of the
Maternite, had not the poison been destroyed by a thorough purification.
[Footnote 16: First Report, p. 105.]
[Footnote 17: Second Report, p. 73.]
[Footnote 18: Collins` Treatise on Midwifery, p. 228, etc.]
In private practice, leaving out of view the cases that are to be
ascribed to the self-acting system of propagation, it would seem that the
disease must be far from common. Mr. White, of Manchester, says: "Out of the
whole number of lying - in patients whom I have delivered (and I may safely
call it a great one), I have never lost one, nor to the best of my
recollection has one been greatly endangered, by the puerperal, miliary, low
nervous, putrid malignant, or milk fever."^19 Dr. Joseph Clarke informed Dr.
Collins that in the course of forty-five years` most extensive practice he
lost but four patients from this disease.^20 One of the most eminent
practitioners of Glasgow who has been engaged in very extensive practice for
upwards of a quarter of a century testifies that he never saw more than twelve
cases of real puerperal fever.^21
[Footnote 19: Op. cit., p. 115.]
[Footnote 20: Op. cit., p. 228.]
[Footnote 21: Lancet, May 4, 1833.]
I have myself been told by two gentlemen practicing in this city, and
having for many years a large midwifery business, that they had neither of
them lost a patient from this disease, and by one of them that he had only
seen it in consultation with other physicians. In five hundred cases of
midwifery, of which Dr. Storer has given an abstract in the first number of
this journal, there was only of instance and fatal puerperal peritonitis.
In the view of these facts it does appear a singular coincidence that one
man or woman should have ten, twenty, thirty, or seventy cases of this rare
disease following his or her footsteps with the keenness of a beagle, through
the streets and lanes of a crowded city, while the scores that cross the same
paths on the same errands know it only by name. It is a series of similar
coincidence which has led us to consider the dagger, the musket, and certain
innocent looking white powders as having some little claim to be regarded as
dangerous. It is the practical inattention to similar coincidences which has
given rise to the unpleasant but often necessary documents called indictments,
which has sharpened a form of the cephalotome sometimes employed in the case
of adults, and adjusted that modification of the fillet which delivers the
world of those who happen to be too much in the way while such striking
coincidences are taking place.
I shall now mention a few instances in which the disease appears to have
been conveyed by the process of direct inoculation.
Dr. Campbell, of Edinburgh, states that in October, 1821, he assisted at
the post-mortem examination of a patient who died with puerperal fever. He
carried the pelvic viscera in his pocket to the class-room. The same evening
he attended a woman in labor without previously changing his clothes; this
patient died. The next morning he delivered a woman with the forceps; she died
also, and of many others who were seized with the disease within a
few weeks, three shared the same fate in succession.
In June, 1823, he assisted some of his pupils at the autopsy of a case
of puerperal fever. He was unable to wash his hands with proper care, for want
of the necessary accommodations. On getting home he found that two patients
required his assistance. He went without further ablution or changing his
clothes; both these patients died with puerperal fever.^22 This same Dr.
Campbell is one of Dr. Churchill`s authorities against contagion.
[Footnote 22: Lond. Med. Gazette, December 10, 1831.]
Mr. Roberton says that in one instance within his knowledge a
practitioner passed the catheter for a patient with puerperal fever late in
the evening; the same night he attended a lady who had the symptoms of the
disease on the second day. In another instance a surgeon was called while in
the act of inspecting the body of a woman who died of this fever, to attend a
labor; within forty-eight hours this patient was seized with the fever.^23
[Footnote 23: Ibid. for January, 1832.]
On the 16th of March, 1831, a medical practitioner examined the body of a
woman who had died a few days after delivery, from puerperal peritonitis. On
the evening of the 17th he delivered a patient, who was seized with puerperal
fever on the 19th, and died on the 24th. Between this period and the 6th of
April the same practitioner attended two other patients, both of whom were
attacked with the same disease and died.^24
[Footnote 24: London Cyc. of Pract. Med., art., "Fever, Puerperal."]
In the autumn of 1829 a physician was present at the examination of a
case of puerperal fever, dissected out the organs, and assisted in sewing up
the body. He had scarcely reached home when he was summoned to attend a young
lady in labor. In sixteen hours she was attacked with the symptoms of
puerperal fever, and narrowly escaped with her life.^25
[Footnote 25: Ibid.]
In December, 1830, a midwife, who had attended two fatal cases of
puerperal fever at the British Lying-in Hospital, examined a patient who had
just been admitted, to ascertain if labor had commenced. This patient remained
two days in the expectation that labor would come on, when she returned home
and was then suddenly taken in labor and delivered before she could set out
for the hospital. She went on favorably for two days, and was then taken with
puerperal fever and died in thirty-six hours.^26
[Footnote 26: Ibid.]
"A young practitioner, contrary to advice, examined the body of a patient
who had died from puerperal fever; there was no epidemic at the time; the case
appeared to be purely sporadic. He delivered three other women shortly
afterwards; they all died with puerperal fever, the symptoms of which broke
out very soon after labor. The patients of his colleague did well, except one,
where he assisted to remove some coagula from the uterus; she was attacked in
the same manner as those whom he had attended, and died also." The writer in
the "British and Foreign Medical Review," from whom I quote this statement, -
and who is no other than Dr. Rigby, - adds: "We trust that this fact alone
will forever silence such doubts, and stamp the well-merited epithet of
`criminal,` as above quoted, upon such attempts.^27
[Footnote 27: Brit. and For. Medical Review for January, 1842, p. 112.]
From the cases given by Mr. Ingleby I select the following: Two
gentlemen, after having been engaged in conducting the postmortem examination
of a case of puerperal fever, went in the same dress, each respectively, to a
case of midwifery. "The one patient was seized with the rigor about thirty
hours afterwards. The other patient was seized with a rigor the third morning
after delivery. One recovered, one died."^28 One of these same gentlemen
attended another woman in the same clothes two days after the autopsy referred
to. "The rigor did not take place until the evening of the fifth day from the
first visit. Result fatal." These cases belonged to a series of seven, the
first of which was thought to have originated in a case of erysipelas.
"Several cases of a mild character followed the foregoing seven, and their
nature being now most unequivocal, my friend declined visiting all midwifery
cases for a time, and there was no recurrence of the disease." These cases
occurred in 1833. Five of them proved fatal. Mr. Ingleby gives another series
of seven cases which occurred to a practitioner in 1836, the first of which
was also attributed to his having opened several erysipelatous abscesses a
short time previously.
[Footnote 28: Edin. Med. and Surg. Journal, April, 1838.]
I need not refer to the case lately read before this Society, in which a
physician went, soon after performing an autopsy of a case of puerperal fever,
to a woman in labor, who was seized with the same disease and perished. The
forfeit of that error has been already paid.
At a meeting of the Medical and Chirurgical Society before referred to,
Dr. Merriman related an instance occurring in his own practice, which excites
a reasonable suspicion that two lives were sacrificed to a still less
dangerous experiment. He was at the examination of a case of puerperal fever
at two o`clock in the afternoon. He took care not to touch the body. At nine
o`clock the same evening he attended a woman in labor; she was so nearly
delivered that he had scarcely anything to do. The next morning she had severe
rigors, and in forty-eight hours she was a corpse. Her infant had erysipelas
and died in two days.^29
[Footnote 29: Lancet, May 2, 1840.]
In connection with the facts which have been stated it seems proper to
allude to the dangerous and often fatal effects which have followed from
wounds received in the post-mortem examination of patients who have died of
puerperal fever. The fact that such wounds are attended with peculiar risk has
been long noticed. I find that Chaussier was in the habit of cautioning his
students against the danger to which they were exposed in these
dissections.^30 The head pharmacien of the Hotel Dieu, in his analysis of the
fluid effused in puerperal peritonitis, says that practitioners are convinced
of its deleterious qualities, and that it is very dangerous to apply it to the
denuded skin.^31 Sir Benjamin Brodie speaks of it as being well known that the
inoculation of lymph or pus from the peritoneum of a puerperal patient is
often attended with dangerous and even fatal symptoms. Three cases in
confirmation of this statement, two of them fatal, have been reported to this
Society within a few months.
[Footnote 30: Stein, L`Art d` Accoucher, 1794; Dict. des Sciences Medicales,
art., "Puerperal."]
[Footnote 31: Journal de Pharmacie, January 1836.]
Of about fifty cases of injuries of this kind, of various degrees of
severity, which I have collected from different sources, at least twelve were
instances of infection from puerperal peritonitis. Some of the others are so
stated as to render it probable that they may have been of the same nature.
Five other cases were of peritoneal inflammation; three in males. Three were
what was called enteritis, in one instance complicated with erysipelas; but it
is well known that this term has been often used to signify inflammation of
the peritoneum covering the intestines. On the other hand, no case of typhus
or typhoid fever is mentioned as giving rise to dangerous consequences, with
the exception of the single instance of an undertaker mentioned by Mr.
Travers, who seems to have been poisoned by a fluid which exuded from the
body. The other accidents were produced by dissection, or some other mode of
contact with bodies of patients who had died of various affections. They also
differed much in severity, the cases of puerperal origin being among the most
formidable and fatal. Now a moment`s reflection will show that the number of
cases of serious consequences ensuing from the dissection of the bodies of
those who had perished of puerperal fever is so vastly disproportioned to the
relatively small number of autopsies made in this complaint as compared with
typhus or pneumonia (from which last disease not one case of poisoning
happened), and still more from all diseases put together, that the conclusion
is irresistible that a most fearful morbid poison is often generated in the
course of this disease. Whether or not it is sui generis, confined to this
disease, or produced in some others, as, for instance, erysipelas, I need not
stop to inquire.
In connection with this may be taken the following statement of Dr.
Rigby: "That the discharges from a patient under puerperal fever are in the
highest degree contagious we have abundant evidence in the history of lying-in
hospitals. The puerperal abscesses are also contagious, and may be
communicated to healthy lying-in women by washing with the same sponge; this
fact has been repeatedly proved in the Vienna Hospital; but they are equally
communicable to women not pregnant; on more than one occasion the women
engaged in washing the soiled bed-linen of the General Lying-in Hospital have
been attacked with abscesses in the fingers or hands, attended with rapidly
spreading inflammation of the cellular tissue."^32
[Footnote 32: System of Midwifery, p. 292.]
Now add to all this the undisputed fact that within the walls of lying-in
hospitals there is often generated a miasm, palpable as the chlorine used to
destroy it, tenacious so as in some cases almost to defy extirpation, deadly
in some institutions as the plague; which has killed women in a private
hospital of London so fast that they were buried two in one coffin to conceal
its horrors; which enabled Tonelle to record two hundred and twenty-two
autopsies at the Maternite of Paris; which has led Dr. Lee to express his
deliberate conviction that the loss of life occasioned by these institutions
completely defeats the objects of their founders; and out of this train of
cumulative evidence, the multiplied groups of cases clustering about
individuals, the deadly results of autopsies, the inoculation by fluids from
the living patient, the murderous poison of hospitals - does there not result
a conclusion that laughs all sophistry to scorn, and renders all argument an
insult?
I have had occasion to mention some instances in which there was an
apparent relation between puerperal fever and erysipelas. The length to which
this paper has extended does not allow me to enter into the consideration of
this most important subject. I will only say that the evidence appears to me
altogether satisfactory that some most fatal series of puerperal fever have
been produced by an infection originating in the matter or effluvia of
erysipelas. In evidence of some connection between the two diseases, I need
not go back to the older authors, as Pouteau or Gordon, but will content
myself with giving the following references, with their dates; from which it
will be seen that the testimony has been constantly coming before the
profession for the last few years:
"London Cyclopaedia of Practical Medicine," article Puerperal Fever,
1833.
Mr. Ceeley`s Account of the Puerperal Fever at Aylesbury, "Lancet,"
1835.
Dr. Ramsbotham`s Lecture, "London Medical Gazette," 1835.
Mr. Yates Ackerly`s Letter in the same Journal, 1838.
Mr. Ingleby on Epidemic Puerperal Fever, "Edinburgh Medical and Surgical
Journal," 1838.
Mr. Paley`s Letter, "London Medical Gazette," 1839.
Remarks at the Medical and Chirurgical Society, "Lancet," 1840.
Dr. Rigby`s "System of Midwifery," 1841.
"Nunneley on Erysipelas," a work which contains a large number of
references on the subject, 1841.
"British and Foreign Quarterly Review," 1842.
Dr. S. Jackson, of Northumberland, as already quoted from the Summary of
the College of Physicians, 1842.
And, lastly, a startling series of cases by Mr. Storrs, of Doncaster, to
be found in the "American Journal of the Medical Sciences" for January, 1843.
The relation of puerperal fever with other continued fevers would seem
to be remote and rarely obvious. Hey refers to two cases of synochus occurring
in the Royal Infirmary of Edinburgh, in women who had attended upon puerperal
patients. Dr. Collins refers to several instances in which puerperal fever has
appeared to originate from a continued proximity to patients suffering with
typhus.^33
[Footnote 33: Treatise on Midwifery, p. 228.]
Such occurrences as those just mentioned, though most important to be
remembered and guarded against, hardly attract our notice in the midst of the
gloomy facts by which they are surrounded. Of these facts, at the risk of
fatiguing repetitions, I have summoned a sufficient number, as I believe, to
convince the most incredulous that every attempt to disguise the truth which
underlies them all is useless.
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