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Part III.
Part III.
It is true that some of the historians of the disease, especially Hulme,
Hull, and Leake, in England; Tonelle, Duges, and Baudelocque, in France,
profess not to have found puerperal fever contagious. At the most they give us
mere negative facts, worthless against an extent of evidence which now
overlaps the widest range of doubt, and doubles upon itself in the redundancy
of superfluous demonstration. Examined in detail, this and much of the show of
testimony brought up to stare the daylight of conviction out of countenance,
proves to be in a great measure unmeaning and inapplicable, as might be easily
shown were it necessary. Nor do I feel the necessity of enforcing the
conclusion which arises spontaneously from the facts which have been
enumerated by formally citing the opinions of those grave authorities who have
for the last half-century been sounding the unwelcome truth it has cost so
many lives to establish.
"It is to the British practitioner," says Dr. Rigby, "that we are
indebted for strongly insisting upon this important and dangerous character of
puerperal fever."^34
[Footnote 34: British and Foreign Med. Rev. for January, 1842.]
The names of Gordon, John Clarke, Denman, Burns, Young,^35 Hamilton,^36
Haighton,^37 Good,^38 Waller,^39 Blundell, Gooch, Ramsbotham, Douglas,^40
Lee, Ingleby, Locock,^41 Abercrombie,^42 Alison,^43 Travers,^44 Rigby, and
Watson^45 many of whose writings I have already referred to, may have some
influence with those who prefer the weight of authorities to the simple
deductions of their own reason from the facts laid before them. A few
Continental writers have adopted similar conclusions.^46 It gives me pleasure
to remember that, while the doctrine has been unceremoniously discredited in
one of the leading journals,^47 and made very light of by teachers in two of
the principal medical schools of this country, Dr. Channing has for many
years inculcated, and enforced by examples, the danger to be apprehended and
the precautions to be taken in the disease under consideration.
[Footnote 35: Encyc. Britannica, xiii, 467, art., "Medicine."]
[Footnote 36: Outlines of Midwifery, p. 109.]
[Footnote 37: Oral Lectures, etc.]
[Footnote 38: Study of Medicine, ii, 195.]
[Footnote 39: Medical and Physical Journal, July, 1830.]
[Footnote 40: Dublin Hospital Reports for 1822.]
[Footnote 41: Library of Practical Medicine, i, 373.]
[Footnote 42: Researches on Diseases of the Stomach, etc., p. 181.]
[Footnote 43: Library of Practical Medicine, i, 96.]
[Footnote 44: Further Researches on Constitutional Irritation, p. 128.]
[Footnote 45: London Medical Gazette, February, 1842.]
[Footnote 46: See British and Foreign Medical Review, vol. iii, p. 525, and
vol. iv, p. 517. Also Ed. Med. and Surg. Journal for July, 1824, and American
Journal of Med. Sciences for January, 1841.]
[Footnote 47: Phil. Med. Journal, vol. xii, p. 364.]
I have no wish to express any harsh feeling with regard to the painful
subject which has come before us. If there are any so far excited by the story
of these dreadful events that they ask for some word of indignant remonstrance
to show that science does not turn the hearts of its followers into ice or
stone, let me remind them that such words have been uttered by those who speak
with an authority I could not claim.^48 It is as a lesson rather than as a
reproach that I call up the memory of these irreparable errors and wrongs. No
tongue can tell the heart-breaking calamity they have caused; they have closed
the eyes just opened upon a new world of love and happiness; they have bowed
the strength of manhood into the dust; they have cast the helplessness of
infancy into the stranger`s arms, or bequeathed it, with less cruelty, the
death of its dying parent. There is no tone deep enough for regret, and no
voice loud enough for warning. The woman about to become a mother or with her
newborn infant upon her bosom, should be the object of trembling care and
sympathy wherever she bears her tender burden or stretches her aching limbs.
The very outcast of the streets has pity upon her sister in degradation when
the seal of promised maternity is impressed upon her. The remorseless
vengeance of the law, brought down upon its victim by a machinery as sure as
destiny, is arrested in its fall at a word which reveals her transient claim
for mercy. The solemn prayer of the liturgy singles out her sorrows from the
multiplied trials of life, to plead for her in the hour of peril. God forbid
that any member of the profession to which she trusts her life, doubly
precious at that eventful period, should hazard it negligently, unadvisedly,
or selfishly!
[Footnote 48: Dr. Blundell and Dr. Rigby in the works already cited.]
There may be some among those whom I address who are disposed to ask the
question, What course are we to follow in relation to this matter? The facts
are before them, and the answer must be left to their own judgment and
conscience. If any should care to know my own conclusions, they are the
following; and in taking the liberty to state them very freely and broadly, I
would ask the inquirer to examine them as freely in the light of the evidence
which has been laid before him.
1. A physician holding himself in readiness to attend cases of midwifery
should never take any active part in the post-mortem examination of cases of
puerperal fever.
2. If a physician is present at such autopsies, he should use thorough
ablution, change every article of dress, and allow twenty-four hours or more
to elapse before attending to any case of midwifery. It may be well to extend
the same caution to cases of simple peritonitis
3. Similar precautions should be taken after the autopsy or surgical
treatment of cases of erysipelas, if the physician is obliged to unite such
offices with his obstetrical duties, which is in the highest degree
inexpedient.
4. On the occurrence of a single case of puerperal fever in his practice,
the physicianhis bound to consider the next female he attends in labor, unless
some weeks at least have elapsed, as in danger of being infected by him, and
it is his duty to take every precaution to diminish her risk of disease and
death.
5. If within a short period two cases of puerperal fever happen close to
each other, in the practice of the same physician, the disease not existing
or prevailing in the neighborhood, he would do wisely to relinquish his
obstetrical practice for at least one month, and endeavor to free himself by
every available means from any noxious influence he may carry about with him
6. The occurrence of three or more closely connected cases, in the
practice of one individual, no others existing in the neighborhood, and no
other sufficient cause being alleged for the coincidence, is prima facie
evidence that he is the vehicle of contagion.
7. It is the duty of the physician to take every precaution that the
disease shall not be introduced by nurses or other assistants, by making
proper inquiries concerning them, and giving timely warning of every suspected
source of danger.
8. Whatever indulgence may be granted to those who have heretofore been
the ignorant causes of so much misery, the time has come when the existence
of a private pestilence in the sphere of a single physician should be looked
upon, not as a misfortune, but a crime; and in the knowledge of such
occurrences the duties of the practitioner to his profession should give way
to his paramount obligations to society.
Additional References And Cases.
Fifth Annual Report of the Registrar-General of England, 1843. Appendix.
Letter from William Farr, Esq. - Several new series of cases are given in the
letter of Mr. Storrs, contained in the appendix to this report. Mr. Storrs
suggests precautions similar to those I have laid down, and these precautions
are strongly enforced by Mr. Farr, who is, therefore, obnoxious to the same
criticisms as myself.
Hall and Dexter, in Am. Journal of Med. Sc. for January, 1844. - Cases of
puerperal fever seeming to originate in erysipelas.
Elkington, of Birmingham, in Provincial Med. Journal, cited in Am.
Journ. Med. Sc. for April, 1844. - Six cases in less than a fortnight, seeming
to originate in a case of erysipelas.
West`s Reports, in Brit. and For. Med. Review for October, 1845, and
January, 1847. - Affection of the arm, resembling malignant pustule, after
removing the placenta of a patient who died from puerperal fever. Reference to
cases at Wurzburg, as proving contagion, and to Keiller`s cases in the Monthly
Journal for February, 1846, as showing connection of puerperal fever and
erysipelas.
Kneeland. - Contagiousness of Puerperal Fever. Am. Jour. Med. Sc.,
January, 1846. Also, Connection between Puerperal Fever and Epidemic
Erysipelas. Ibid., April, 1846.
Robert Storrs. - Contagious Effects of Puerperal Fever on the Male
Subject; or on Persons not Child-bearing. (From Provincial Med. and Surg.
Journal.) Am. Jour. Med. Sc., January, 1846. Numerous cases. See also Dr.
Reid`s case in same journal for April, 1846.
Routh`s paper in Proc. of Royal Med. Chir. Soc., Am. Jour. Med. Sc.,
April, 1849, also in B. and F. Med. Chir. Review, April, 1850.
Hill, of Leuchars. - A Series of Cases Illustrating the Contagious Nature
of Erysipelas and Puerperal Fever, and their Intimate Pathological
Connection. (From Monthly Journal of Med. Sc.) Am. Jour. Med. Sc., July, 1850.
Skoda on the Causes of Puerperal Fever. (Peritonitis in rabbits, from
inoculation with different morbid secretions.) Am. Jour. Med. Sc., October,
1850.
Arneth. - Paper read before the National Academy of Medicine. Annales
d`Hygiene, Tome LXV. 2^e Partie. (Means of Disinfection proposed by M.
"Semmeliveis." Semmelweiss.) Lotions of chloride of lime and use of nail-brush
before admission to lying-in wards. Alleged sudden and great decrease of
mortality from puerperal fever. Cause of disease attributed to inoculation
with cadaveric matters.) See also Routh`s paper, mentioned above.
Moir. - Remarks at a meeting of the Edinburgh Medico-chirurgical Society.
Refers to cases of Dr. Kellie, of Leith. Sixteen in succession, all fatal.
Also to several instances of individual pupils having had a succession of
cases in various quarters of the town, while others, practising as extensively
in the same localities, had none. Also to several special cases not mentioned
elsewhere. Am. Jour. Med. Sc. for October, 1851. (From New Monthly Journal of
Med. Science.)
Simpson. - Observations at a Meeting of the Edinburgh Obstetrical
Society. (An "eminent gentleman," according to Dr. Meigs, whose "name is as
well known in America as in (his) native land," Obstetrics, Phil., 1852, pp.
368, 375.) The student is referred to this paper for a valuable resume of many
of the facts, and the necessary inferences, relating to this subject. Also for
another series of cases, Mr. Sidey`s, five or six in rapid succession. Dr.
Simpson attended the dissection of two of Dr. Sidey`s cases, and freely
handled the diseased parts. His next four child-bed patients were affected
with puerperal fever, and it was the first time he had seen it in practice. As
Dr. Simpson is a gentleman (Dr. Meigs, as above), and as "a gentleman`s hands
are clean" (Dr. Meigs` sixth letter), it follows that a gentleman with clean
hands may carry the disease. Am. Jour. Med. Sc., October, 1851.
Peddie. - The five or six cases of Dr. Sidey, followed by the four of Dr.
Simpson, did not end the series. A practitioner in Leith having examined in
Dr. Simpson`s house, a portion of the uterus obtained from one of the
patients, had immediately afterwards three fatal cases of puerperal fever.
Dr. Peddie referred to two distinct series of consecutive cases in his own
practice. He had since taken precautions, and not met with any such cases.
Am. Jour. Med. Sc., October, 1851.
Copland. - Considers it proved that puerperal fever may be propagated by
the hands and the clothes, or either, of a third person, the bed-clothes or
body-clothes of a patient. Mentions a new series of cases, one of which he
saw, with the practitioner who had attended them. She was the sixth he had had
within a few days. All died. Dr. Copland insisted that contagion had caused
these cases; advised precautionary measures, and the practitioner had no other
cases for a considerable time. Considers it criminal, after the evidence
adduced, - which he could have quadrupled, - and the weight of authority
brought forward, for a practitioner to be the medium of transmitting contagion
and death to his patients. Dr. Copland lays down rules similar to those
suggested by myself, and is therefore entitled to the same epithet for so
doing. Medical Dictionary, New York, 1852. Article, Puerperal States and
Diseases.
If there is any appetite for facts so craving as to be yet unappeased, -
lassata, necdum satiata, - more can be obtained. Dr. Hodge remarks that "the
frequency and importance of this singular circumstance (that the disease is
occasionally more prevalent with one practitioner than another) has been
exceedingly overrated." More than thirty strings of cases, more than two
hundred and fifty sufferers from puerperal fever, more than one hundred and
thirty deaths, appear as the results of a sparing estimate of such among the
facts I have gleaned as could be numerically valued. These facts constitute,
we may take it for granted, but a small fraction of those that have actually
occurred. The number of them might be greater, but "`tis enough, `twill
serve," in Mercutio`s modest phrase, so far as frequency is concerned. For a
just estimate of the importance of the singular circumstance, it might be
proper to consult the languid survivors, the widowed husbands, and the
motherless children, as well as "the unfortunate accoucheur."
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