medical essays-第26节
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s's book and my Essay in his hands at the same time。
Question。 〃If such facts as Roberton's cases were before you； and the attendant had had ten； or even five fatal cases； or three； or two even； would you； or would you not； if insuring the life of the next patient to be taken care of by that attendant； expect an extra premium over that of an average case of childbirth？〃
Answer。 〃 Of course I should require a very large extra premium； if I would take take risk at all。〃
But I do not choose to add the expressions of indignation which the examination of the facts before him called out。 I was satisfied from the effect they produced on him； that if all the hideous catalogues of cases now accumulated were fully brought to the knowledge of the public； nothing； since the days of Burke and Hare； has raised such a cry of horror as would be shrieked in the ears of the Profession。
Dr。 Meigs has elsewhere invoked 〃Providence〃 as the alternative of accident； to account for the 〃coincidences。〃 （〃Obstetrics；〃 Phil。 1852； p。 631。） If so； Providence either acts through the agency of secondary causes； as in other diseases； or not。 If through such causes； let us find out what they are； as we try to do in other cases。 It may be true that offences； or diseases； will come； but 〃woe unto him through whom they come；〃 if we catch him in the voluntary or careless act of bringing them！ But if Providence does not act through secondary causes in this particular sphere of etiology； then why does Dr。 Meigs take such pains to reason so extensively about the laws of contagion； which； on that supposition； have no more to do with this case than with the plague which destroyed the people after David had numbered them？ Above all； what becomes of the theological aspect of the question； when he asserts that a practitioner was 〃only unlucky in meeting with the epidemic cases？〃 （ Op。 cit。 p。 633。） We do not deny that the God of battles decides the fate of nations； but we like to have the biggest squadrons on our side； and we are particular that our soldiers should not only say their prayers； but also keep their powder dry。 We do not deny the agency of Providence in the disaster at Norwalk； but we turn off the engineer； and charge the Company five thousand dollars apiece for every life that is sacrificed。
Why a grand jury should not bring in a bill against a physician who switches off a score of women one after the other along his private track； when he knows that there is a black gulf at the end of it； down which they are to plunge； while the great highway is clear； is more than I can answer。 It is not by laying the open draw to Providence that he is to escape the charge of manslaughter。
To finish with all these lesser matters of question； I am unable to see why a female must necessarily be unattended in her confinement； because she declines the services of a particular practitioner。 In all the series of cases mentioned； the death…carrying attendant was surrounded by others not tracked by disease and its consequences。 Which； I would ask； is worse；to call in another； even a rival practitioner； or to submit an unsuspecting female to a risk which an Insurance Company would have nothing to do with？
I do not expect ever to return to this subject。 There is a point of mental saturation； beyond which argument cannot be forced without breeding impatient； if not harsh； feelings towards those who refuse to be convinced。 If I have so far manifested neither； it is well to stop here； and leave the rest to those younger friends who may have more stomach for the dregs of a stale argument。
The extent of my prefatory remarks may lead some to think that I attach too much importance to my own Essay。 Others may wonder that I should expend so many words upon the two productions referred to； the Letter and the Lecture。 I do consider my Essay of much importance so long as the doctrine it maintains is treated as a question； and so long as any important part of the defence of that doctrine is thought to rest on its evidence or arguments。 I cannot treat as insignificant any opinions bearing on life； and interests dearer than life； proclaimed yearly to hundreds of young men； who will carry them to their legitimate results in practice。
The teachings of the two Professors in the great schools of Philadelphia are sure to be listened to； not only by their immediate pupils； but by the Profession at large。 I am too much in earnest for either humility or vanity； but I do entreat those who hold the keys of life and death to listen to me also for this once。 I ask no personal favor； but I beg to be heard in behalf of the women whose lives are at stake； until some stronger voice shall plead for them。
I trust that I have made the issue perfectly distinct and intelligible。 And let it be remembered that this is no subject to be smoothed over by nicely adjusted phrases of half…assent and half… censure divided between the parties。 The balance must be struck boldly and the result declared plainly。 If I have been hasty； presumptuous； ill…informed； illogical； if my array of facts means nothing； if there is no reason for any caution in the view of these facts； let me be told so on such authority that I must believe it； and I will be silent henceforth； recognizing that my mind is in a state of disorganization。 If the doctrine I have maintained is a mournful truth； if to disbelieve it； and to practise on this disbelief； and to teach others so to disbelieve and practise； is to carry desolation； and to charter others to carry it； into confiding families； let it be proclaimed as plainly what is to be thought of the teachings of those who sneer at the alleged dangers； and scout the very idea of precaution。 Let it be remembered that persons are nothing in this matter； better that twenty pamphleteers should be silenced； or as many professors unseated； than that one mother's life should be taken。 There is no quarrel here between men； but there is deadly incompatibility and exterminating warfare between doctrines。 Coincidences； meaning nothing； though a man have a monopoly of the disease for weeks or months； or cause and effect； the cause being in some way connected with the person； this is the question。 If I am wrong； let me be put down by such a rebuke as no rash declaimer has received since there has been a public opinion in the medical profession of America； if I am right； let doctrines which lead to professional homicide be no longer taught from the chairs of those two great Institutions。 Indifference will not do here； our Journalists and Committees have no right to take up their pages with minute anatomy and tediously detailed cases； while it is a question whether or not the 〃blackdeath〃 of child…bed is to be scattered broadcast by the agency of the mother's friend and adviser。 Let the men who mould opinions look to it； if there is any voluntary blindness； any interested oversight； any culpable negligence； even； in such a matter； and the facts shall reach the public ear； the pestilence…carrier of the lying…in chamber must look to God for pardon； for man will never forgive him。
THE CONTAGIOUSNESS OF PUERPERAL FEVER。
In collecting； enforcing； and adding to the evidence accumulated upon this most serious subject； I would not be understood to imply that there exists a doubt in the mind of any well…informed member of the medical profession as to the fact that puerperal fever is sometimes communicated from one person to another； both directly and indirectly。 In the present state of our knowledge upon this point I should consider such doubts merely as a proof that the sceptic had either not examined the evidence； or； having examined it； refused to accept its plain and unavoidable consequences。 I should be sorry to think； with Dr。 Rigby； that it was a case of 〃oblique vision；〃 I should be unwilling to force home the argumentum ad hominem of Dr。 Blundell； but I would not consent to make a question of a momentous fact which is no longer to be considered as a subject for trivial discussions； but to be acted upon with silent promptitude。 It signifies nothing that wise and experienced practitioners have sometimes doubted the reality of the danger in question； no man has the right to doubt it any longer。 No negative facts； no opposing opinions； be they what they may； or whose they may； can form any answer to the series of cases now within the reach of all who choose to explore the records of medical science。
If there are some who conceive that any important end would be answered by recording such opinions； or by collecting the history of all the cases they could find in which no evidence of the influence of contagion existed； I believe they are in error。 Suppose a few writers of authority can be found to profess a disbelief in contagion；and they are very few compared with those who think differently；is it quite clear that they formed their opinions on a view of all the facts； or is it not apparent that they relied mostly on their own solitary experience？ Still further； of those whose names are quoted； is it not true that scarcely a single one could by any possibility have known the half or the tenth of the facts bearing on the subject which have reached
