medical essays-第29节
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at period among the other patients of the Westminster General Dispensary； who had been attended by the other midwives belonging to that institution。〃
The recurrence of long series of cases like those I have cited； reported by those most interested to disbelieve in contagion； scattered along through an interval of half a century； might have been thought sufficient to satisfy the minds of all inquirers that here was something more than a singular coincidence。 But if； on a more extended observation； it should be found that the same ominous groups of cases clustering about individual practitioners were observed in a remote country； at different times； and in widely separated regions； it would seem incredible that any should be found too prejudiced or indolent to accept the solemn truth knelled into their ears by the funeral bells from both sides of the ocean；the plain conclusion that the physician and the disease entered； hand in hand； into the chamber of the unsuspecting patient。
That such series of cases have been observed in this country； and in this neighborhood； I proceed to show。
In Dr。 Francis's 〃Notes to Denman's Midwifery；〃 a passage is cited from Dr。 Hosack； in which he refers to certain puerperal cases which proved fatal to several lying…in women； and in some of which the disease was supposed to be conveyed by the accoucheurs themselves。
A writer in the 〃New York Medical and Physical Journal〃 for October； 1829； in speaking of the occurrence of puerperal fever； confined to one man's practice； remarks； 〃We have known cases of this kind occur； though rarely； in New York。〃
I mention these little hints about the occurrence of such cases； partly because they are the first I have met with in American medical literature； but more especially because they serve to remind us that behind the fearful array of published facts there lies a dark list of similar events； unwritten in the records of science； but long remembered by many a desolated fireside。
Certainly nothing can be more open and explicit than the account given by Dr。 Peirson of Salem； of the cases seen by him。 In the first nineteen days of January； 1829； he had five consecutive cases of puerperal fever； every patient he attended being attacked； and the three first cases proving fatal。 In March of the same year he had two moderate cases； in June； another case； and in July； another； which proved fatal。 〃Up to this period；〃 he remarks； 〃I am not informed that a single case had occurred in the practice of any other physician。 Since that period I have had no fatal case in my practice； although I have had several dangerous cases。 I have attended in all twenty cases of this disease； of which four have been fatal。 I am not aware that there has been any other case in the town of distinct puerperal peritonitis； although I am willing to admit my information may be very defective on this point。 I have been told of some I 'mixed cases；' and 'morbid affections after delivery。'〃
In the 〃Quarterly Summary of the Transactions of the College of Physicians of Philadelphia〃 may be found some most extraordinary developments respecting a series of cases occurring in the practice of a member of that body。
Dr。 Condie called the attention of the Society to the prevalence； at the present time； of puerperal fever of a peculiarly insidious and malignant character。 〃In the practice of one gentleman extensively engaged as an obstetrician； nearly every female he has attended in confinement； during several weeks past； within the above limits〃 （the southern sections and neighboring districts）； 〃had been attacked by the fever。〃
〃An important query presents itself； the Doctor observed； in reference to the particular form of fever now prevalent。 Is it； namely； capable of being propagated by contagion； and is a physician who has been in attendance upon a case of the disease warranted in continuing； without interruption； his practice as an obstetrician？ Dr。 C。； although not a believer in the contagious character of many of those affections generally supposed to be propagated in this manner； has nevertheless become convinced by the facts that have fallen under his notice； that the puerperal fever now prevailing is capable of being communicated by contagion。 How otherwise can be explained the very curious circumstance of the disease in one district being exclusively confined to the practice of a single physician； a Fellow of this College； extensively engaged in obstetrical practice；while no instance of the disease has occurred in the patients under the care of any other accoucheur practising within the same district； scarcely a female that has been delivered for weeks past has escaped an attack？〃
Dr。 Rutter； the practitioner referred to； 〃observed that； after the occurrence of a number of cases of the disease in his practice； he had left the city and remained absent for a week； but on returning； no article of clothing he then wore having been used by him before； one of the very first cases of parturition he attended was followed by an attack of the fever； and terminated fatally； he cannot； readily； therefore； believe in the transmission of the disease from female to female； in the person or clothes of the physician。〃
The meeting at which these remarks were made was held on the 3d of May； 1842。 In a letter dated December 20； 1842； addressed to Dr。 Meigs； and to be found in the 〃Medical Examiner；〃 he speaks of 〃those horrible cases of puerperal fever； some of which you did me the favor to see with me during the past summer；〃 and talks of his experience in the disease； 〃now numbering nearly seventy cases； all of which have occurred within less than a twelvemonth past。〃
And Dr。 Meigs asserts； on the same page； 〃Indeed； I believe that his practice in that department of the profession was greater than that of any other gentleman； which was probably the cause of his seeing a greater number of the cases。〃 This from a professor of midwifery； who some time ago assured a gentleman whom he met in consultation； that the night on which they met was the eighteenth in succession that he himself had been summoned from his repose； seems hardly satisfactory。
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 efluvia。 And here I may mention； that this very Dr。 Samuel Jackson of Northumberland is one of Dr。 Dewees's 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；
