medical essays-第18章

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in　practice；　if　we　may　trust　the　authority　of　its　founder；　with　heartless　and　shameless　imposition。　　Because　it　is　suffered　so　often　to　appeal　unanswered　to　the　public；　because　it　has　its　journals；　its　patrons；　its　apostles；　some　are　weak　enough　to　suppose　it　can　escape　the　inevitable　doom　of　utter　disgrace　and　oblivion。　　Not　many　years　can　pass　away　before　the　same　curiosity　excited　by　one　of　Perkins's　Tractors　will　be　awakened　at　the　sight　of　one　of　the　Infinitesimal　Globules。　　If　it　should　claim　a　longer　existence；　it　can　only　be　by　falling　into　the　hands　of　the　sordid　wretches　who　wring　their　bread　from　the　cold　grasp　of　disease　and　death　in　the　hovels　of　ignorant　poverty。

As　one　humble　member　of　a　profession　which　for　more　than　two　thousand　years　has　devoted　itself　to　the　pursuit　of　the　best　earthly　interests　of　mankind；　always　assailed　and　insulted　from　without　by　such　as　are　ignorant　of　its　infinite　perplexities　and　labors；　always　striving　in　unequal　contest　with　the　hundred…armed　giant　who　walks　in　the　noonday；　and　sleeps　not　in　the　midnight；　yet　still　toiling；　not　merely　for　itself　and　the　present　moment；　but　for　the　race　and　the　future；　I　have　lifted　my　voice　against　this　lifeless　delusion；　rolling　its　shapeless　bulk　into　the　path　of　a　noble　science　it　is　too　weak　to　strike；　or　to　injure。






THE　CONTAGIOUSNESS　OF　PUERPERAL　FEVER　Printed　in　1843；　reprinted　with　additions；　1855。


THE　POINT　AT　ISSUE。


THE　AFFIRMATIVE。

〃The　disease　known　as　Puerperal　Fever　is　so　far　contagious　as　to　be　frequently　carried　from　patient　to　patient　by　physicians　and　nurses。〃　O。　W。　Holmes；　1843。


THE　NEGATIVE。

〃The　result　of　the　whole　discussion　will；　I　trust；　serve；　not　only　to　exalt　your　views　of　the　value　and　dignity　of　our　profession；　but　to　divest　your　minds　of　the　overpowering　dread　that　you　can　ever　become；　especially　to　woman；　under　the　extremely　interesting　circumstances　of　gestation　and　parturition；　the　minister　of　evil；　that　you　can　ever　convey；　in　any　possible　manner；　a　horrible　virus；　so　destructive　in　its　effects；　and　so　mysterious　in　its　operations　as　that　attributed　to　puerperal　fever。〃　Professor　Hodge；　1852。

〃I　prefer　to　attribute　them　to　accident；　or　Providence；　of　which　I　can　form　a　conception；　rather　than　to　a　contagion　of　which　I　cannot　form　any　clear　idea；　at　least　as　to　this　particular　malady。〃　Professor　Meigs；　1852。

〃　。　　。　　。　　in　the　propagation　of　which　they　have　no　more　to　do；　than　with　the　propagation　of　cholera　from　Jessore　to　San　Francisco；　and　from　Mauritius　to　St。　Petersburg。〃Professor　Meigs；　1854。

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〃I　arrived　at　that　certainty　in　the　matter；　that　I　could　venture　to　foretell　what　women　would　be　affected　with　the　disease；　upon　hearing　by　what　midwife　they　were　to　be　delivered；　or　by　what　nurse　they　were　to　be　attended；　during　their　lying…in；　and；　almost　in　every　instance；　my　prediction　was　verified。〃　Gordon；　1795。

〃A　certain　number　of　deaths　is　caused　every　year　by　the　contagion　of　puerperal　fever；　communicated　by　the　nurses　and　medical　attendants。〃　Farr；　in　Fifth　Annual　Report　of　Registrar…General　of　England；　1843。

〃。　　。　　。　　boards　of　health；　if　such　exist；　or；　without　them；　the　medical　institutions　of　a　country；　should　have　the　power　of　coercing；　or　of　inflicting　some　kind　of　punishment　on　those　who　recklessly　go　from　cases　of　puerperal　fevers　to　parturient　or　puerperal　females；　without　using　due　precaution；　and　who；　having　been　shown　the　risk；　criminally　encounter　it；　and　convey　pestilence　and　death　to　the　persons　they　are　employed　to　aid　in　the　most　interesting　and　suffering　period　of　female　existence。〃　Copland's　Medical　Dictionary；　Art。　　Puerperal　States　and　Diseases；　1852。

〃We　conceive　it　unnecessary　to　go　into　detail　to　prove　the　contagious　nature　of　this　disease；　as　there　are　few；　if　any；　American　practitioners　who　do　not　believe　in　this　doctrine。〃　Dr。　Lee；　in　Additions　to　Article　last　cited。

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＇INTRODUCTORY　NOTE。＇　It　happened；　some　years　ago；　that　a　discussion　arose　in　a　Medical　Society　of　which　I　was　a　member；　involving　the　subject　of　a　certain　supposed　cause　of　disease；　about　which　something　was　known；　a　good　deal　suspected；　and　not　a　little　feared。　　The　discussion　was　suggested　by　a　case；　reported　at　the　preceding　meeting；　of　a　physician　who　made　an　examination　of　the　body　of　a　patient　who　had　died　with　puerperal　fever；　and　who　himself　died　in　less　than　a　week；　apparently　in　consequence　of　a　wound　received　at　the　examination；　having　attended　several　women　in　confinement　in　the　mean　time；　all　of　whom；　as　it　was　alleged；　were　attacked　with　puerperal　fever。

Whatever　apprehensions　and　beliefs　were　entertained；　it　was　plain　that　a　fuller　knowledge　of　the　facts　relating　to　the　subject　would　be　acceptable　to　all　present。　　I　therefore　felt　that　it　would　be　doing　a　good　service　to　look　into　the　best　records　I　could　find；　and　inquire　of　the　most　trustworthy　practitioners　I　knew；　to　learn　what　experience　had　to　teach　in　the　matter；　and　arrived　at　the　results　contained　in　the　following　pages。

The　Essay　was　read　before　the　Boston　Society　for　Medical　Improvement；　and；　at　the　request　of　the　Society；　printed　in　the　〃New　England　Quarterly　Journal　of　Medicine　and　Surgery〃　for　April；　1843。　　As　this　Journal　never　obtained　a　large　circulation；　and　ceased　to　be　published　after　a　year's　existence；　and　as　the　few　copies　I　had　struck　off　separately　were　soon　lost　sight　of　among　the　friends　to　whom　they　were　sent；　the　Essay　can　hardly　be　said　to　have　been　fully　brought　before　the　Profession。

The　subject　of　this　Paper　has　the　same　profound　interest　for　me　at　the　present　moment　as　it　had　when　I　was　first　collecting　the　terrible　evidence　out　of　which；　as　it　seems　to　me；　the　commonest　exercise　of　reason　could　not　help　shaping　the　truth　it　involved。　　It　is　not　merely　on　account　of　the　bearing　of　the　question；if　there　is　a　question；on　all　that　is　most　sacred　in　human　life　and　happiness；　that　the　subject　cannot　lose　its　interest。　　It　is　because　it　seems　evident　that　a　fair　statement　of　the　facts　must　produce　its　proper　influence　on　a　very　large　proportion　of　well…constituted　and　unprejudiced　minds。　　Individuals　may；　here　and　there；　resist　the　practical　bearing　of　the　evidence　on　their　own　feelings　or　interests；　some　may　fail　to　see　its　meaning；　as　some　persons　may　be　found　who　cannot　tell　red　from　green；　but　I　cannot　doubt　that　most　readers　will　be　satisfied　and　convinced；　to　loathing；　long　before　they　have　finished　the　dark　obituary　calendar　laid　before　them。

I　do　not　know　that　I　shall　ever　again　have　so　good　an　opportunity　of　being　useful　as　was　granted　me　by　the　raising　of　the　question　which　produced　this　Essay。　　For　I　have　abundant　evidence　that　it　has　made　many　practitioners　more　cautious　in　their　relations　with　puerperal　females；　and　I　have　no　doubt　it　will　do　so　still；　if　it　has　a　chance　of　being　read；　though　it　should　call　out　a　hundred　counterblasts；　proving　to　the　satisfaction　of　their　authors　that　it　proved　nothing。　And　for　my　part；　I　had　rather　rescue　one　mother　from　being　poisoned　by　her　attendant；　than　claim　to　have　saved　forty　out　of　fifty　patients　to　whom　I　had　carried　the　disease。　　Thus；　I　am　willing　to　avail　myself　of　any　hint　coming　from　without　to　offer　this　paper　once　more　to　the　press。　　The　occasion　has　presented　itself；　as　will　be　seen；　in　a　convenient　if　not　in　a　flattering　form。


I　send　this　Essay　again　to　the　MEDICAL　PROFESSION；　without　the　change　of　a　word　or　syllable。　　I　find；　on　reviewing　it；　that　it　anticipates　and　eliminates　those　secondary　questions　which　cannot　be　entertained　for　a　moment　until　the　one　great　point　of　fact　is　peremptorily　settled。　　In　its　very　statement　of　the　doctrine　maintained　it　avoids　all　discussion　of　the　nature　of　the　disease　〃known　as　puerperal　fever；〃　and　all　the　somewhat　stale　philology　of　the　word　contagion。　It　mentions；　fairly　enough；　the　names　of　sceptics；　or　unbelievers　as　to　the　reality　of　personal　transmission；　of　Dewees；　of　Tonnelle；　of　Duges；　of　Baudelocque；　and　others；　of　course；　not　including　those　whose　works　were　then　unwritten　or　unpublished；　nor　enumerating　all　the　Continental　writers　who；　in　ignorance　of　the　great　mass　of　evidence　accumulated　by　British　practitioners；　could　hardly　be　called　well　informed　on　this　subject。　　It　meets　all　the　array　of　negative　cases；those　in　which　disease　did　not　follow　exposure；by　the　striking　example　of　small…pox；　which；　although　one　of　the　most　contagious　of　diseases；　is　subject　to　the　most　remarkable　irregularities　and　seeming　caprices　in　its　transmission。　　It　makes　full　allowance　for　other　causes　besides　personal　transmission；　especially　for　epidemic　influences。　　It　allows　for　the　possibility　of　different　modes　of　conveyance　of　the　destructive　principle。　　It　recognizes　and　supports　the　belief　that　a　series　of　cases　may　originate　from　a　single　primitive　source　which　affects　each　new　patient　in　turn；　and　especially　from　cases　of　Erysipelas。　　It　does　not　undertake　to　discuss　the　theoretical　aspect　of　the　subject；　that　is　a　secondary　matter　of　consideration。　　Where　facts　are　numerous；　and　unquestionable；　and　unequivocal　in　their　significance；　theory　must　follow　them　as　it　best　may；　keeping　time　with　their　step；　and　not　go　before　them；　marching　to　the　sound　of　its　own　drum　and　trumpet。　　Having　thus　narrowed　its　area　to　a　limited　practical　platform　of　discussion；　a　matter　of　life　and　death；　and　not　of　phrases　or　theories；　it　covers　every　inch　of　it　with　a　mass　of　evidence　which　I　conceive　a　Committee　of　Husbands；　who　can　count　coincidences　and　draw　conclusions　as　well　as　a　Synod　of　Accoucheurs；　would　justly　consider　as　affording　ample　reasons　for　an　unceremonious　dismissal　of　a　practitioner　（if　it　is　conceivable　that　such　a　step　could　be　waited　for）；　after　five　or　six　funerals　had　marked　the　path　of　his　daily　visits；　while　other　practitioners　were　not　thus　escorted。　　To　the　Profession；　therefore；　I　submit　the　paper　in　its　original　form；　and　leave　it　to　take　care　of　itself。

To　the　MEDICAL　STUDENTS；　into　whose　hands　this　Essay　may　fall；　some　words　of　introduction　may　be　appropriate；　and　perhaps；　to　a　small　number　of　them；　necessary。　　There　are　some　among　them　who；　from　youth；　or　want　of　training；　are　easily　bewildered　and　confused　in　any　conflict　of　opinions　into　which　their　studies　lead　them。　　They　are　liable　to　lose　sight　of　the　main　question　in　collateral　issues；　and　to　be　run　away　with　by　suggestive　speculations。　　They　confound　belief　with　evidence；　often　trusting　the　first　because　it　is　expressed　with　energy；　and　slighting　the　latter　because　it　is　calm　and　unimpassioned。　　They　are　not　satisfied　with　proof；　they　cannot　believe　a　point　is　settled　so　long　as　everybody　is　not　silenced。　They　have　not　learned　that　error　is　got　out　of　the　minds　that　cherish　it；　as　the　taenia　is　removed　from　the　body；　one　joint；　or　a　few　joints　at　a　time；　for　the　most　part；　rarely　the　whole　evil　at　once。　They　naturally　have　faith　in　their　instructors；　turning　to　them　for　truth；　and　taking　what　they　may　choose　to　give　them；　babes　in　knowledge；　not　yet　able　to　tell　the　breast　from　the　bottle；　pumping　away　for　the　milk　of　truth　at　all　that　offers；　were　it　nothing　better　than　a　Professor's　shrivelled　forefinger。

In　the　earliest　and　embryonic　stage　of　professi