medical essays-第21章

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itis　may　produce　such　a　poison；　and　puerperal　women　may　be　very　sensible　to　its　influences；　conveyed　by　contact　or　exhalation。　　Whether　this　is　so　or　not；　facts　alone　can　determine；　and　to　facts　we　have　had　recourse　to　settle　it。

The　following　statement　is　made　by　Dr。　Meigs　in　his　142d　paragraph；　and　developed　more　at　length；　with　rhetorical　amplifications；　in　the　134th。　　〃No　human　being；　save　a　pregnant　or　parturient　woman；　is　susceptible　to　the　poison。〃　　This　statement　is　wholly　incorrect；　as　I　am　sorry　to　have　to　point　out　to　a　Teacher　in　Dr。　Meigs's　position。　I　do　not　object　to　the　erudition　which　quotes　Willis　and　Fernelius；　the　last　of　whom　was　pleasantly　said　to　have　〃preserved　the　dregs　of　the　Arabs　in　the　honey　of　his　Latinity。〃　　But　I　could　wish　that　more　modern　authorities　had　not　been　overlooked。　　On　this　point；　for　instance；　among　the　numerous　facts　disproving　the　statement；　the　〃American　Journal　of　Medical　Sciences；〃　published　not　far　from　his　lecture…room；　would　have　presented　him　with　a　respectable　catalog　of　such　cases。　　Thus　he　might　refer　to　Mr。　Storrs's　paper　〃On　the　Contagious　Effects　of　Puerperal　Fever　on　the　Male　Subject；　or　on　Persons　not　Childbearing〃（Jan。　　1846）；　or　to　Dr。　Reid's　case　（April；　1846）；　or　to　Dr。　Barron's　statement　of　the　children's　dying　of　peritonitis　in　an　epidemic　of　puerperal　fever　at　the　Philadelphia　Hospital　（Oct。　　1842）；　or　to　various　instances　cited　in　Dr。　Kneeland's　article　（April；　186）。　　Or；　if　he　would　have　referred　to　the　〃New　York　Journal；〃　he　might　have　seen　Prof。　Austin　Flint's　cases。　　Or；　if　he　had　honored　my　Essay　so　far；　he　might　have　found　striking　instances　of　the　same　kind　in　the　first　of　the　new　series　of　cases　there　reported　and　elsewhere。　　I　do　not　see　the　bearing　of　his　proposition；　if　it　were　true。　　But　it　is　one　of　those　assertions　that　fall　in　a　moment　before　a　slight　examination　of　the　facts；　and　I　confess　my　surprise；　that　a　professor　who　lectures　on　the　Diseases　of　Women　should　have　ventured　to　make　it。

Nearly　seven　pages　are　devoted　to　showing　that　I　was　wrong　in　saying　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。〃　　I　will　devote　seven　lines　to　these　seven　pages；　which　seven　lines；　if　I　may　say　it　without　offence；　are；　as　it　seems　to　me；　six　more　than　are　strictly　necessary。

The　following　authors　are　cited　as　sceptics　by　Dr。　Meigs　：　Dewees。　I　cited　the　same　passage。　　Did　not　know　half　the　facts。　Robert　Lee。　Believes　the　disease　is　sometimes　communicable　by　contagion。　　Tonnelle；　Baudelocque。　　Both　cited　by　me。　　Jacquemier。　Published　three　years　after　my　Essay。　　Kiwisch。　　Behindhand　in　knowledge　of　Puerperal　Fever。〃　＇B。　&　F。　　Med。　　Rev。　　Jan。　　1842。＇　Paul　Dubois。　Scanzoni。

These　Continental　writers　not　well　informed　on　this　point。＇See　Dr。　Simpson's　Remarks　at　Meeting　of　Edin。　　Med。　　Chir。　　Soc。　　（Am。　　Jour。　Oct。　　1851。）＇

The　story　of　Von　Busch　is　of　interest　and　value；　but　there　is　nothing　in　it　which　need　perplex　the　student。　　It　is　not　pretended　that　the　disease　is　always；　or　even；　it　may　be；　in　the　majority　of　cases；　carried　about　by　attendants；　only　that　it　is　so　carried　in　certain　cases。　　That　it　may　have　local　and　epidemic　causes；　as　well　as　that　depending　on　personal　transmission；　is　not　disputed。　　Remember　how　small…pox　often　disappears　from　a　community　in　spite　of　its　contagious　character；　and　the　necessary　exposure　of　many　persons　to　those　suffering　from　it；　in　both　diseases　contagion　is　only　one　of　the　coefficients　of　the　disease。

I　have　already　spoken　of　the　possibility　that　Dr。　Meigs　may　have　been　the　medium　of　transfer　of　puerperal　fever　in　some　of　the　cases　he　has　briefly　catalogued。　　Of　Dr。　Rutter's　cases　I　do　not　know　how　to　speak。　　I　only　ask　the　student　to　read　the　facts　stated　by　Dr。　Condie；　as　given　in　my　Essay；　and　say　whether　or　not　a　man　should　allow　his　wife　to　be　attended　by　a　practitioner　in　whose　hands　〃scarcely　a　female　that　has　been　delivered　for　weeks　past　has　escaped　an　attack；〃　　〃while　no　instance　of　the　disease　has　occurred　in　the　patients　of　any　other　accoucheur　practising　in　the　same　district。〃　If　I　understand　Dr。　Meigs　and　Dr。　Hodge；　they　would　not　warn　the　physician　or　spare　the　patient　under　such　circumstances。　　They　would　〃go　on；〃　if　I　understand　them；　not　to　seven；　or　seventy；　only；　but　to　seventy　times　seven；　if　they　could　find　patients。　　If　this　is　not　what　they　mean；　may　we　respectfully　ask　them　to　state　what　they　do　mean；　to　their　next　classes；　in　the　name　of　humanity；　if　not　of　science！

I　might　repeat　the　question　asked　concerning　Dr。　Rutter's　cases；　with　reference　to　those　reported　by　Dr。　Roberton。　　Perhaps；　however；　the　student　would　like　to　know　the　opinion　of　a　person　in　the　habit　of　working　at　matters　of　this　kind　in　a　practical　point　of　view。　　To　satisfy　him　on　this　ground；　I　addressed　the　following　question　to　the　President　of　one　of　our　principal　Insurance　Companies；　leaving　Dr。　Meigs'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　wi