medical essays-第24章

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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；　　　〃　　　　　　　　May　　　8；　had　some　symptoms；（also　recovered。）

These　were　the　only　cases　attended　by　this　physician　during　the　period　referred　to。　　〃They　were　all　attended　by　him　until　their　termination；　with　the　exception　of　the　patient　No。　　6；　who　fell　into　the　hands　of　another　physician　on　the　2d　of　May。　　（Dr。　C。　left　town　for　a　few　days　at　this　time。）　Dr。　C。　　attended　cases　immediately　before　and　after　the　above…named　periods；　none　of　which；　however；　presented　any　peculiar　symptoms　of　the　disease。

About　the　1st　of　July　he　attended　another　patient　in　a　neighboring　village；　who　died　two　or　three　days　after　delivery。

The　first　patient；　it　is　stated；　was　delivered　on　the　20th　of　March。　〃On　the　19th；　Dr。　C。　made　the　autopsy　of　a　man　who　died　suddenly；　sick　only　forty…eight　hours；　had　oedema　of　the　thigh；　and　gangrene　extending　from　a　little　above　the　ankle　into　the　cavity　of　the　abdomen。〃　　Dr。　C。　wounded　himself；　very　slightly；　in　the　right　hand　during　the　autopsy。　　The　hand　was　quite　painful　the　night　following；　during　his　attendance　on　the　patient　No。　1。　　He　did　not　see　this　patient　after　the　20th；　being　confined　to　the　house；　and　very　sick　from　the　wound　just　mentioned；　from　this　time　until　the　3d　of　April。

Several　cases　of　erysipelas　occurred　in　the　house　where　the　autopsy　mentioned　above　took　place；　soon　after　the　examination。　　There　were　also　many　cases　of　erysipelas　in　town　at　the　time　of　the　fatal　puerperal　cases　which　have　been　mentioned。

The　nurse　who　laid　out　the　body　of　the　patient　No。　3　was　taken　on　the　evening　of　the　same　day　with　sore　throat　and　erysipelas；　and　died　in　ten　days　from　the　first　attack。

The　nurse　who　laid　out　the　body　of　the　patient　No。　4　was　taken　on　the　day　following　with　symptoms　like　those　of　this　patient；　and　died　in　a　week；　without　any　external　marks　of　erysipelas。

〃No　other　cases　of　similar　character　with　those　of　Dr。　C。　occurred　in　the　practice　of　any　of　the　physicians　in　the　town　or　vicinity　at　the　time。　　Deaths　following　confinement　have　occurred　in　the　practice　of　other　physicians　during　the　past　year；　but　they　were　not　cases　of　puerperal　fever。　　No　post…mortem　examinations　were　held　in　any　of　these　puerperal　cases。〃

Some　additional　statements　in　this　letter　are　deserving　of　insertion。

〃A　physician　attended　a　woman　in　the　immediate　neighborhood　of　the　cases　numbered　2；　3；　and　4。　　This　patient　was　confined　the　morning　of　March　1st；　and　died　on　the　night　of　March　7th。　　It　is　doubtful　whether　this　should　be　considered　a　case　of　puerperal　fever。　　She　had　suffered　from　canker；　indigestion；　and　diarrhoea　for　a　year　previous　to　her　delivery。　　Her　complaints　were　much　aggravated　for　two　or　three　months　previous　to　delivery；　she　had　become　greatly　emaciated；　and　weakened　to　such　an　extent　that　it　had　not　been　expected　that　she　would　long　survive　her　confinement；　if　indeed　she　reached　that　period。　　Her　labor　was　easy　enough；　she　flowed　a　good　deal；　seemed　exceedingly　prostrated；　had　ringing　in　the　ears；　and　other　symptoms　of　exhaustion；　the　pu