medical essays-第25章

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trated；　had　ringing　in　the　ears；　and　other　symptoms　of　exhaustion；　the　pulse　was　quick　and　small。　　On　the　second　and　third　day　there　was　some　tenderness　and　tumefaction　of　the　abdomen；　which　increased　somewhat　on　the　fourth　and　fifth。　　He　had　cases　in　midwifery　before　and　after　this；　which　presented　nothing　peculiar。〃

It　is　also　mentioned　in　the　same　letter；　that　another　physician　had　a　case　during　the　last　summer　and　another　last　fall；　both　of　which　recovered。

Another　gentleman　reports　a　case　last　December；　a　second　case　five　weeks；　and　another　three　weeks　since。　　All　these　recovered。　　A　case　also　occurred　very　recently　in　the　practice　of　a　physician　in　the　village　where　the　eighth　patient　of　Dr。　C。　resides；　which　proved　fatal。　　〃This　patient　had　some　patches　of　erysipelas　on　the　legs　and　arms。　　The　same　physician　has　delivered　three　cases　since；　which　have　all　done　well。　　There　have　been　no　other　cases　in　this　town　or　its　vicinity　recently。　　There　have　been　some　few　cases　of　erysipelas。〃　It　deserves　notice　that　the　partner　of　Dr。　C。；　who　attended　the　autopsy　of　the　man　above　mentioned　and　took　an　active　part　in　it；　who　also　suffered　very　slightly　from　a　prick　under　the　thumb…nail　received　during　the　examination；　had　twelve　cases　of　midwifery　between　March　26th　and　April　12th；　all　of　which　did　well；　and　presented　no　peculiar　symptoms。　　It　should　also　be　stated；　that　during　these　seventeen　days　he　was　in　attendance　on　all　the　cases　of　erysipelas　in　the　house　where　the　autopsy　had　been　performed。

I　owe　these　facts　to　the　prompt　kindness　of　a　gentleman　whose　intelligence　and　character　are　sufficient　guaranty　for　their　accuracy。

The　two　following　letters　were　addressed　to　my　friend　Dr。　Scorer；　by　the　gentleman　in　whose　practice　the　cases　of　puerperal　fever　occurred。　　His　name　renders　it　unnecessary　to　refer　more　particularly　to　these　gentlemen；　who　on　their　part　have　manifested　the　most　perfect　freedom　and　courtesy　in　affording　these　accounts　of　their　painful　experience。


〃January　28；　1843。

II。　　。　　。　　。　　〃The　time　to　which　you　allude　was　in　1830。　　The　first　case　was　in　February；　during　a　very　cold　time。　　She　was　confined　the　4th；　and　died　the　12th。　　Between　the　10th　and　28th　of　this　month；　I　attended　six　women　in　labor；　all　of　whom　did　well　except　the　last；　as　also　two　who　were　confined　March　1st　and　5th。　　Mrs。　E。；　confined　February　28th；　sickened；　and　died　March　8th。　　The　next　day；　9th；　I　inspected　the　body；　and　the　night　after　attended　a　lady；　Mrs。　B。；　who　sickened；　and　died　16th。　　The　10th；　I　attended　another；　Mrs。　G。；　who　sickened；　but　recovered。　　March　16th；　I　went　from　Mrs。　G。's　room　to　attend　a　Mrs。　H。；　who　sickened；　and　died　21st。　　The　17th；　I　inspected　Mrs。　B。　　On　the　19th；　I　went　directly　from　Mrs。　H。's　room　to　attend　another　lady；　Mrs。　G。；　who　also　sickened；　and　died　22d。　　While　Mrs。　B。　was　sick；　on　15th；　I　went　directly　from　her　room　a　few　rods；　and　attended　another　woman；　who　was　not　sick。　　Up　to　20th　of　this　month　I　wore　the　same　clothes。　　I　now　refused　to　attend　any　labor；　and　did　not　till　April　21st；　when；　having　thoroughly　cleansed　myself；　I　resumed　my　practice；　and　had　no　more　puerperal　fever。

〃The　cases　were　not　confined　to　a　narrow　space。　　The　two　nearest　were　half　a　mile　from　each　other；　and　half　that　distance　from　my　residence。　　The　others　were　from　two　to　three　miles　apart；　and　nearly　that　distance　from　my　residence。　　There　were　no　other　cases　in　their　immediate　vicinity　which　came　to　my　knowledge。　　The　general　health　of　all　the　women　was　pretty　good；　and　all　the　labors　as　good　as　common；　except　the　first。　　This　woman；　in　consequence　of　my　not　arriving　in　season；　and　the　child　being　half…born　at　some　time　before　I　arrived；　was　very　much　exposed　to　the　cold　at　the　time　of　confinement；　and　afterwards；　being　confined　in　a　very　open；　cold　room。　　Of　the　six　cases　you　perceive　only　one　recovered。

〃In　the　winter　of　1817　two　of　my　patients　had　puerperal　fever；　one　very　badly；　the　other　not　so　badly。　　Both　recovered。　　One　other　had　swelled　leg；　or　phlegmasia　dolens；　and　one　or　two　others　did　not　recover　as　well　as　usual。

〃In　the　summer　of　1835　another　disastrous　period　occurred　in　my　practice。　　July　1st；　I　attended　a　lady　in　labor；　who　was　afterwards　quite　ill　and　feverish；　but　at　the　time　I　did　not　consider　her　case　a　decided　puerperal　fever。　　On　the　8th；　I　attended　one　who　did　well。　On　the　12th；　one　who　was　seriously　sick。　　This　was　also　an　equivocal　case；　apparently　arising　from　constipation　and　irritation　of　the　rectum。　　These　women　were　ten　miles　apart　and　five　from　my　residence。　On　15th　and　20th；　two　who　did　well。　　On　25th；　I　attended　another。　This　was　a　severe　labor；　and　followed　by　unequivocal　puerperal　fever；　or　peritonitis。　　She　recovered。　　August　2d　and　3d；　in　about　twenty…　four　hours　I　attended　four　persons。　　Two　of　them　did　very　well；　one　was　attacked　with　some　of　the　common　symptoms；　which　however　subsided　in　a　day　or　two；　and　the　other　had　decided　puerperal　fever；　but　recovered。　　This　woman　resided　five　miles　from　me。　　Up　to　this　time　I　wore　the　same　coat。　　All　my　other　clothes　had　frequently　been　changed。　　On　6th；　I　attended　two　women；　one　of　whom　was　not　sick　at　all；　but　the　other；　Mrs。　L。；　was　afterwards　taken　ill。　　On　10th；　I　attended　a　lady；　who　did　very　well。　　I　had　previously　changed　all　my　clothes；　and　had　no　garment　on　which　had　been　in　a　puerperal　room。　On　12th；　I　was　called　to　Mrs。　S。；　in　labor。　　While　she　was　ill；　I　left　her　to　visit　Mrs。　L。；　one　of　the　ladies　who　was　confined　on　6th。　Mrs。　L。　　had　been　more　unwell　than　usual；　but　I　had　not　considered　her　case　anything　more　than　common　till　this　visit。　　I　had　on　a　surtout　at　this　visit；　which；　on　my　return　to　Mrs。　　S。；　I　left　in　another　room。　　Mrs。　S。　　was　delivered　on　13th　with　forceps。　　These　women　both　died　of　decided　puerperal　fever。

〃While　I　attended　these　women　in　their　fevers；　I　changed　my　clothes；　and　washed　my　hands　in　a　solution　of　chloride　of　lime　after　each　visit。　　I　attended　seven　women　in　labor　during　this　period；　all　of　whom　recovered　without　sickness。

〃In　my　practice　I　have　had　several　single　cases　of　puerperal　fever；　some　of　whom　have　died　and　some　have　recovered。　　Until　the　year　1830　I　had　no　suspicion　that　the　disease　could　be　communicated　from　one　patient　to　another　by　a　nurse　or　midwife；　but　I　now　think　the　foregoing　facts　strongly　favor　that　idea。　　I　was　so　much　convinced　of　this　fact；　that　I　adopted　the　plan　before　related。

〃I　believe　my　own　health　was　as　good　as　usual　at　each　of　the　above　periods。　　I　have　no　recollections　to　the　contrary。

〃I　believe　I　have　answered　all　your　questions。　　I　have　been　more　particular　on　some　points　perhaps　than　necessary；　but　I　thought　you　could　form　your　own　opinion　better　than　to　take　mine。　　In　1830　I　wrote　to　Dr。　Charming　a　more　particular　statement　of　my　cases。　　If　I　have　not　answered　your　questions　sufficiently；　perhaps　Dr。　C。　　may　have　my　letter　to　him；　and　you　can　find　your　answer　there。〃　＇In　a　letter　to　myself；　this　gentleman　also　stated；　〃I　do　not　recollect　that　there　was　any　erysipelas　or　any　other　disease　particularly　prevalent　at　the　time。〃＇


〃BOSTON；　February　3；　1843。

III。　　〃MY　DEAR　SIR；I　received　a　note　from　you　last　evening；　requesting　me　to　answer　certain　questions　therein　proposed；　touching　the　cases　of　puerperal　fever　which　came　under　my　observation　the　past　summer。　　It　gives　me　pleasure　to　comply　with　your　request；　so　far　as　it　is　in　my　power　so　to　do；　but；　owing　to　the　hurry　in　preparing　for　a　journey；　the　notes　of　the　cases　I　had　then　taken　were　lost　or　mislaid。　　The　principal　facts；　however；　are　too　vivid　upon　my　recollection　to　be　soon　forgotten。　　I　think；　therefore；　that　I　shall　be　able　to　give　you　all　the　information　you　may　require。

〃All　the　cases　that　occurred　in　my　practice　took　place　between　the　7th　of　May　and　the　17th　of　June　1842。

〃They　were　not　confined　to　any　particular　part　of　the　city。　　The　first　two　cases　were　patients　residing　at　the　South　End；　the　next　was　at　the　extreme　North　End；　one　living　in　Sea　Street　and　the　other　in　Roxbury。　　The　following　is　the　order　in　which　they　occurred：

〃Case　1。　　Mrs。_____　　was　confined　on　the　7th　of　May；　at　5　o'clock；　P。　M。；　after　a　natural　labor　of　six　hours。　　At　12　o'clock　at　night；　on　the　9th　（thirty…one　hours　after　confinement）；　she　was　taken　with　severe　chill；　previous　to　which　she　was　as　comfortable　as　women　usually　are　under　the　circumstances。　　She　died　on　the　10th。

〃Case　2。　　Mrs。_____　　was　confined　on　the　10th　of　June　（four　weeks　after　Mrs。　　C。）；　at　11　A。　M。；　after　a　natural；　but　somewhat　severe　labor　of　five　hours。　　At　7　o'clock；　on　the　morning　of　the　11th；　she　had　a　chill。　　Died　on　the　12th。

〃Case　3。　　Mrs。_____　；　confined　on　the　14th　of　June；　was　comfortable　until　the　18th；　when　symptoms　of　puerperal　fever　were　manifest。　　She　died　on　the　20th。

〃Case　4。　　Mrs。_____　；　confined　June　17th；　at　5　o'clock；　A。　　M。；　was　doing　well　until　the　morning　of　the　19th。　　She　died　on　the　evening　of　the　21st。

〃Case　5。　　Mrs。_____　　was　confined　with　her　fifth　child　on　the　17th　of　June；　at　6　o'clock　in　the　evening。　　This　patient　had　been　attacked　with　puerperal　fever；　at　three　of　her　previous　confinements；　but　the　disease　yielded　to　depletion　and　other　remedies　without　difficulty。　This　time；　I　regret　to　say；　I　was　not　so　fortunate。　　She　was　not　attacked；　as　were　the　other　patients；　with　a　chill；　but　complained　of　extreme　pain　in　abdomen；　and　tenderness　on　pressure；　almost　from　the　moment　of　her　confinement。　　In　this　as　in　the　other　cases；　the　disease　resisted　all　remedies；　and　she　died　in　great　distress　on　the　22d　of　the　same　month。　　Owing　to　the　extreme　heat　of　the　season；　and　my　own　indisposition；　none　of　the　subjects　were　examined　after　death。　Dr。　Channing；　who　was　in　attendance　with　me　on　the　three　last　cases；　proposed　to　have　a　post…mortem　examination　of　the　subject　of　case　No。　5；　but　from　some　cause　which　I　do　not　now　recollect　it　was　not　obtained。

〃You　wish　to　know　whether　I　wore　the　same　clothes　when　attending　the　different　cases。　　I　cannot　positively　say；　but　I　should　think　I　did　not；　as　the　weather　became　warmer　after　the　first　two　cases；　I　therefore　think　it　probable　that　I　made　a　change　of　at　least　a　part　of　my　dress。　　I　have　had　no　other　case　of　puerperal　fever　in　my　own　practice　for　three　years；　save　those　above　related；　and　I　do　not　remember　to　have　lost　a　patient　before　with　this　disease。　　While　absent；　last　July；　I　visited　two　patients　sick　with　puerperal　fever；　with　a　friend　of　mine　in　the　country。　　Both　of　them　recovered。

〃The　cases　that　I　have　recorded　were　not　confined　to　any　particular　constitution　or　temperament；　but　it　seized　upon　the　strong　and　the　weak；　the　old　and　the　young；one　being　over　forty　years；　and　the　youngest　under　eighteen　years　of　age　。　　。　　。　　。　　If　the　disease　is　of　an　erysipelatous　nature；　as　many　suppose；　contagionists　may　perhaps　find　some　ground　for　their　belief　in　the　fact；　that；　for　two　weeks　previous　to　my　first　case　of　puerperal　fever；　I　had　been　attending　a　severe　case　of　erysipelas；　and　the　infection　may　have　been　conveyed　through　me　to　the　patient；　but；　on　the　other　hand；　why　is　not　this　the　case　with　other　physicians；　or　with　the　same　physician　at　all　times；　for　since　my　return　from　the　country　I　have　had　a　more　inveterate　case　of