medical essays-第26章

按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！


me　physician　at　all　times；　for　since　my　return　from　the　country　I　have　had　a　more　inveterate　case　of　erysipelas　than　ever　before；　and　no　difficulty　whatever　has　attended　any　of　my　midwifery　cases？〃


I　am　assured；　on　unquestionable　authority；　that　〃About　three　years　since；　a　gentleman　in　extensive　midwifery　business；　in　a　neighboring　State；　lost　in　the　course　of　a　few　weeks　eight　patients　in　child…bed；　seven　of　them　being　undoubted　cases　of　puerperal　fever。　　No　other　physician　of　the　town　lost　a　single　patient　of　this　disease　during　the　same　period。〃　　And　from　what　I　have　heard　in　conversation　with　some　of　our　most　experienced　practitioners；　I　am　inclined　to　think　many　cases　of　the　kind　might　be　brought　to　light　by　extensive　inquiry。


This　long　catalogue　of　melancholy　histories　assumes　a　still　darker　aspect　when　we　remember　how　kindly　nature　deals　with　the　parturient　female；　when　she　is　not　immersed　in　the　virulent　atmosphere　of　an　impure　lying…in　hospital；　or　poisoned　in　her　chamber　by　the　unsuspected　breath　of　contagion。　　From　all　causes　together；　not　more　than　four　deaths　in　a　thousand　births　and　miscarriages　happened　in　England　and　Wales　during　the　period　embraced　by　the　first　Report　of　the　Registrar…General。〃　　In　the　second　Report　the　mortality　was　shown　to　be　about　five　in　one　thousand。　In　the　Dublin　Lying…in　Hospital；　during　the　seven　years　of　Dr。　Collins's　mastership；　there　was　one　case　of　puerperal　fever　to　178　deliveries；　or　less　than　six　to　the　thousand；　and　one　death　from　this　disease　in　278　cases；　or　between　three　and　four　to　the　thousand　a　yet　during　this　period　the　disease　was　endemic　in　the　hospital；　and　might　have　gone　on　to　rival　the　horrors　of　the　pestilence　of　the　Maternite；　had　not　the　poison　been　destroyed　by　a　thorough　purification。

In　private　practice；　leaving　out　of　view　the　cases　that　are　to　be　ascribed　to　the　self…acting　system　of　propagation；　it　would　seem　that　the　disease　must　be　far　from　common。　　Mr。　White　of　Manchester　says；　〃Out　of　the　whole　number　of　lying…in　patients　whom　I　have　delivered　（and　I　may　safely　call　it　a　great　one）；　I　have　never　lost　one；　nor　to　the　best　of　my　recollection　has　one　been　greatly　endangered；　by　the　puerperal；　miliary；　low　nervous；　putrid　malignant；　or　milk　fever。〃　Dr。　Joseph　Clarke　informed　Dr。　Collins；　that　in　the　course　of　forty…　five　years'　most　extensive　practice　he　lost　but　four　patients　from　this　disease。　　One　of　the　most　eminent　practitioners　of　Glasgow；　who　has　been　engaged　in　very　extensive　practice　for　upwards　of　a　quarter　of　a　century；　testifies　that　he　never　saw　more　than　twelve　cases　of　real　puerperal　fever。＇Lancet；　May　4；　1833＇

I　have　myself　been　told　by　two　gentlemen　practising　in　this　city；　and　having　for　many　years　a　large　midwifery　business；　that　they　had　neither　of　them　lost　a　patient　from　this　disease；　and　by　one　of　them　that　he　had　only　seen　it　in　consultation　with　other　physicians。　　In　five　hundred　cases　of　midwifery；　of　which　Dr。　Storer　has　given　an　abstract　in　the　first　number　of　this　Journal；　there　was　only　one　instance　of　fatal　puerperal　peritonitis。

In　the　view　of　these　facts；　it　does　appear　a　singular　coincidence；　that　one　man　or　woman　should　have　ten；　twenty；　thirty；　or　seventy　cases　of　this　rare　disease　following　his　or　her　footsteps　with　the　keenness　of　a　beagle；　through　the　streets　and　lanes　of　a　crowded　city；　while　the　scores　that　cross　the　same　paths　on　the　same　errands　know　it　only　by　name。　　It　is　a　series　of　similar　coincidences　which　has　led　us　to　consider　the　dagger；　the　musket；　and　certain　innocent…　looking　white　powders　as　having　some　little　claim　to　be　regarded　as　dangerous。　　It　is　the　practical　inattention　to　similar　coincidences　which　has　given　rise　to　the　unpleasant　but　often　necessary　documents　called　indictments；　which　has　sharpened　a　form　of　the　cephalotome　sometimes　employed　in　the　case　of　adults；　and　adjusted　that　modification　of　the　fillet　which　delivers　the　world　of　those　who　happen　to　be　too　much　in　the　way　while　such　striking　coincidences　are　taking　place。

I　shall　now　mention　a　few　instances　in　which　the　disease　appears　to　have　been　conveyed　by　the　process　of　direct　inoculation。

Dr。　Campbell　of　Edinburgh　states　that　in　October；　1821；　he　assisted　at　the　post…mortem　examination　of　a　patient　who　died　with　puerperal　fever。　　He　carried　the　pelvic　viscera　in　his　pocket　to　the　class…　room。　　The　same　evening　he　attended　a　woman　in　labor　without　previously　changing　his　clothes；　this　patient　died。　　The　next　morning　he　delivered　a　woman　with　the　forceps；　she　died　also；　and　of　many　others　who　were　seized　with　the　disease　within　a　few　weeks；　three　shared　the　same　fate　in　succession。

In　June；　1823；　he　assisted　some　of　his　pupils　at　the　autopsy　of　a　case　of　puerperal　fever。　　He　was　unable　to　wash　his　hands　with　proper　care；　for　want　of　the　necessary　accommodations。　　On　getting　home　he　found　that　two　patients　required　his　assistance。　　He　went　without　further　ablution；　or　changing　his　clothes；　both　these　patients　died　with　puerperal　fever。　　This　same　Dr。　Campbell　is　one　of　Dr。　Churchill's　authorities　against　contagion。

Mr。　Roberton　says　that　in　one　instance　within　his　knowledge　a　practitioner　passed　the　catheter　for　a　patient　with　puerperal　fever　late　in　the　evening；　the　same　night　he　attended　a　lady　who　had　the　symptoms　of　the　disease　on　the　second　day。　　In　another　instance　a　surgeon　was　called　while　in　the　act　of　inspecting　the　body　of　a　woman　who　had　died　of　this　fever；　to　attend　a　labor；　within　forty…eight　hours　this　patient　was　seized　with　the　fever。'

On　the　16th　of　March；　1831；　a　medical　practitioner　examined　the　body　of　a　woman　who　had　died　a　few　days　after　delivery；　from　puerperal　peritonitis。　　On　the　evening　of　the　17th　he　delivered　a　patient；　who　was　seized　with　puerperal　fever　on　the　19th；　and　died　on　the　24th。　Between　this　period　and　the　6th　of　April；　the　same　practitioner　attended　two　other　patients；　both　of　whom　were　attacked　with　the　same　disease　and　died。

In　the　autumn　of　1829　a　physician　was　present　at　the　examination　of　a　case　of　puerperal　fever；　dissected　out　the　organs；　and　assisted　in　sewing　up　the　body。　　He　had　scarcely　reached　home　when　he　was　summoned　to　attend　a　young　lady　in　labor。　　In　sixteen　hours　she　was　attacked　with　the　symptoms　of　puerperal　fever；　and　narrowly　escaped　with　her　life。

In　December；　1830；　a　midwife；　who　had　attended　two　fatal　cases　of　puerperal　fever　at　the　British　Lying…in　Hospital；　examined　a　patient　who　had　just　been　admitted；　to　ascertain　if　labor　had　commenced。　This　patient　remained　two　days　in　the　expectation　that　labor　would　come　on；　when　she　returned　home　and　was　then　suddenly　taken　in　labor　and　delivered　before　she　could　set　out　for　the　hospital。　　She　went　on　favorably　for　two　days；　and　was　then　taken　with　puerperal　fever　and　died　in　thirty…six　hours。

〃A　young　practitioner；　contrary　to　advice；　examined　the　body　of　a　patient　who　had　died　from　puerperal　fever；　there　was　no　epidemic　at　the　time；　the　case　appeared　to　be　purely　sporadic。　　He　delivered　three　other　women　shortly　afterwards；　they　all　died　with　puerperal　fever；　the　symptoms　of　which　broke　out　very　soon　after　labor。　　The　patients　of　his　colleague　did　well；　except　one；　where　he　assisted　to　remove　some　coagula　from　the　uterus；　she　was　attacked　in　the　same　manner　as　those　whom　he　had　attended；　and　died　also。〃　　The　writer　in　the　〃British　and　Foreign　Medical　Review；〃　from　whom　I　quote　this　statement；and　who　is　no　other　than　Dr。　Rigby；　adds；　〃We　trust　that　this　fact　alone　will　forever　silence　such　doubts；　and　stamp　the　well…　merited　epithet　of　'criminal；'　as　above　quoted；　upon　such　attempts。〃　＇Brit。　　and　For。　　Medical　Review　for　Jan。　　1842；　p。　　112。＇

》From　the　cases　given　by　Mr。　Ingleby；　I　select　the　following。　　Two　gentlemen；　after　having　been　engaged　in　conducting　the　post…mortem　examination　of　a　case　of　puerperal　fever；　went　in　the　same　dress；　each　respectively；　to　a　case　of　midwifery。　　〃The　one　patient　was　seized　　with　the　rigor　about　thirty　hours　afterwards。　　The　other　patient　was　seized　with　a　rigor　the　third　morning　after　delivery。　One　recovered；　one　died。〃　＇Edin。　　Med。　　and　Surg。　　Journal；　April；　1838。＇

One　of　these　same　gentlemen　attended　another　woman　in　the　same　clothes　two　days　after　the　autopsy　referred　to。　　〃The　rigor　did　not　take　place　until　the　evening　of　the　fifth　day　from　the　first　visit。　Result　fatal。〃　　These　cases　belonged　to　a　series　of　seven；　the　first　of　which　was　thought　to　have　originated　in　a　case　of　erysipelas。　〃Several　cases　of　a　mild　character　followed　the　foregoing　seven；　and　their　nature　being　now　most　unequivocal；　my　friend　declined　visiting　all　midwifery　cases　for　a　time；　and　there　was　no　recurrence　of　the　disease。〃　　These　cases　occurred　in　1833。　　Five　of　them　proved　fatal。　Mr。　Ingleby　gives　another　series　of　seven　eases　which　occurred　to　a　practitioner　in　1836；　the　first　of　which　was　also　attributed　to　his　having　opened　several　erysipelatous　abscesses　a　short　time　previously。

I　need　not　refer　to　the　case　lately　read　before　this　Society；　in　which　a　physician　went；　soon　after　performing　an　autopsy　of　a　case　of　puerperal　fever；　to　a　woman　in　labor；　who　was　seized　with　the　same　disease　and　perished。　　The　forfeit　of　that　error　has　been　already　paid。

At　a　meeting　of　the　Medical　and　Chirurgical　Society　before　referred　to；　Dr。　Merriman　related　an　instance　occurring　in　his　own　practice；　which　excites　a　reasonable　suspicion　that　two　lives　were　sacrificed　to　a　still　less　dangerous　experiment。　　He　was　at　the　examination　of　a　case　of　puerperal　fever　at　two　o'clock　in　the　afternoon。　　He　took　care　not　to　touch　the　body。　　At　nine　o'clock　the　same　evening　he　attended　a　woman　in　labor；　she　was　so　nearly　delivered　that　he　had　scarcely　anything　to　do。　　The　next　morning　she　had　severe　rigors；　and　in　forty…eight　hours　she　was　a　corpse。　　Her　infant　had　erysipelas　and　died　in　two　days。　＇Lancet；　May　2；　1840。＇

In　connection　with　the　facts　which　have　been　stated；　it　seems　proper　to　allude　to　the　dangerous　and　often　fatal　effects　which　have　followed　from　wounds　received　in　the　post…mortem　examination　of　patients　who　have　died　of　puerperal　fever。　　The　fact　that　such　wounds　are　attended　with　peculiar　risk　has　been　long　noticed。　　I　find　that　Chaussier　was　in　the　habit　of　cautioning　his　students　against　the　danger　to　which　they　were　exposed　in　these　dissections。　＇Stein；　L'Art　d'Accoucher；　1794；　Dict。　des　Sciences　Medicales；　art。　　〃Puerperal。〃＇　The　head　pharmacien　of　the　Hotel　Dieu；　in　his　analysis　of　the　fluid　effused　in　puerperal　peritonitis；　says　that　practitioners　are　convinced　of　its　deleterious　qualities；　and　that　it　is　very　dangerous　to　apply　it　to　the　denuded　skin。　＇Journal　de　Pharmacie；　January；　1836。＇　　Sir　Benjamin　Brodie　speaks　of　it　as　being　well　known　that　the　inoculation　of　lymph　or　pus　from　the　peritoneum　of　a　puerperal　patient　is　often　attended　with　dangerous　and　even　fatal　symptoms。　Three　cases　in　confirmation　of　this　statement；　two　of　them　fatal；　have　been　reported　to　this　Society　within　a　few　months。

Of　about　fifty　cases　of　injuries　of　this　kind；　of　various　degrees　of　severity；　which　I　have　collected　from　different　sources；　at　least　twelve　were　instances　of　infection　from　puerperal　peritonitis。　　Some　of　the　others　are　so　stated　as　to　render　it　probable　that　they　may　have