medical essays-第25章
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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 professional development； any violent impression on the instructor's mind is apt to be followed by some lasting effect on that of the pupil。 No mother's mark is more permanent than the mental naevi and moles； and excrescences； and mutilations； that students carry with them out of the lecture…room； if once the teeming intellect which nourishes theirs has been scared from its propriety by any misshapen fantasy。 Even an impatient or petulant expression； which to a philosopher would be a mere index of the low state of amiability of the speaker at the moment of its utterance； may pass into the young mind as an element of its future constitution； to injure its temper or corrupt its judgment。 It is a duty； therefore； which we owe to this younger class of students； to clear any important truth which may have been rendered questionable in their minds by such language； or any truth…teller against whom they may have been prejudiced by hasty epithets； from the impressions such words have left。 Until this is done； they are not ready for the question； where there is a question； for them to decide。 Even if we ourselves are the subjects of the prejudice； there seems to be no impropriety in showing that this prejudice is local or personal； and not an acknowledged conviction with the public at large。 It may be necessary to break through our usual habits of reserve to do this； but this is the fault of the position in which others have placed us。
Two widely…known and highly…esteemed practitioners； Professors in two of the largest Medical Schools of the Union； teaching the branch of art which includes the Diseases of Women； and therefore speaking with authority； addressing in their lectures and printed publications large numbers of young men； many of them in the tenderest immaturity of knowledge； have recently taken ground in a formal way against the doctrine maintained in this paper：
On the Non…Contagious Character of Puerperal Fever： An Introductory Lecture。 By Hugh L。 Hodge； M。 D。； Professor of Obstetrics in
