medical essays-第26章
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On the Non…Contagious Character of Puerperal Fever： An Introductory Lecture。 By Hugh L。 Hodge； M。 D。； Professor of Obstetrics in the University of Pennsylvania。 Delivered Monday； October 11； 1852。 Philadelphia； 1852。
On the Nature； Signs； and Treatment of Childbed Fevers ： in a Series of Letters addressed to the Students of his Class。 By Charles D。 Meigs； M。 D。； Professor of Midwifery and the Diseases of Women and Children in Jefferson Medical College； Philadelphia； etc。； etc。 Philadelphia； 1854。 Letter VI。
The first of the two publications； Dr。 Hodge's Lecture； while its theoretical considerations and negative experiences do not seem to me to require any further notice than such as lay ready for them in my Essay written long before； is； I am pleased to say； unobjectionable in tone and language； and may be read without offence。
This can hardly be said of the chapter of Dr。 Meigs's volume which treats of Contagion in Childbed Fever。 There are expressions used in it which might well put a stop to all scientific discussions； were they to form the current coin in our exchange of opinions。 I leave the 〃very young gentlemen；〃 whose careful expositions of the results of practice in more than six thousand cases are characterized as 〃the jejune and fizenless dreamings of sophomore writers；〃 to the sympathies of those 〃dear young friends；〃 and 〃dear young gentlemen；〃 who will judge how much to value their instructor's counsel to think for themselves； knowing what they are to expect if they happen not to think as he does。
One unpalatable expression I suppose the laws of construction oblige me to appropriate to myself； as my reward for a certain amount of labor bestowed on the investigation of a very important question of evidence； and a statement of my own practical conclusions。 I take no offence； and attempt no retort。 No man makes a quarrel with me over the counterpane that covers a mother； with her new…born infant at her breast。 There is no epithet in the vocabulary of slight and sarcasm that can reach my personal sensibilities in such a controversy。 Only just so far as a disrespectful phrase may turn the student aside from the examination of the evidence； by discrediting or dishonoring the witness； does it call for any word of notice。
I appeal from the disparaging language by which the Professor in the Jefferson School of Philadelphia world dispose of my claims to be listened to。 I appeal； not to the vote of the Society for Medical Improvement； although this was an unusual evidence of interest in the paper in question； for it was a vote passed among my own townsmen； nor to the opinion of any American； for none know better than the Professors in the great Schools of Philadelphia how cheaply the praise of native contemporary criticism is obtained。 I appeal to the recorded opinions of those whom I do not know； and who do not know me； nor care for me； except for the truth that I may have uttered； to Copland； in his 〃Medical Dictionary；〃 who has spoken of my Essay in phrases to which the pamphlets of American 〃scribblers〃 are seldom used from European authorities； to Ramsbotham； whose compendious eulogy is all that self…love could ask； to the 〃Fifth Annual Report〃 of the Registrar…General of England； in which the second…hand abstract of my Essay figures largely； and not without favorable comment； in an important appended paper。 These testimonies； half forgotten until this circumstance recalled them； are dragged into the light； not in a paroxysm of vanity； but to show that there may be food for thought in the small pamphlet which the Philadelphia Teacher treats so lightly。 They were at least unsought for； and would never have been proclaimed but for the sake of securing the privilege of a decent and unprejudiced hearing。
I will take it for granted that they have so far counterpoised the depreciating language of my fellow…countryman and fellow…teacher as to gain me a reader here and there among the youthful class of students I am now addressing。 It is only for their sake that I think it necessary to analyze； or explain； or illustrate； or corroborate any portion of the following Essay。 But I know that nothing can be made too plain for beginners； and as I do not expect the practitioner； or even the more mature student； to take the trouble to follow me through an Introduction which I consider wholly unnecessary and superfluous for them； I shall not hesitate to stoop to the most elementary simplicity for the benefit of the younger student。 I do this more willingly because it affords a good opportunity； as it seems to me； of exercising the untrained mind in that medical logic which does not seem to have been either taught or practised in our schools of late； to the extent that might be desired。
I will now exhibit； in a series of propositions reduced to their simplest expression； the same essential statements and conclusions as are contained in the Essay； with such commentaries and explanations as may be profitable to the inexperienced class of readers addressed。
I。 It has been long believed； by many competent observers； that Puerperal Fever （so called） is sometimes carried from patient to patient by medical assistants。
II。 The express object of this Essay is to prove that it is so carried。
III。 In order to prove this point； it is not necessary to consult any medical theorist as to whether or not it is consistent with his preconceived notions that such a mode of transfer should exist。
IV。 If the medical theorist insists on being consulted； and we see fit to indulge him； he cannot be allowed to assume that the alleged laws of contagion； deduced from observation in other diseases； shall be cited to disprove the alleged laws deduced from observation in this。 Science would never make progress under such conditions。 Neither the long incubation of hydrophobia； nor the protecting power of vaccination； would ever have been admitted； if the results of observation in these affections had been rejected as contradictory to the previously ascertained laws of contagion。
V。 The disease in question is not a common one； producing； on the average； about three deaths in a thousand births； according to the English Registration returns which I have examined。
VI。 When an unusually large number of cases of this disease occur about the same time； it is inferred； therefore； that there exists some special cause for this increased frequency。 If the disease prevails extensively over a wide region of country； it is attributed without dispute to an epidemic influence。 If it prevails in a single locality； as in a hospital； and not elsewhere； this is considered proof that some local cause is there active in its production。
VII。 When a large number of cases of this disease occur in rapid succession； in one individual's ordinary practice； and few or none elsewhere； these cases appearing in scattered localities； in patients of the same average condition as those who escape under the care of others； there is the same reason for connecting the cause of the disease with the person in this instance； as with the place in that last mentioned。
VIII。 Many series of cases； answering to these conditions； are given in this Essay； and many others will be referred to which have occurred since it was written。
IX。 The alleged results of observation may be set aside； first； because the so…called facts are in their own nature equivocal； secondly； because they stand on insufficient authority； thirdly； because they are not sufficiently numerous。 But； in this case； the disease is one of striking and well…marked character； the witnesses are experts； interested in denying and disbelieving the facts； the number of consecutive cases in many instances frightful； and the number of series of cases such that I have no room for many of them except by mere reference。
X。 These results of observation； being admitted； may； we will suppose； be interpreted in different methods。 Thus the coincidences may be considered the effect of chance。 I have had the chances calculated by a competent person； that a given practitioner； A。； shall have sixteen fatal cases in a month； on the following data： A。 to average attendance upon two hundred a
