medical essays-第28章
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aken immediately with the symptoms of typhus。〃＇Am。 Jour。 Med。 Sciences； Feb。 1837； p。 299。＇ It is by notes of cases； rather than notes of admiration； that we must be guided； when we study the Revised Statutes of Nature； as laid down from the curule chairs of Medicine。
Let the student read Dr。 Meigs's 140th paragraph soberly； and then remember； that not only does he infer； suspect； and surmise； but he actually asserts （page 154； 〃there was poison in the house；〃 because three out of five patients admitted into a ward had puerperal fever and died。 Have I not as much right to draw a positive inference from 〃Dr。 A。's 〃 seventy exclusive cases as he from the three cases in the ward of the Dublin Hospital？ All practical medicine； and all action in common affairs； is founded on inferences。 How does Dr。 Meigs know that the patients he bled in puerperal fever would not have all got well if he had not bled them？
〃You see a man discharge a gun at another； you see the flash； you hear the report； you see the person fall a lifeless corpse； and you infer； from all these circumstances； that there was a ball discharged from the gun； which entered his body and caused his death； because such is the usual and natural cause of such an effect。 But you did not see the ball leave the gun； pass through the air； and enter the body of the slain； and your testimony to the fact of killing is； therefore； only inferential；in other words； circumstantial。 It is possible that no ball was in the gun； and we infer that there was； only because we cannot account for death on any other supposition。〃 ＇Chief Justice Gibson； in Am。 Law Journal； vol。 vi。 p。 123。＇
〃The question always comes to this： Is the circumstance of intercourse with the sick followed by the appearance of the disease in a proportion of cases so much greater than any other circumstance common to any portion of the inhabitants of the place under observation； as to make it inconceivable that the succession of cases occurring in persons having that intercourse should have been the result of chance？ If so； the inference is unavoidable； that that intercourse must have acted as a cause of the disease。 All observations which do not bear strictly on that point are irrelevant； and； in the case of an epidemic first appearing in a town or district； a succession of two cases is sometimes sufficient to furnish evidence which； on the principle I have stated； is nearly irresistible。〃
Possibly an inexperienced youth may be awe…struck by the quotation from Cuvier。 These words； or their equivalent； are certainly to be found in his Introduction。 So are the words 〃top not come down〃！ to be found in the Bible； and they were as much meant for the ladies' head…dresses as the words of Cuvier were meant to make clinical observation wait for a permit from anybody to look with its eyes and count on its fingers。 Let the inquiring youth read the whole Introduction； and he will see what they mean。
I intend no breach of courtesy； but this is a proper place to warn the student against skimming the prefaces and introductions of works for mottoes and embellishments to his thesis。 He cannot learn anatomy by thrusting an exploring needle into the body。 He will be very liable to misquote his author's meaning while he is picking off his outside sentences。 He may make as great a blunder as that simple prince who praised the conductor of his orchestra for the piece just before the overture； the musician was too good a courtier to tell him that it was only the tuning of the instruments。
To the six propositions in the 142d paragraph； and the remarks about 〃specific〃 diseases； the answer； if any is necessary； seems very simple。 An inflammation of a serous membrane may give rise to secretions which act as a poison； whether that be a 〃specific〃 poison or not； as Dr。 Homer has told his young readers； and as dissectors know too well； and that poison may produce its symptoms in a few hours after the system has received it； as any may see in Druitt's 〃Surgery；〃 if they care to look。 Puerperal peritonitis may produce such a poison； and puerperal women may be very sensible to its influences； conveyed by contact or exhalation。 Whether this is so or not； facts alone can determine； and to facts we have had recourse to settle it。
The following statement is made by Dr。 Meigs in his 142d paragraph； and developed more at length； with rhetorical amplifications； in the 134th。 〃No human being； save a pregnant or parturient woman； is susceptible to the poison。〃 This statement is wholly incorrect； as I am sorry to have to point out to a Teacher in Dr。 Meigs's position。 I do not object to the erudition which quotes Willis and Fernelius； the last of whom was pleasantly said to have 〃preserved the dregs of the Arabs in the honey of his Latinity。〃 But I could wish that more modern authorities had not been overlooked。 On this point； for instance； among the numerous facts disproving the statement； the 〃American Journal of Medical Sciences；〃 published not far from his lecture…room； would have presented him with a respectable catalog of such cases。 Thus he might refer to Mr。 Storrs's paper 〃On the Contagious Effects of Puerperal Fever on the Male Subject； or on Persons not Childbearing〃（Jan。 1846）； or to Dr。 Reid's case （April； 1846）； or to Dr。 Barron's statement of the children's dying of peritonitis in an epidemic of puerperal fever at the Philadelphia Hospital （Oct。 1842）； or to various instances cited in Dr。 Kneeland's article （April； 186）。 Or； if he would have referred to the 〃New York Journal；〃 he might have seen Prof。 Austin Flint's cases。 Or； if he had honored my Essay so far； he might have found striking instances of the same kind in the first of the new series of cases there reported and elsewhere。 I do not see the bearing of his proposition； if it were true。 But it is one of those assertions that fall in a moment before a slight examination of the facts； and I confess my surprise； that a professor who lectures on the Diseases of Women should have ventured to make it。
Nearly seven pages are devoted to showing that I was wrong in saying I would not be 〃understood to imply that there exists a doubt in the mind of any well…informed member of the medical profession as to the fact that puerperal fever is sometimes communicated from one person to another； both directly and indirectly。〃 I will devote seven lines to these seven pages； which seven lines； if I may say it without offence； are； as it seems to me； six more than are strictly necessary。
The following authors are cited as sceptics by Dr。 Meigs ： Dewees。 I cited the same passage。 Did not know half the facts。 Robert Lee。 Believes the disease is sometimes communicable by contagion。 Tonnelle； Baudelocque。 Both cited by me。 Jacquemier。 Published three years after my Essay。 Kiwisch。 Behindhand in knowledge of Puerperal Fever。〃 ＇B。 & F。 Med。 Rev。 Jan。 1842。＇ Paul Dubois。 Scanzoni。
These Continental writers not well informed on this point。＇See Dr。 Simpson's Remarks at Meeting of Edin。 Med。 Chir。 Soc。 （Am。 Jour。 Oct。 1851。）＇
The story of Von Busch is of interest and value； but there is nothing in it which need perplex the student。 It is not pretended that the disease is always； or even； it may be； in the majority of cases； carried about by attendants； only that it is so carried in certain cases。 That it may have local and epidemic causes； as well as that depending on personal transmission； is not disputed。 Remember how small…pox often disappears from a community in spite of its contagious character； and the necessary exposure of many persons to those suffering from it； in both diseases contagion is only one of the coefficients of the disease。
I have already spoken of the possibility that Dr。 Meigs may have been the medium of transfer of puerperal fever in some of the cases he has briefly catalogued。 Of Dr。 Rutter's cases I do not know how to speak。 I only ask the student to read the facts stated by Dr。 Condie； as given in my Essay； and say whether or not a man should allow his wife to be attended by a practitioner in whose hands 〃scarcely a female that has been delivered for weeks past has escaped an attack；〃 〃while no instance of
