medical essays-第31章

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contagion；　yet　it　goes　through　the　same　periods　of　periodical　increase　and　diminution　which　have　been　remarked　in　puerperal　fever。　　If　the　question　is　asked　how　we　are　to　reconcile　the　great　variations　in　the　mortality　of　puerperal　fever　in　different　seasons　and　places　with　the　supposition　of　contagion；　I　will　answer　it　by　another　question　from　Mr。　Farr's　letter　to　the　Registrar…　General。　　He　makes　the　statement　that　〃five　die　weekly　of　small…pox　in　the　metropolis　when　the　disease　is　not　epidemic；〃and　adds；　〃The　problem　for　solution　is；　Why　do　the　five　deaths　become　10；　15；　20；　31；　58；　88；　weekly；　and　then　progressively　fall　through　the　same　measured　steps？〃

5。　　I　take　it　for　granted；　that　if　it　can　be　shown　that　great　numbers　of　lives　have　been　and　are　sacrificed　to　ignorance　or　blindness　on　this　point；　no　other　error　of　which　physicians　or　nurses　may　be　occasionally　suspected　will　be　alleged　in　palliation　of　this；　but　that　whenever　and　wherever　they　can　be　shown　to　carry　disease　and　death　instead　of　health　and　safety；　the　common　instincts　of　humanity　will　silence　every　attempt　to　explain　away　their　responsibility。


The　treatise　of　Dr。　Gordon　of　Aberdeen　was　published　in　the　year　1795；　being　among　the　earlier　special　works　upon　the　disease。　　Apart　of　his　testimony　has　been　occasionally　copied　into　other　works；　but　his　expressions　are　so　clear；　his　experience　is　given　with　such　manly　distinctness　and　disinterested　honesty；　that　it　may　be　quoted　as　a　model　which　might　have　been　often　followed　with　advantage。

〃This　disease　seized　such　women　only　as　were　visited；　or　delivered　by　a　practitioner；　or　taken　care　of　by　a　nurse；　who　had　previously　attended　patients　affected　with　the　disease。〃

〃I　had　evident　proofs　of　its　infectious　nature；　and　that　the　infection　was　as　readily　communicated　as　that　of　the　small…pox　or　measles；　and　operated　more　speedily　than　any　other　infection　with　which　I　am　acquainted。〃

〃I　had　evident　proofs　that　every　person　who　had　been　with　a　patient　in　the　puerperal　fever　became　charged　with　an　atmosphere　of　infection；　which　was　communicated　to　every　pregnant　woman　who　happened　to　come　within　its　sphere。　　This　is　not　an　assertion；　but　a　fact；　admitting　of　demonstration；　as　may　be　seen　by　a　perusal　of　the　foregoing　table；〃referring　to　a　table　of　seventy…seven　cases；　in　many　of　which　the　channel　of　propagation　was　evident。

He　adds；　〃It　is　a　disagreeable　declaration　for　me　to　mention；　that　I　myself　was　the　means　of　carrying　the　infection　to　a　great　number　of　women。〃　　He　then　enumerates　a　number　of　instances　in　which　the　disease　was　conveyed　by　midwives　and　others　to　the　neighboring　villages；　and　declares　that　〃these　facts　fully　prove　that　the　cause　of　the　puerperal　fever；　of　which　I　treat；　was　a　specific　contagion；　or　infection；　altogether　unconnected　with　a　noxious　constitution　of　the　atmosphere。〃

But　his　most　terrible　evidence　is　given　in　these　words：　〃I　ARRIVED　AT　THAT　CERTAINTY　IN　THE　MATTER；　THAT　I　COULD　VENTURE　TO　FORETELL　WHAT　WOMEN　WOULD　BE　AFFECTED　WITH　THE　DISEASE；　UPON　HEARING　BY　WHAT　MIDWIFE　THEY　WERE　TO　BE　DELIVERED；　OR　BY　WHAT　NURSE　THEY　WERE　TO　BE　ATTENDED；　DURING　THEIR　LYING…IN：　AND　ALMOST　IN　EVERY　INSTANCE；　MY　PREDICTION　WAS　VERIFIED。〃

Even　previously　to　Gordon；　Mr。　White　of　Manchester　had　said；　〃I　am　acquainted　with　two　gentlemen　in　another　town；　where　the　whole　business　of　midwifery　is　divided　betwixt　them；　and　it　is　very　remarkable　that　one　of　them　loses　several　patients　every　year　of　the　puerperal　fever；　and　the　other　never　so　much　as　meets　with　the　disorder；〃a　difference　which　he　seems　to　attribute　to　their　various　modes　of　treatment。　＇On　the　Management　of　Lying…in　Women；　p。　　120。＇

Dr。　Armstrong　has　given　a　number　of　instances　in　his　Essay　on　Puerperal　Fever；　of　the　prevalence　of　the　disease　among　the　patients　of　a　single　practitioner。　　At　Sunderland；　〃in　all；　forty…three　cases　occurred　from　the　1st　of　January　to　the　1st　of　October；　when　the　disease　ceased；　and　of　this　number　forty　were　witnessed　by　Mr。　Gregson　and　his　assistant；　Mr。　Gregory；　the　remainder　having　been　separately　seen　by　three　accoucheurs。〃　　There　is　appended　to　the　London　edition　of　this　Essay；　a　letter　from　Mr。　Gregson；　in　which　that　gentleman　says；　in　reference　to　the　great　number　of　cases　occurring　in　his　practice；　〃The　cause　of　this　I　cannot　pretend　fully　to　explain；　but　I　should　be　wanting　in　common　liberality　if　I　were　to　make　any　hesitation　in　asserting；　that　the　disease　which　appeared　in　my　practice　was　highly　contagious；　and　communicable　from　one　puerperal　woman　to　another。〃　　〃It　is　customary　among　the　lower　and　middle　ranks　of　people　to　make　frequent　personal　visits　to　puerperal　women　resident　in　the　same　neighborhood；　and　I　have　ample　evidence　for　affirming　that　the　infection　of　the　disease　was　often　carried　about　in　that　manner；　and；　however　painful　to　my　feelings；　I　must　in　candor　declare；　that　it　is　very　probable　the　contagion　was　conveyed；　in　some　instances；　by　myself；　though　I　took　every　possible　care　to　prevent　such　a　thing　from　happening；　the　moment　that　I　ascertained　that　the　distemper　was　infectious。〃　　Dr。　Armstrong　goes　on　to　mention　six　other　instances　within　his　knowledge；　in　which　the　disease　had　at　different　times　and　places　been　limited；　in　the　same　singular　manner；　to　the　practice　of　individuals；　while　it　existed　scarcely　if　at　all　among　the　patients　of　others　around　them。　　Two　of　the　gentlemen　became　so　convinced　of　their　conveying　the　contagion；　that　they　withdrew　for　a　time　from　practice。

I　find　a　brief　notice；　in　an　American　Journal；　of　another　series　of　cases；　first　mentioned　by　Mr。　Davies；　in　the　〃Medical　Repository。〃　This　gentleman　stated　his　conviction　that　the　disease　is　contagious。

〃In　the　autumn　of　1822　he　met　with　twelve　cases；　while　his　medical　friends　in　the　neighborhood　did　not　meet　with　any；　'　or　at　least　very　few。'　　He　could　attribute　this　circumstance　to　no　other　cause　than　his　having　been　present　at　the　examination；　after　death；　of　two　cases；　some　time　previous；　and　of　his　having　imparted　the　disease　to　his　patients；　notwithstanding　every　precaution。'〃

Dr。　Gooch　says；　〃It　is　not　uncommon　for　the　greater　number　of　cases　to　occur　in　the　practice　of　one　man；　whilst　the　other　practitioners　of　the　neighborhood；　who　are　not　more　skilful　or　more　busy；　meet　with　few　or　none。　　A　practitioner　opened　the　body　of　a　woman　who　had　died　of　puerperal　fever；　and　continued　to　wear　the　same　clothes。　　A　lady　whom　he　delivered　a　few　days　afterwards　was　attacked　with　and　died　of　a　similar　disease；　two　more　of　his　lying…in　patients；　in　rapid　succession；　met　with　the　same　fate；　struck　by　the　thought；　that　he　might　have　carried　contagion　in　his　clothes；　he　instantly　changed　them；　and　met　with　no　more　cases　of　the　kind。'　　A　woman　in　the　country；　who　was　employed　as　washerwoman　and　nurse；　washed　the　linen　of　one　who　had　died　of　puerperal　fever；　the　next　lying…in　patient　she　nursed　died　of　the　same　disease；　a　third　nursed　by　her　met　with　the　same　fate；　till　the　neighborhood；　getting　afraid　of　her；　ceased　to　employ　her。〃

In　the　winter　of　the　year　1824；　〃Several　instances　occurred　of　its　prevalence　among　the　patients　of　particular　practitioners；　whilst　others　who　were　equally　busy　met　with　few　or　none。　　One　instance　of　this　kind　was　very　remarkable。　　A　general　practitioner；　in　large　midwifery　practice；　lost　so　many　patients　from　puerperal　fever；　that　he　determined　to　deliver　no　more　for　some　time；　but　that　his　partner　should　attend　in　his　place。　　This　plan　was　pursued　for　one　month；　during　which　not　a　case　of　the　disease　occurred　in　their　practice。　The　elder　practitioner；　being　then　sufficiently　recovered；　returned　to　his　practice；　but　the　first　patient　he　attended　was　attacked　by　the　disease　and　died。　　A　physician；　who　met　him　in　consultation　soon　afterwards；　about　a　case　of　a　different　kind；　and　who　knew　nothing　of　his　misfortune；　asked　him　whether　puerperal　fever　was　at　all　prevalent　in　his　neighborhood；　on　which　he　burst　into　tears；　and　related　the　above　circumstances。

〃Among　the　cases　which　I　saw　this　season　in　consultation；　four　occurred　in　one　month　in　the　practice　of　one　medical　man；　and　all　of　them　terminated　fatally。〃　＇Lond。　　Med。　　Gaz。　　May　2；　1835。＇

Dr。　Ramsbotha