medical essays-第32章
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medical man； and all of them terminated fatally。〃 ＇Lond。 Med。 Gaz。 May 2； 1835。＇
Dr。 Ramsbotham asserted； in a Lecture at the London Hospital； that he had known the disease spread through a particular district； or be confined to the practice of a particular person； almost every patient being attacked with it； while others had not a single case。 It seemed capable； he thought； of conveyance； not only by common modes； but through the dress of the attendants upon the patient。
In a letter to be found in the 〃London Medical Gazette〃for January； 1840； Mr。 Roberton of Manchester makes the statement which I here give in a somewhat condensed form。
A midwife delivered a woman on the 4th of December； 1830； who died soon after with the symptoms of puerperal fever。 In one month from this date the same midwife delivered thirty women； residing in different parts of an extensive suburb； of which number sixteen caught the disease and all died。 These were the only cases which had occurred for a considerable time in Manchester。 The other midwives connected with the same charitable institution as the woman already mentioned are twenty…five in number； and deliver； on an average； ninety women a week； or about three hundred and eighty a month。 None of these women had a case of puerperal fever。 〃Yet all this time this woman was crossing the other midwives in every direction； scores of the patients of the charity being delivered by them in the very same quarters where her cases of fever were happening。〃
Mr。 Roberton remarks； that little more than half the women she delivered during this month took the fever； that on some days all escaped； on others only one or more out of three or four； a circumstance similar to what is seen in other infectious maladies。
Dr。 Blundell says； 〃Those who have never made the experiment can have but a faint conception how difficult it is to obtain the exact truth respecting any occurrence in which feelings and interests are concerned。 Omitting particulars； then； I content myself with remarking； generally； that from more than one district I have received accounts of the prevalence of puerperal fever in the practice of some individuals； while its occurrence in that of others； in the same neighborhood； was not observed。 Some； as I have been told； have lost ten； twelve； or a greater number of patients； in scarcely broken succession； like their evil genius； the puerperal fever has seemed to stalk behind them wherever they went。 Some have deemed it prudent to retire for a time from practice。 In fine； that this fever may occur spontaneously； I admit； that its infectious nature may be plausibly disputed； I do not deny； but I add； considerately； that in my own family I had rather that those I esteemed the most should be delivered； unaided； in a stable； by the manger…side； than that they should receive the best help； in the fairest apartment； but exposed to the vapors of this pitiless disease。 Gossiping friends； wet…nurses； monthly nurses； the practitioner himself； these are the channels by which； as I suspect； the infection is principally conveyed。〃
At a meeting of the Royal Medical and Chirurgical Society； Dr。 King mentioned that some years since a practitioner at Woolwich lost sixteen patients from puerperal fever in the same year。 He was compelled to give up practice for one or two years； his business being divided among the neighboring practitioners。 No case of puerperal fever occurred afterwards； neither had any of the neighboring surgeons any cases of this disease。
At the same meeting Mr。 Hutchinson mentioned the occurrence of three consecutive cases of puerperal fever； followed subsequently by two others； all in the practice of one accoucheur。＇Lancet； May 2； 1840。＇
Dr。 Lee makes the following statement： 〃In the last two weeks of September； 1827； five fatal cases of uterine inflammation came under our observation。 All the individuals so attacked had been attended in labor by the same midwife； and no example of a febrile or inflammatory disease of a serious nature occurred during that period among the other patients of the Westminster General Dispensary； who had been attended by the other midwives belonging to that institution。〃
The recurrence of long series of cases like those I have cited； reported by those most interested to disbelieve in contagion； scattered along through an interval of half a century； might have been thought sufficient to satisfy the minds of all inquirers that here was something more than a singular coincidence。 But if； on a more extended observation； it should be found that the same ominous groups of cases clustering about individual practitioners were observed in a remote country； at different times； and in widely separated regions； it would seem incredible that any should be found too prejudiced or indolent to accept the solemn truth knelled into their ears by the funeral bells from both sides of the ocean；the plain conclusion that the physician and the disease entered； hand in hand； into the chamber of the unsuspecting patient。
That such series of cases have been observed in this country； and in this neighborhood； I proceed to show。
In Dr。 Francis's 〃Notes to Denman's Midwifery；〃 a passage is cited from Dr。 Hosack； in which he refers to certain puerperal cases which proved fatal to several lying…in women； and in some of which the disease was supposed to be conveyed by the accoucheurs themselves。
A writer in the 〃New York Medical and Physical Journal〃 for October； 1829； in speaking of the occurrence of puerperal fever； confined to one man's practice； remarks； 〃We have known cases of this kind occur； though rarely； in New York。〃
I mention these little hints about the occurrence of such cases； partly because they are the first I have met with in American medical literature； but more especially because they serve to remind us that behind the fearful array of published facts there lies a dark list of similar events； unwritten in the records of science； but long remembered by many a desolated fireside。
Certainly nothing can be more open and explicit than the account given by Dr。 Peirson of Salem； of the cases seen by him。 In the first nineteen days of January； 1829； he had five consecutive cases of puerperal fever； every patient he attended being attacked； and the three first cases proving fatal。 In March of the same year he had two moderate cases； in June； another case； and in July； another； which proved fatal。 〃Up to this period；〃 he remarks； 〃I am not informed that a single case had occurred in the practice of any other physician。 Since that period I have had no fatal case in my practice； although I have had several dangerous cases。 I have attended in all twenty cases of this disease； of which four have been fatal。 I am not aware that there has been any other case in the town of distinct puerperal peritonitis； although I am willing to admit my information may be very defective on this point。 I have been told of some I 'mixed cases；' and 'morbid affections after delivery。'〃
In the 〃Quarterly Summary of the Transactions of the College of Physicians of Philadelphia〃 may be found some most extraordinary developments respecting a series of cases occurring in the practice of a member of that body。
Dr。 Condie called the attention of the Society to the prevalence； at the present time； of puerperal fever of a peculiarly insidious and malignant character。 〃In the practice of one gentleman extensively engaged as an obstetrician； nearly every female he has attended in confinement； during several weeks past； within the above limits〃 （the southern sections and neighboring districts）； 〃had been attacked by the fever。〃
〃An important query presents itself； the Doctor observed； in reference to the particular form of fever now prevalent。 Is it； namely； capable of being propagated by contagion； and is a physician who has been in attendance upon a case of the disease warranted in continuing； without interruption； his practice as an obstetrician？ Dr。 C。； although not a believer in the contagious character of many of those affections generally supposed to be propagated in this manner； has nevertheless become convinced by the facts that have fallen under his n
