medical essays-第33章
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opagated in this manner； has nevertheless become convinced by the facts that have fallen under his notice； that the puerperal fever now prevailing is capable of being communicated by contagion。 How otherwise can be explained the very curious circumstance of the disease in one district being exclusively confined to the practice of a single physician； a Fellow of this College； extensively engaged in obstetrical practice；while no instance of the disease has occurred in the patients under the care of any other accoucheur practising within the same district； scarcely a female that has been delivered for weeks past has escaped an attack？〃
Dr。 Rutter； the practitioner referred to； 〃observed that； after the occurrence of a number of cases of the disease in his practice； he had left the city and remained absent for a week； but on returning； no article of clothing he then wore having been used by him before； one of the very first cases of parturition he attended was followed by an attack of the fever； and terminated fatally； he cannot； readily； therefore； believe in the transmission of the disease from female to female； in the person or clothes of the physician。〃
The meeting at which these remarks were made was held on the 3d of May； 1842。 In a letter dated December 20； 1842； addressed to Dr。 Meigs； and to be found in the 〃Medical Examiner；〃 he speaks of 〃those horrible cases of puerperal fever； some of which you did me the favor to see with me during the past summer；〃 and talks of his experience in the disease； 〃now numbering nearly seventy cases； all of which have occurred within less than a twelvemonth past。〃
And Dr。 Meigs asserts； on the same page； 〃Indeed； I believe that his practice in that department of the profession was greater than that of any other gentleman； which was probably the cause of his seeing a greater number of the cases。〃 This from a professor of midwifery； who some time ago assured a gentleman whom he met in consultation； that the night on which they met was the eighteenth in succession that he himself had been summoned from his repose； seems hardly satisfactory。
I must call the attention of the inquirer most particularly to the （Quarterly Report above referred to； and the letters of Dr。 Meigs and Dr。 Rutter； to be found in the 〃Medical Examiner。〃 Whatever impression they may produce upon his mind； I trust they will at least convince him that there is some reason for looking into this apparently uninviting subject。
At a meeting of the College of Physicians just mentioned； Dr。 Warrington stated； that a few days after assisting at an autopsy of puerperal peritonitis； in which he laded out the contents of the abdominal cavity with his hands； he was called upon to deliver three women in rapid succession。 All of these women were attacked with different forms of what is commonly called puerperal fever。 Soon after these he saw two other patients； both on the same day； with the same disease。 Of these five patients two died。
At the same meeting； Dr。 West mentioned a fact related to him by Dr。 Samuel Jackson of Northumberland。 Seven females； delivered by Dr。 Jackson in rapid succession； while practising in Northumberland County； were all attacked with puerperal fever； and five of them died。 〃Women；〃 he said； 〃who had expected me to attend upon them； now becoming alarmed； removed out of my reach； and others sent for a physician residing several miles distant。 These women； as well as those attended by midwives； all did well； nor did we hear of any deaths in child…bed within a radius of fifty miles； excepting two； and these I afterwards ascertained to have been caused by other diseases。〃 He underwent； as he thought； a thorough purification； and still his next patient was attacked with the disease and died。 He was led to suspect that the contagion might have been carried in the gloves which he had worn in attendance upon the previous cases。 Two months or more after this he had two other cases。 He could find nothing to account for these； unless it were the instruments for giving enemata； which had been used in two of the former cases； and were employed by these patients。 When the first case occurred； he was attending and dressing a limb extensively mortified from erysipelas； and went immediately to the accouchement with his clothes and gloves most thoroughly imbued with its efluvia。 And here I may mention； that this very Dr。 Samuel Jackson of Northumberland is one of Dr。 Dewees's authorities against contagion。
The three following statements are now for the first time given to the public。 All of the cases referred to occurred within this State； and two of the three series in Boston and its immediate vicinity。
I。 The first is a series of cases which took place during the last spring in a town at some distance from this neighborhood。 A physician of that town； Dr。 C。； had the following consecutive cases。
No。 1； delivered March 20； died March 24。 〃 2； 〃 April 9； 〃 April 14。 〃 3； 〃 〃 10； 〃 〃 14。 〃 4； 〃 〃 11； 〃 〃 18。 〃 5； 〃 〃 27； 〃 May 3。 〃 6； 〃 〃 28； had some symptoms；（recovered。） 〃 7； 〃 May 8； had some symptoms；（also recovered。）
These were the only cases attended by this physician during the period referred to。 〃They were all attended by him until their termination； with the exception of the patient No。 6； who fell into the hands of another physician on the 2d of May。 （Dr。 C。 left town for a few days at this time。） Dr。 C。 attended cases immediately before and after the above…named periods； none of which； however； presented any peculiar symptoms of the disease。
About the 1st of July he attended another patient in a neighboring village； who died two or three days after delivery。
The first patient； it is stated； was delivered on the 20th of March。 〃On the 19th； Dr。 C。 made the autopsy of a man who died suddenly； sick only forty…eight hours； had oedema of the thigh； and gangrene extending from a little above the ankle into the cavity of the abdomen。〃 Dr。 C。 wounded himself； very slightly； in the right hand during the autopsy。 The hand was quite painful the night following； during his attendance on the patient No。 1。 He did not see this patient after the 20th； being confined to the house； and very sick from the wound just mentioned； from this time until the 3d of April。
Several cases of erysipelas occurred in the house where the autopsy mentioned above took place； soon after the examination。 There were also many cases of erysipelas in town at the time of the fatal puerperal cases which have been mentioned。
The nurse who laid out the body of the patient No。 3 was taken on the evening of the same day with sore throat and erysipelas； and died in ten days from the first attack。
The nurse who laid out the body of the patient No。 4 was taken on the day following with symptoms like those of this patient； and died in a week； without any external marks of erysipelas。
〃No other cases of similar character with those of Dr。 C。 occurred in the practice of any of the physicians in the town or vicinity at the time。 Deaths following confinement have occurred in the practice of other physicians during the past year； but they were not cases of puerperal fever。 No post…mortem examinations were held in any of these puerperal cases。〃
Some additional statements in this letter are deserving of insertion。
〃A physician attended a woman in the immediate neighborhood of the cases numbered 2； 3； and 4。 This patient was confined the morning of March 1st； and died on the night of March 7th。 It is doubtful whether this should be considered a case of puerperal fever。 She had suffered from canker； indigestion； and diarrhoea for a year previous to her delivery。 Her complaints were much aggravated for two or three months previous to delivery； she had become greatly emaciated； and weakened to such an extent that it had not been expected that she would long survive her confinement； if indeed she reached that period。 Her labor was easy enough； she flowed a good deal； seemed exceedingly prostrated； had ringing in the ears； and other symptoms of exhaustion； the pulse was quick and small。 O
