medical essays-第34章
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trated； had ringing in the ears； and other symptoms of exhaustion； the pulse was quick and small。 On the second and third day there was some tenderness and tumefaction of the abdomen； which increased somewhat on the fourth and fifth。 He had cases in midwifery before and after this； which presented nothing peculiar。〃
It is also mentioned in the same letter； that another physician had a case during the last summer and another last fall； both of which recovered。
Another gentleman reports a case last December； a second case five weeks； and another three weeks since。 All these recovered。 A case also occurred very recently in the practice of a physician in the village where the eighth patient of Dr。 C。 resides； which proved fatal。 〃This patient had some patches of erysipelas on the legs and arms。 The same physician has delivered three cases since； which have all done well。 There have been no other cases in this town or its vicinity recently。 There have been some few cases of erysipelas。〃 It deserves notice that the partner of Dr。 C。； who attended the autopsy of the man above mentioned and took an active part in it； who also suffered very slightly from a prick under the thumb…nail received during the examination； had twelve cases of midwifery between March 26th and April 12th； all of which did well； and presented no peculiar symptoms。 It should also be stated； that during these seventeen days he was in attendance on all the cases of erysipelas in the house where the autopsy had been performed。
I owe these facts to the prompt kindness of a gentleman whose intelligence and character are sufficient guaranty for their accuracy。
The two following letters were addressed to my friend Dr。 Scorer； by the gentleman in whose practice the cases of puerperal fever occurred。 His name renders it unnecessary to refer more particularly to these gentlemen； who on their part have manifested the most perfect freedom and courtesy in affording these accounts of their painful experience。
〃January 28； 1843。
II。 。 。 。 〃The time to which you allude was in 1830。 The first case was in February； during a very cold time。 She was confined the 4th； and died the 12th。 Between the 10th and 28th of this month； I attended six women in labor； all of whom did well except the last； as also two who were confined March 1st and 5th。 Mrs。 E。； confined February 28th； sickened； and died March 8th。 The next day； 9th； I inspected the body； and the night after attended a lady； Mrs。 B。； who sickened； and died 16th。 The 10th； I attended another； Mrs。 G。； who sickened； but recovered。 March 16th； I went from Mrs。 G。's room to attend a Mrs。 H。； who sickened； and died 21st。 The 17th； I inspected Mrs。 B。 On the 19th； I went directly from Mrs。 H。's room to attend another lady； Mrs。 G。； who also sickened； and died 22d。 While Mrs。 B。 was sick； on 15th； I went directly from her room a few rods； and attended another woman； who was not sick。 Up to 20th of this month I wore the same clothes。 I now refused to attend any labor； and did not till April 21st； when； having thoroughly cleansed myself； I resumed my practice； and had no more puerperal fever。
〃The cases were not confined to a narrow space。 The two nearest were half a mile from each other； and half that distance from my residence。 The others were from two to three miles apart； and nearly that distance from my residence。 There were no other cases in their immediate vicinity which came to my knowledge。 The general health of all the women was pretty good； and all the labors as good as common； except the first。 This woman； in consequence of my not arriving in season； and the child being half…born at some time before I arrived； was very much exposed to the cold at the time of confinement； and afterwards； being confined in a very open； cold room。 Of the six cases you perceive only one recovered。
〃In the winter of 1817 two of my patients had puerperal fever； one very badly； the other not so badly。 Both recovered。 One other had swelled leg； or phlegmasia dolens； and one or two others did not recover as well as usual。
〃In the summer of 1835 another disastrous period occurred in my practice。 July 1st； I attended a lady in labor； who was afterwards quite ill and feverish； but at the time I did not consider her case a decided puerperal fever。 On the 8th； I attended one who did well。 On the 12th； one who was seriously sick。 This was also an equivocal case； apparently arising from constipation and irritation of the rectum。 These women were ten miles apart and five from my residence。 On 15th and 20th； two who did well。 On 25th； I attended another。 This was a severe labor； and followed by unequivocal puerperal fever； or peritonitis。 She recovered。 August 2d and 3d； in about twenty… four hours I attended four persons。 Two of them did very well； one was attacked with some of the common symptoms； which however subsided in a day or two； and the other had decided puerperal fever； but recovered。 This woman resided five miles from me。 Up to this time I wore the same coat。 All my other clothes had frequently been changed。 On 6th； I attended two women； one of whom was not sick at all； but the other； Mrs。 L。； was afterwards taken ill。 On 10th； I attended a lady； who did very well。 I had previously changed all my clothes； and had no garment on which had been in a puerperal room。 On 12th； I was called to Mrs。 S。； in labor。 While she was ill； I left her to visit Mrs。 L。； one of the ladies who was confined on 6th。 Mrs。 L。 had been more unwell than usual； but I had not considered her case anything more than common till this visit。 I had on a surtout at this visit； which； on my return to Mrs。 S。； I left in another room。 Mrs。 S。 was delivered on 13th with forceps。 These women both died of decided puerperal fever。
〃While I attended these women in their fevers； I changed my clothes； and washed my hands in a solution of chloride of lime after each visit。 I attended seven women in labor during this period； all of whom recovered without sickness。
〃In my practice I have had several single cases of puerperal fever； some of whom have died and some have recovered。 Until the year 1830 I had no suspicion that the disease could be communicated from one patient to another by a nurse or midwife； but I now think the foregoing facts strongly favor that idea。 I was so much convinced of this fact； that I adopted the plan before related。
〃I believe my own health was as good as usual at each of the above periods。 I have no recollections to the contrary。
〃I believe I have answered all your questions。 I have been more particular on some points perhaps than necessary； but I thought you could form your own opinion better than to take mine。 In 1830 I wrote to Dr。 Charming a more particular statement of my cases。 If I have not answered your questions sufficiently； perhaps Dr。 C。 may have my letter to him； and you can find your answer there。〃 ＇In a letter to myself； this gentleman also stated； 〃I do not recollect that there was any erysipelas or any other disease particularly prevalent at the time。〃＇
〃BOSTON； February 3； 1843。
III。 〃MY DEAR SIR；I received a note from you last evening； requesting me to answer certain questions therein proposed； touching the cases of puerperal fever which came under my observation the past summer。 It gives me pleasure to comply with your request； so far as it is in my power so to do； but； owing to the hurry in preparing for a journey； the notes of the cases I had then taken were lost or mislaid。 The principal facts； however； are too vivid upon my recollection to be soon forgotten。 I think； therefore； that I shall be able to give you all the information you may require。
〃All the cases that occurred in my practice took place between the 7th of May and the 17th of June 1842。
〃They were not confined to any particular part of the city。 The first two cases were patients residing at the South End； the next was at the extreme North End； one living in Sea Street and the other in Roxbury。 The following is the order in which they occurred：
〃Case 1。 Mrs。_____ was confined on the 7th of May； at 5 o'clock； P。 M。； after a natural labor of six hours。 At 12 o'clo
