按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！
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