medical essays-第29部分

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st　contagion。

Mr。　Roberton　says　that　in　one　instance　within　his　knowledge　a　practitioner　passed　the　catheter　for　a　patient　with　puerperal　fever　late　in　the　evening；　the　same　night　he　attended　a　lady　who　had　the　symptoms　of　the　disease　on　the　second　day。　　In　another　instance　a　surgeon　was　called　while　in　the　act　of　inspecting　the　body　of　a　woman　who　had　died　of　this　fever；　to　attend　a　labor；　within　forty…eight　hours　this　patient　was　seized　with　the　fever。'

On　the　16th　of　March；　1831；　a　medical　practitioner　examined　the　body　of　a　woman　who　had　died　a　few　days　after　delivery；　from　puerperal　peritonitis。　　On　the　evening　of　the　17th　he　delivered　a　patient；　who　was　seized　with　puerperal　fever　on　the　19th；　and　died　on　the　24th。　Between　this　period　and　the　6th　of　April；　the　same　practitioner　attended　two　other　patients；　both　of　whom　were　attacked　with　the　same　disease　and　died。

In　the　autumn　of　1829　a　physician　was　present　at　the　examination　of　a　case　of　puerperal　fever；　dissected　out　the　organs；　and　assisted　in　sewing　up　the　body。　　He　had　scarcely　reached　home　when　he　was　summoned　to　attend　a　young　lady　in　labor。　　In　sixteen　hours　she　was　attacked　with　the　symptoms　of　puerperal　fever；　and　narrowly　escaped　with　her　life。

In　December；　1830；　a　midwife；　who　had　attended　two　fatal　cases　of　puerperal　fever　at　the　British　Lying…in　Hospital；　examined　a　patient　who　had　just　been　admitted；　to　ascertain　if　labor　had　commenced。　This　patient　remained　two　days　in　the　expectation　that　labor　would　come　on；　when　she　returned　home　and　was　then　suddenly　taken　in　labor　and　delivered　before　she　could　set　out　for　the　hospital。　　She　went　on　favorably　for　two　days；　and　was　then　taken　with　puerperal　fever　and　died　in　thirty…six　hours。

〃A　young　practitioner；　contrary　to　advice；　examined　the　body　of　a　patient　who　had　died　from　puerperal　fever；　there　was　no　epidemic　at　the　time；　the　case　appeared　to　be　purely　sporadic。　　He　delivered　three　other　women　shortly　afterwards；　they　all　died　with　puerperal　fever；　the　symptoms　of　which　broke　out　very　soon　after　labor。　　The　patients　of　his　colleague　did　well；　except　one；　where　he　assisted　to　remove　some　coagula　from　the　uterus；　she　was　attacked　in　the　same　manner　as　those　whom　he　had　attended；　and　died　also。〃　　The　writer　in　the　〃British　and　Foreign　Medical　Review；〃　from　whom　I　quote　this　statement；and　who　is　no　other　than　Dr。　Rigby；　adds；　〃We　trust　that　this　fact　alone　will　forever　silence　such　doubts；　and　stamp　the　well…　merited　epithet　of　'criminal；'　as　above　quoted；　upon　such　attempts。〃　＇Brit。　　and　For。　　Medical　Review　for　Jan。　　1842；　p。　　112。＇

》From　the　cases　given　by　Mr。　Ingleby；　I　select　the　following。　　Two　gentlemen；　after　having　been　engaged　in　conducting　the　post…mortem　examination　of　a　case　of　puerperal　fever；　went　in　the　same　dress；　each　respectively；　to　a　case　of　midwifery。　　〃The　one　patient　was　seized　　with　the　rigor　about　thirty　hours　afterwards。　　The　other　patient　was　seized　with　a　rigor　the　third　morning　after　delivery。　One　recovered；　one　died。〃　＇Edin。　　Med。　　and　Surg。　　Journal；　April；　1838。＇

One　of　these　same　gentlemen　attended　another　woman　in　the　same　clothes　two　days　after　the　autopsy　referred　to。　　〃The　rigor　did　not　take　place　until　the　evening　of　the　fifth　day　from　the　first　visit。　Result　fatal。〃　　These　cases　belonged　to　a　series　of　seven；　the　first　of　which　was　thought　to　have　originated　in　a　case　of　erysipelas。　〃Several　cases　of　a　mild　character　followed　the　foregoing　seven；　and　their　nature　being　now　most　unequivocal；　my　friend　declined　visiting　all　midwifery　cases　for　a　time；　and　there　was　no　recurrence　of　the　disease。〃　　These　cases　occurred　in　1833。　　Five　of　them　proved　fatal。　Mr。　Ingleby　gives　another　series　of　seven　eases　which　occurred　to　a　practitioner　in　1836；　the　first　of　which　was　also　attributed　to　his　having　opened　several　erysipelatous　abscesses　a　short　time　previously。

I　need　not　refer　to　the　case　lately　read　before　this　Society；　in　which　a　physician　went；　soon　after　performing　an　autopsy　of　a　case　of　puerperal　fever；　to　a　woman　in　labor；　who　was　seized　with　the　same　disease　and　perished。　　The　forfeit　of　that　error　has　been　already　paid。

At　a　meeting　of　the　Medical　and　Chirurgical　Society　before　referred　to；　Dr。　Merriman　related　an　instance　occurring　in　his　own　practice；　which　excites　a　reasonable　suspicion　that　two　lives　were　sacrificed　to　a　still　less　dangerous　experiment。　　He　was　at　the　examination　of　a　case　of　puerperal　fever　at　two　o'clock　in　the　afternoon。　　He　took　care　not　to　touch　the　body。　　At　nine　o'clock　the　same　evening　he　attended　a　woman　in　labor；　she　was　so　nearly　delivered　that　he　had　scarcely　anything　to　do。　　The　next　morning　she　had　severe　rigors；　and　in　forty…eight　hours　she　was　a　corpse。　　Her　infant　had　erysipelas　and　died　in　two　days。　＇Lancet；　May　2；　1840。＇

In　connection　with　the　facts　which　have　been　stated；　it　seems　proper　to　allude　to　the　dangerous　and　often　fatal　effects　which　have　followed　from　wounds　received　in　the　post…mortem　examination　of　patients　who　have　died　of　puerperal　fever。　　The　fact　that　such　wounds　are　attended　with　peculiar　risk　has　been　long　noticed。　　I　find　that　Chaussier　was　in　the　habit　of　cautioning　his　students　against　the　danger　to　which　they　were　exposed　in　these　dissections。　＇Stein；　L'Art　d'Accoucher；　1794；　Dict。　des　Sciences　Medicales；　art。　　〃Puerperal。〃＇　The　head　pharmacien　of　the　Hotel　Dieu；　in　his　analysis　of　the　fluid　effused　in　puerperal　peritonitis；　says　that　practitioners　are　convinced　of　its　deleterious　qualities；　and　that　it　is　very　dangerous　to　apply　it　to　the　denuded　skin。　＇Journal　de　Pharmacie；　January；　1836。＇　　Sir　Benjamin　Brodie　speaks　of　it　as　being　well　known　that　the　inoculation　of　lymph　or　pus　from　the　peritoneum　of　a　puerperal　patient　is　often　attended　with　dangerous　and　even　fatal　symptoms。　Three　cases　in　confirmation　of　this　statement；　two　of　them　fatal；　have　been　reported　to　this　Society　within　a　few　months。

Of　about　fifty　cases　of　injuries　of　this　kind；　of　various　degrees　of　severity；　which　I　have　collected　from　different　sources；　at　least　twelve　were　instances　of　infection　from　puerperal　peritonitis。　　Some　of　the　others　are　so　stated　as　to　render　it　probable　that　they　may　have　been　of　the　same　nature。　　Five　other　cases　were　of　peritoneal　inflammation；　three　in　males。　　Three　were　what　was　called　enteritis；　in　one　instance　complicated　with　erysipelas；　but　it　is　well　known　that　this　term　has　been　often　used　to　signify　inflammation　of　the　peritoneum　covering　the　intestines。　　On　the　other　hand；　no　case　of　typhus　or　typhoid　fever　is　mentioned　as　giving　rise　to　dangerous　consequences；　with　the　exception　of　the　single　instance　of　an　undertaker　mentioned　by　Mr。　Travers；　who　seems　to　have　been　poisoned　by　a　fluid　which　exuded　from　the　body。　　The　other　accidents　were　produced　by　dissection；　or　some　other　mode　of　contact　with　bodies　of　patients　who　had　died　of　various　affections。　　They　also　differed　much　in　severity；　the　cases　of　puerperal　origin　being　among　the　most　formidable　and　fatal。　　Now　a　moment's　reflection　will　show　that　the　number　of　cases　of　serious　consequences　ensuing　from　the　dissection　of　the　bodies　of　those　who　had　perished　of　puerperal　fever　is　so　vastly　disproportioned　to　the　relatively　small　number　of　autopsies　made　in　this　complaint　as　compared　with　typhus　or　pneumonia　（from　which　last　disease　not　one　case　of　poisoning　happened）；　and　still　more　from　all　diseases　put　together；　that　the　conclusion　is　irresistible　that　a　most　fearful　morbid　poison　is　often　generated　in　the　course　of　this　disease。　　Whether　or　not　it　is　sui　generis；　confined　to　this　disease；　or　produced　in　some　others；　as；　for　instance；　erysipelas；　I　need；　not　stop　to　inquire。

In　connection　with　this　may　be　taken　the　following　statement　of　Dr。　Rigby。　　〃That　the　discharges　from　a　patient　under　puerperal　fever　are　in　the　highest　degree　contagious　we　have　abundant　evidence　in　the　history　of　lying…in　hospitals。　　The　puerperal　abscesses　are　also　contagious；　and　may　be　communicated　to　healthy　lying…in　women　by　washing　with　the　same　sponge；　this　fact　has　been　repeatedly　proved　in　the　Vienna　Hospital；　but　they　are　equally　communicable　to　women　not　pregnant；　on　more　than　one　occasion　the　women　engaged　in　washing　the　soiled　bed…linen　of　the　General　Lying…in　Hospital　have　been　attacked　with　abscess　in　the　fingers　or　hands；　attended　with　rapidly　spreading　inflammation　of　the　cellular　tissue。〃

Now　add　to　all　this　the　undisputed　fact；　that　within　the　walls　of　lying…in　hospitals　there　is　often　generated　a　miasm；　palpable　as　the　chlorine　used　to　destroy　it；　tenacious　so　as　in　some　cases　almost　to　defy　extirpation；　deadly　in　some　institutions　as　the　plague；　which　has　killed　women　in　a　private　hospital　of　London　so　fast　that　they　were　buried　two　in　one　coffin　to　conceal　its　horrors；　which　enabled　Tonnelle　to　record　two　hundred　and　twenty…two　autopsies　at　the　Maternite　of　Paris；　which　has　led　Dr。　Lee　to　express　his　deliberate　conviction　that　the　loss　of　life　occasioned　by　these　institutions　completely　defeats　the　objects　of　their　founders；　and　out　of　this　train　of　cumulative　evidence；　the　multiplied　groups　of　cases　clustering　about　individuals；　the　deadly　results　of　autopsies；　the　inoculation　by　fluids　from　the　living　patient；　the　murderous　poison　of　hospitals；　…does　there　not　result　a　conclusion　that　laughs　all　sophistry　to　scorn；　and　renders　all　argument　an　insult？

I　have　had　occasion　to　mention　some　instances　in　which　there　was　an　apparent　relation　between　puerperal　fever　and　erysipelas。　　The　length　to　which　this　paper　has　extended　does　not　allow　me　to　enter　into　the　consideration　of　this　most　important　subject。　　I　will　only　say；　that　the　evidence　appears　to　me　altogether　satisfactory　that　some　most　fatal　series　of　puerperal　fever　have　been　produced　by　an　infection　originating　in　the　matter　or　effluvia　of　erysipelas。　　In　evidence　of　some　connection　between　the　two　diseases；　I　need　not　go　back　to　the　older　authors；　as　Pouteau　or　Gordon；　but　will　content　myself　with　giving　the　following　references；　with　their　dates；　from　which　it　will　be　seen　that　the　testimony　has　been　constantly　coming　before　the　profession　for　the　last　few　years。

〃London　Cyclopaedia　of　Practical　Medicine；〃　article　Puerperal　Fever；　1833。

Mr。　Ceeley's　Account