medical essays-第31部分

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！


。

Skoda　on　the　Causes　of　Puerperal　Fever。　　（Peritonitis　in　rabbits；　from　inoculation　with　different　morbid　secretions。）　Am。　　Jour。　　Med。　Se。；　October；　1850。

Arneth。　　Paper　read　before　the　National　Academy　of　Medicine。　　Annales　d'Hygiene；　Tome　LXV。　　2e　Partie。　　（Means　of　Disinfection　proposed　by　M。　　〃Semmeliveis〃　（Semmelweiss。）　Lotions　of　chloride　of　lime　and　use　of　nail…brush　before　admission　to　lying…in　wards。　　Alleged　sudden　and　great　decrease　of　mortality　from　puerperal　fever。　　Cause　of　disease　attributed　to　inoculation　with　cadaveric　matters。）　See　also　Routh's　paper；　mentioned　above。

Moir。　　Remarks　at　a　meeting　of　the　Edinburgh　Medico…Chirurgical　Society。　　Refers　to　cases　of　Dr。　Kellie；　of　Leith。　　Sixteen　in　succession；　all　fatal。　　Also　to　several　instances　of　individual　pupils　having　had　a　succession　of　cases　in　various　quarters　of　the　town；　while　others；　practising　as　extensively　in　the　same　localities；　had　none。　　Also　to　several　special　cases　not　mentioned　elsewhere。　Am。　　Jour。　　Med。　　Se。　　for　October；　1851。　　（From　New　Monthly　Journal　of　Med。　　Science。）

Simpson。　Observations　at　a　Meeting　of　the　Edinburgh　Obstetrical　Society。　　（An　〃eminent　gentleman；〃　according　to　Dr。　　Meigs；　whose　〃name　is　as　well　known　in　America　as　in　（his）　native　land。〃　Obstetrics。　　Phil。　　1852；　pp。　　368；　375。）　The　student　is　referred　to　this　paper　for　a　valuable　resume　of　many　of　the　facts；　and　the　necessary　inferences；　relating　to　this　subject。　　Also　for　another　series　of　cases；　Mr。　Sidey's；　five　or　six　in　rapid　succession。　Dr。　Simpson　attended　the　dissection　of　two　of　Dr。　Sidey's　cases；　and　freely　handled　the　diseased　parts。　　His　next　four　child…bed　patients　were　affected　with　puerperal　fever；　and　it　was　the　first　time　he　had　seen　it　in　practice。　　As　Dr。　Simpson　is　a　gentleman　（Dr。　Meigs；　as　above）；　and　as　〃a　gentleman's　hands　are　clean　〃　（Dr。　Meigs'　Sixth　Letter）；　it　follows　that　a　gentleman　with　clean　hands　may　carry　the　disease。　　Am。　　Jour。　　Med。　　Sc。；　October；　1851。

Peddle。　The　five　or　six　cases　of　Dr。　Sidey；　followed　by　the　four　of　Dr。　Simpson；　did　not　end　the　series。　　A　practitioner　in　Leith　having　examined　in　Dr。　Simpson's　house；　a　portion　of　the　uterus　obtained　from　one　of　the　patients；　had　immediately　afterwards　three　fatal　cases　of　puerperal　fever。　　Dr。　　Veddie　referred　to　two　distinct　series　of　consecutive　cases　in　his　own　practice。　　He　had　since　taken　precautions；　and　not　met　with　any　such　cases。　　Am。　　Jour。　　Med。　　Sc。；　October；　1851。

Copland。　　Considers　it　proved　that　puerperal　fever　maybe　propagated　by　the　hands　and　the　clothes；　or　either；　of　a　third　person；　the　bed…　clothes　or　body…clothes　of　a　patient。　　Mentions　a　new　series　of　cases；　one　of　which　he　saw；　with　the　practitioner　who　had　attended　them。　　She　was　the　sixth　he　had　had　within　a　few　days。　　All　died。　Dr。　Copland　insisted　that　contagion　had　caused　these　cases；　advised　precautionary　measures；　and　the　practitioner　had　no　other　cases　for　a　considerable　time。　　Considers　it　criminal；　after　the　evidence　adduced；which　he　could　have　quadrupled；and　the　weight　of　authority　brought　forward；　for　a　practitioner　to　be　the　medium　of　transmitting　contagion　and　death　to　his　patients。　　Dr。　Copland　lays　down　rules　similar　to　those　suggested　by　myself；　and　is　therefore　entitled　to　the　same　epithet　for　so　doing。　　Medical　Dictionary；　New　York；　1852。　　Article；　Puerperal　States　and　Diseases。

If　there　is　any　appetite　for　facts　so　craving　as　to　be　yet　unappeased；Lesotho；　necdum　satiata；more　can　be　obtained。　Dr。　　Hodge　remarks　that　〃the　frequency　and　importance　of　this　singular　circumstance　（that　the　disease　is　occasionally　more　prevalent　with　one　practitioner　than　another）　has　been　exceedingly　overrated。〃　　More　than　thirty　strings　of　cases；　more　than　two　hundred　and　fifty　sufferers　from　puerperal　fever；　more　than　one　hundred　and　thirty　deaths　appear　as　the　results　of　a　sparing　estimate　of　such　among　the　facts　I　have　gleaned　as　could　be　numerically　valued。　　These　facts　constitute；　we　may　take　it　for　granted；　but　a　small　fraction　of　those　that　have　actually　occurred。　　The　number　of　them　might　be　greater；　but　〃't　is　enough；　't　will　serve；〃　in　Mercutio's　modest　phrase；　so　far　as　frequency　is　concerned。　　For　a　just　estimate　of　the　importance　of　the　singular　circumstance；　it　might　be　proper　to　consult　the　languid　survivors；　the　widowed　husbands；　and　the　motherless　children；　as　well　as　〃the　unfortunate　accoucheur。〃






III

CURRENTS　AND　COUNTER…CURRENTS　IN　MEDICAL　SCIENCE

An　Address　delivered　before　the　Massachusetts　Medical　Society；　at　the　Annual　Meeting；　May　30；　1860。

　　　　　　　　　　　　　　　〃Facultate　magis　quam　violentia。　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　HIPPOCRATES。

Our　Annual　Meeting　never　fails　to　teach　us　at　least　one　lesson。　　The　art　whose　province　it　is　to　heal　and　to　save　cannot　protect　its　own　ranks　from　the　inroads　of　disease　and　the　waste　of　the　Destroyer。

Seventeen　of　our　associates　have　been　taken　from　us　since　our　last　Anniversary。　　Most　of　them　followed　their　calling　in　the　villages　or　towns　that　lie　among　the　hills　or　along　the　inland　streams。　　Only　those　who　have　lived　the　kindly；　mutually　dependent　life　of　the　country；　can　tell　how　near　the　physician　who　is　the　main　reliance　in　sickness　of　all　the　families　throughout　a　thinly　settled　region　comes　to　the　hearts　of　the　people　among　whom　he　labors；　how　they　value　him　while　living；　how　they　cherish　his　memory　when　dead。　　For　these　friends　of　ours　who　have　gone　before；　there　is　now　no　more　toil；　they　start　from　their　slumbers　no　more　at　the　cry　of　pain；　they　sally　forth　no　more　into　the　storms；　they　ride　no　longer　over　the　lonely　roads　that　knew　them　so　well；　their　wheels　are　rusting　on　their　axles　or　rolling　with　other　burdens；　their　watchful　eyes　are　closed　to　all　the　sorrows　they　lived　to　soothe。　　Not　one　of　these　was　famous　in　the　great　world；　some　were　almost　unknown　beyond　their　own　immediate　circle。　　But　they　have　left　behind　them　that　loving　remembrance　which　is　better　than　fame；　and　if　their　epitaphs　are　chiselled　briefly　in　stone；　they　are　written　at　full　length　on　living　tablets　in　a　thousand　homes　to　which　they　carried　their　ever…welcome　aid　and　sympathy。

One　whom　we　have　lost；　very　widely　known　and　honored；　was　a　leading　practitioner　of　this　city。　　His　image　can　hardly　be　dimmed　in　your　recollection；　as　he　stood　before　you　only　three　years　ago；　filling　the　same　place　with　which　I　am　now　honored。　　To　speak　of　him　at　all　worthily；　would　be　to　write　the　history　of　professional　success；　won　without　special　aid　at　starting；　by　toil；　patience；　good　sense；　pure　character；　and　pleasing　manners；　won　in　a　straight　uphill　ascent；　without　one　breathing…space　until　he　sat　down；　not　to　rest；　but　to　die。　　If　prayers　could　have　shielded　him　from　the　stroke；　if　love　could　have　drawn　forth　the　weapon；　and　skill　could　have　healed　the　wound；　this　passing　tribute　might　have　been　left　to　other　lips　and　to　another　generation。

Let　us　hope　that　our　dead　have　at　last　found　that　rest　which　neither　summer　nor　winter；　nor　day　nor　night；　had　granted　to　their　unending　earthly　labors！　　And　let　us　remember　that　our　duties　to　our　brethren　do　not　cease　when　they　become　unable　to　share　our　toils；　or　leave　behind　them　in　want　and　woe　those　whom　their　labor　had　supported。　　It　is　honorable　to　the　Profession　that　it　has　organized　an　Association　a　for　the　relief　of　its　suffering　members　and　their　families；　it　owes　this　tribute　to　the　ill…rewarded　industry　and　sacrifices　of　its　less　fortunate　brothers　who　wear　out　health　and　life　in　the　service　of　humanity。　　I　have　great　pleasure　in　referring　to　this　excellent　movement；　which　gives　our　liberal　profession　a　chance　to　show　its　liberality；　and　serves　to　unite　us　all；　the　successful　and　those　whom　fortune　has　cast　down；　in　the　bonds　of　a　true　brotherhood。

A　medical　man；　as　he　goes　about　his　daily　business　after　twenty　years　of　practice；　is　apt　to　suppose　that　he　treats　his　patients　according　to　the　teachings　of　his　experience。　　No　doubt　this　is　true　to　some　extent；　to　what　extent　depending　much　on　the　qualities　of　the　individual。　　But　it　is　easy　to　prove　that　the　prescriptions　of　even　wise　physicians　are　very　commonly　founded　on　something　quite　different　from　experience。　　Experience　must　be　based　on　the　permanent　facts　of　nature。　　But　a　glance　at　the　prevalent　modes　of　treatment　of　any　two　successive　generations　will　show　that　there　is　a　changeable　as　well　as　a　permanent　element　in　the　art　of　healing；　not　merely　changeable　as　diseases　vary；　or　as　new　remedies　are　introduced；　but　changeable　by　the　going　out　of　fashion　of　special　remedies；　by　the　decadence　of　a　popular　theory　from　which　their　fitness　was　deduced；　or　other　cause　not　more　significant。　　There　is　no　reason　to　suppose　that　the　present　time　is　essentially　different　in　this　respect　from　any　other。　　Much；　therefore；　which　is　now　very　commonly　considered　to　be　the　result　of　experience；　will　be　recognized　in　the　next；　or　in　some　succeeding　generation；　as　no　such　result　at　all；　but　as　a　foregone　conclusion；　based　on　some　prevalent　belief　or　fashion　of　the　time。

There　are；　of　course；　in　every　calling；　those　who　go　about　the　work　of　the　day　before　them；　doing　it　according　to　the　rules　of　their　craft；　and　asking　no　questions　of　the　past　or　of　the　future；　or　of　the　aim　and　end　to　which　their　special　labor　is　contributing。　　These　often　consider　and　call　themselves　practical　men。　　They　pull　the　oars　of　society；　and　have　no　leisure　to　watch　the　currents　running　this　or　that　way；　let　theorists　and　philosophers　attend　to　them。　　In　the　mean　time；　however；　these　currents　are　carrying　the　practical　men；　too；　and　all　their　work　may　be　thrown　away；　and　worse　than　thrown　away；　if　they　do　not　take　knowledge　of　them　and　get　out　of　the　wrong　ones　and　into　the　right　ones　as　soon　as　they　may。　　Sir　Edward　Parry　and　his　party　were　going　straight　towards　the　pole　in　one　of　their　arctic　expeditions；　travelling　at　the　rate　of　ten　miles　a　day。　　But　the　ice　over　which　they　travelled　was　drifting　straight　towards　the　equator；　at　the　rate　of　twelve　miles　a　day；　and　yet　no　man　among　them　would　have　known　that　he　was　travelling　two　miles　a　day　backward　unless　he　had　lifted　his　eyes　from　the　track　in　which　he　was　plodding。　　It　is　not　only　going　backward　that　the　plain