第19章

Thatsuchseriesofcaseshavebeenobservedinthiscountry，andinthisneighborhood，Iproceedtoshow。

InDr。Francis’s“NotestoDenman’sMidwifery，“apassageiscitedfromDr。Hosack，inwhichhereferstocertainpuerperalcaseswhichprovedfataltoseverallying-inwomen，andinsomeofwhichthediseasewassupposedtobeconveyedbytheaccoucheursthemselves。

Awriterinthe“NewYorkMedicalandPhysicalJournal“forOctober，1829，inspeakingoftheoccurrenceofpuerperalfever，confinedtooneman’spractice，remarks，“Wehaveknowncasesofthiskindoccur，thoughrarely，inNewYork。“

Imentiontheselittlehintsabouttheoccurrenceofsuchcases，partlybecausetheyarethefirstIhavemetwithinAmericanmedicalliterature，butmoreespeciallybecausetheyservetoremindusthatbehindthefearfularrayofpublishedfactsthereliesadarklistofsimilarevents，unwrittenintherecordsofscience，butlongrememberedbymanyadesolatedfireside。

CertainlynothingcanbemoreopenandexplicitthantheaccountgivenbyDr。PeirsonofSalem，ofthecasesseenbyhim。InthefirstnineteendaysofJanuary，1829，hehadfiveconsecutivecasesofpuerperalfever，everypatientheattendedbeingattacked，andthethreefirstcasesprovingfatal。InMarchofthesameyearhehadtwomoderatecases，inJune，anothercase，andinJuly，another，whichprovedfatal。“Uptothisperiod，“heremarks，“Iamnotinformedthatasinglecasehadoccurredinthepracticeofanyotherphysician。SincethatperiodIhavehadnofatalcaseinmypractice，althoughIhavehadseveraldangerouscases。Ihaveattendedinalltwentycasesofthisdisease，ofwhichfourhavebeenfatal。Iamnotawarethattherehasbeenanyothercaseinthetownofdistinctpuerperalperitonitis，althoughIamwillingtoadmitmyinformationmaybeverydefectiveonthispoint。IhavebeentoldofsomeI’mixedcases，’and’morbidaffectionsafterdelivery。’“

Inthe“QuarterlySummaryoftheTransactionsoftheCollegeofPhysiciansofPhiladelphia“maybefoundsomemostextraordinarydevelopmentsrespectingaseriesofcasesoccurringinthepracticeofamemberofthatbody。

Dr。CondiecalledtheattentionoftheSocietytotheprevalence，atthepresenttime，ofpuerperalfeverofapeculiarlyinsidiousandmalignantcharacter。“Inthepracticeofonegentlemanextensivelyengagedasanobstetrician，nearlyeveryfemalehehasattendedinconfinement，duringseveralweekspast，withintheabovelimits“(thesouthernsectionsandneighboringdistricts)，“hadbeenattackedbythefever。“

“Animportantquerypresentsitself，theDoctorobserved，inreferencetotheparticularformoffevernowprevalent。Isit，namely，capableofbeingpropagatedbycontagion，andisaphysicianwhohasbeeninattendanceuponacaseofthediseasewarrantedincontinuing，withoutinterruption，hispracticeasanobstetrician？

Dr。C。，althoughnotabelieverinthecontagiouscharacterofmanyofthoseaffectionsgenerallysupposedtobepropagatedinthismanner，hasneverthelessbecomeconvincedbythefactsthathavefallenunderhisnotice，thatthepuerperalfevernowprevailingiscapableofbeingcommunicatedbycontagion。Howotherwisecanbeexplainedtheverycuriouscircumstanceofthediseaseinonedistrictbeingexclusivelyconfinedtothepracticeofasinglephysician，aFellowofthisCollege，extensivelyengagedinobstetricalpractice，——whilenoinstanceofthediseasehasoccurredinthepatientsunderthecareofanyotheraccoucheurpractisingwithinthesamedistrict；scarcelyafemalethathasbeendeliveredforweekspasthasescapedanattack？“

Dr。Rutter，thepractitionerreferredto，“observedthat，aftertheoccurrenceofanumberofcasesofthediseaseinhispractice，hehadleftthecityandremainedabsentforaweek，butonreturning，noarticleofclothinghethenworehavingbeenusedbyhimbefore，oneoftheveryfirstcasesofparturitionheattendedwasfollowedbyanattackofthefever，andterminatedfatally；hecannot，readily，therefore，believeinthetransmissionofthediseasefromfemaletofemale，inthepersonorclothesofthephysician。“

Themeetingatwhichtheseremarksweremadewasheldonthe3dofMay，1842。InaletterdatedDecember20，1842，addressedtoDr。

Meigs，andtobefoundinthe“MedicalExaminer，“hespeaksof“thosehorriblecasesofpuerperalfever，someofwhichyoudidmethefavortoseewithmeduringthepastsummer，“andtalksofhisexperienceinthedisease，“nownumberingnearlyseventycases，allofwhichhaveoccurredwithinlessthanatwelvemonthpast。“

AndDr。Meigsasserts，onthesamepage，“Indeed，Ibelievethathispracticeinthatdepartmentoftheprofessionwasgreaterthanthatofanyothergentleman，whichwasprobablythecauseofhisseeingagreaternumberofthecases。“Thisfromaprofessorofmidwifery，whosometimeagoassuredagentlemanwhomhemetinconsultation，thatthenightonwhichtheymetwastheeighteenthinsuccessionthathehimselfhadbeensummonedfromhisrepose，seemshardlysatisfactory。

Imustcalltheattentionoftheinquirermostparticularlytothe(QuarterlyReportabovereferredto，andthelettersofDr。MeigsandDr。Rutter，tobefoundinthe“MedicalExaminer。“Whateverimpressiontheymayproduceuponhismind，Itrusttheywillatleastconvincehimthatthereissomereasonforlookingintothisapparentlyuninvitingsubject。

AtameetingoftheCollegeofPhysiciansjustmentioned，Dr。

Warringtonstated，thatafewdaysafterassistingatanautopsyofpuerperalperitonitis，inwhichheladedoutthecontentsoftheabdominalcavitywithhishands，hewascalledupontodeliverthreewomeninrapidsuccession。Allofthesewomenwereattackedwithdifferentformsofwhatiscommonlycalledpuerperalfever。Soonafterthesehesawtwootherpatients，bothonthesameday，withthesamedisease。Ofthesefivepatientstwodied。

Atthesamemeeting，Dr。WestmentionedafactrelatedtohimbyDr。

SamuelJacksonofNorthumberland。Sevenfemales，deliveredbyDr。

Jacksoninrapidsuccession，whilepractisinginNorthumberlandCounty，wereallattackedwithpuerperalfever，andfiveofthemdied。“Women，“hesaid，“whohadexpectedmetoattenduponthem，nowbecomingalarmed，removedoutofmyreach，andotherssentforaphysicianresidingseveralmilesdistant。Thesewomen，aswellasthoseattendedbymidwives；alldidwell；nordidwehearofanydeathsinchild-bedwithinaradiusoffiftymiles，exceptingtwo，andtheseIafterwardsascertainedtohavebeencausedbyotherdiseases。“Heunderwent，ashethought，athoroughpurification，andstillhisnextpatientwasattackedwiththediseaseanddied。Hewasledtosuspectthatthecontagionmighthavebeencarriedinthegloveswhichhehadworninattendanceuponthepreviouscases。Twomonthsormoreafterthishehadtwoothercases。Hecouldfindnothingtoaccountforthese，unlessitweretheinstrumentsforgivingenemata，whichhadbeenusedintwooftheformercases，andwereemployedbythesepatients。Whenthefirstcaseoccurred，hewasattendinganddressingalimbextensivelymortifiedfromerysipelas，andwentimmediatelytotheaccouchementwithhisclothesandglovesmostthoroughlyimbuedwithitsefluvia。AndhereImaymention，thatthisveryDr。SamuelJacksonofNorthumberlandisoneofDr。Dewees’sauthoritiesagainstcontagion。

Thethreefollowingstatementsarenowforthefirsttimegiventothepublic。AllofthecasesreferredtooccurredwithinthisState，andtwoofthethreeseriesinBostonanditsimmediatevicinity。

I。Thefirstisaseriesofcaseswhichtookplaceduringthelastspringinatownatsomedistancefromthisneighborhood。A

physicianofthattown，Dr。C。，hadthefollowingconsecutivecases。

No。1，deliveredMarch20，diedMarch24。

“2，“April9，“April14。

“3，““10，““14。

“4，““11，““18。

“5，““27，“May3。

“6，““28，hadsomesymptoms，(recovered。)

“7，“May8，hadsomesymptoms，(alsorecovered。)

Theseweretheonlycasesattendedbythisphysicianduringtheperiodreferredto。“Theywereallattendedbyhimuntiltheirtermination，withtheexceptionofthepatientNo。6，whofellintothehandsofanotherphysicianonthe2dofMay。(Dr。C。lefttownforafewdaysatthistime。)Dr。C。attendedcasesimmediatelybeforeandaftertheabove-namedperiods，noneofwhich，however，presentedanypeculiarsymptomsofthedisease。

Aboutthe1stofJulyheattendedanotherpatientinaneighboringvillage，whodiedtwoorthreedaysafterdelivery。

Thefirstpatient，itisstated，wasdeliveredonthe20thofMarch。

“Onthe19th，Dr。C。madetheautopsyofamanwhodiedsuddenly，sickonlyforty-eighthours；hadoedemaofthethigh，andgangreneextendingfromalittleabovetheankleintothecavityoftheabdomen。“Dr。C。woundedhimself，veryslightly，intherighthandduringtheautopsy。Thehandwasquitepainfulthenightfollowing，duringhisattendanceonthepatientNo。1。Hedidnotseethispatientafterthe20th，beingconfinedtothehouse，andverysickfromthewoundjustmentioned，fromthistimeuntilthe3dofApril。

Severalcasesoferysipelasoccurredinthehousewheretheautopsymentionedabovetookplace，soonaftertheexamination。Therewerealsomanycasesoferysipelasintownatthetimeofthefatalpuerperalcaseswhichhavebeenmentioned。

ThenursewholaidoutthebodyofthepatientNo。3wastakenontheeveningofthesamedaywithsorethroatanderysipelas，anddiedintendaysfromthefirstattack。

ThenursewholaidoutthebodyofthepatientNo。4wastakenonthedayfollowingwithsymptomslikethoseofthispatient，anddiedinaweek，withoutanyexternalmarksoferysipelas。

“NoothercasesofsimilarcharacterwiththoseofDr。C。occurredinthepracticeofanyofthephysiciansinthetownorvicinityatthetime。Deathsfollowingconfinementhaveoccurredinthepracticeofotherphysiciansduringthepastyear，buttheywerenotcasesofpuerperalfever。Nopost-mortemexaminationswereheldinanyofthesepuerperalcases。“

Someadditionalstatementsinthisletteraredeservingofinsertion。

“Aphysicianattendedawomanintheimmediateneighborhoodofthecasesnumbered2，3，and4。ThispatientwasconfinedthemorningofMarch1st，anddiedonthenightofMarch7th。Itisdoubtfulwhetherthisshouldbeconsideredacaseofpuerperalfever。Shehadsufferedfromcanker，indigestion，anddiarrhoeaforayearprevioustoherdelivery。Hercomplaintsweremuchaggravatedfortwoorthreemonthsprevioustodelivery；shehadbecomegreatlyemaciated，andweakenedtosuchanextentthatithadnotbeenexpectedthatshewouldlongsurviveherconfinement，ifindeedshereachedthatperiod。Herlaborwaseasyenough；sheflowedagooddeal，seemedexceedinglyprostrated，hadringingintheears，andothersymptomsofexhaustion；thepulsewasquickandsmall。Onthesecondandthirddaytherewassometendernessandtumefactionoftheabdomen，whichincreasedsomewhatonthefourthandfifth。Hehadcasesinmidwiferybeforeandafterthis，whichpresentednothingpeculiar。“

Itisalsomentionedinthesameletter，thatanotherphysicianhadacaseduringthelastsummerandanotherlastfall，bothofwhichrecovered。

AnothergentlemanreportsacaselastDecember，asecondcasefiveweeks，andanotherthreeweekssince。Alltheserecovered。AcasealsooccurredveryrecentlyinthepracticeofaphysicianinthevillagewheretheeighthpatientofDr。C。resides，whichprovedfatal。“Thispatienthadsomepatchesoferysipelasonthelegsandarms。Thesamephysicianhasdeliveredthreecasessince，whichhavealldonewell。Therehavebeennoothercasesinthistownoritsvicinityrecently。Therehavebeensomefewcasesoferysipelas。“

ItdeservesnoticethatthepartnerofDr。C。，whoattendedtheautopsyofthemanabovementionedandtookanactivepartinit；whoalsosufferedveryslightlyfromaprickunderthethumb-nailreceivedduringtheexamination，hadtwelvecasesofmidwiferybetweenMarch26thandApril12th，allofwhichdidwell，andpresentednopeculiarsymptoms。Itshouldalsobestated，thatduringtheseseventeendayshewasinattendanceonallthecasesoferysipelasinthehousewheretheautopsyhadbeenperformed。

Iowethesefactstothepromptkindnessofagentlemanwhoseintelligenceandcharacteraresufficientguarantyfortheiraccuracy。

ThetwofollowingletterswereaddressedtomyfriendDr。Scorer，bythegentlemaninwhosepracticethecasesofpuerperalfeveroccurred。Hisnamerendersitunnecessarytorefermoreparticularlytothesegentlemen，whoontheirparthavemanifestedthemostperfectfreedomandcourtesyinaffordingtheseaccountsoftheirpainfulexperience。

“January28，1843。

II……“Thetimetowhichyoualludewasin1830。ThefirstcasewasinFebruary，duringaverycoldtime。Shewasconfinedthe4th，anddiedthe12th。Betweenthe10thand28thofthismonth，I

attendedsixwomeninlabor，allofwhomdidwellexceptthelast，asalsotwowhowereconfinedMarch1stand5th。Mrs。E。，confinedFebruary28th，sickened，anddiedMarch8th。Thenextday，9th，I