The relation of puerperal fever with other continued fevers would seem to be remote and rarely obvious. Hey refers to two cases of synochus occurring in the Royal Infirmary of Edinburgh, in women who had attended upon puerperal patients. Dr. Collins refers to several instances in which puerperal fever has appeared to originate from a continued proximity to patients suffering with typhus. [Footnote: Treatise on Midwifery, p. 228.]
Such occurrences as those just mentioned, though most important to be remembered and guarded against, hardly attract our notice in the midst of the gloomy facts by which they are surrounded. Of these facts, at the risk of fatiguing repetitions, I have summoned a sufficient number, as I believe, to convince the most incredulous that every attempt to disguise the truth which underlies them all is useless.
It is true that some of the historians of the disease, especially Hulme, Hull, and Leake, in England; Tonnelle, Duges, and Baudelocque, in France, profess not to have found puerperal fever contagious. At the most they give us mere negative facts, worthless against an extent of evidence which now overlaps the widest range of doubt, and doubles upon itself in the redundancy of superfluous demonstration. Examined in detail, this and much of the show of testimony brought up to stare the daylight of conviction out of countenance, proves to be in a great measure unmeaning and inapplicable, as might be easily shown were it necessary. Nor do I feel the necessity of enforcing the conclusion which arises spontaneously from the facts which have been enumerated by formally citing the opinions of those grave authorities who have for the last half-century been sounding the unwelcome truth it has cost so many lives to establish.
"It is to the British practitioner," says Dr. Rigby, "that we are indebted for strongly insisting upon this important and dangerous character of puerperal fever." [Footnote: British and Foreign Med. Rev. for January, 1842.]
The names of Gordon, John Clarke, Denman, Burns, Young, [Footnote: Encyc. Britannica, xiii, 467, art., "Medicine.">[ Hamilton,[Footnote: Outlines of Midwifery, p. 109.] Haighton, [Footnote: Oral Lectures, etc.] Good, [Footnote: Study of Medicine, ii, 195.] Waller, [Footnote: Medical and Physical Journal, July, 1830.] Blundell, Gooch, Ramsbotham, Douglas, [Footnote: Dublin Hospital Reports for 1822.] Lee, Ingleby, Locock, [Footnote: Library of Practical Medicine, I. 373], Abercrombie [Footnote: Researches on Diseases of the Stomach, etc. p. 1841], Alison [Footnote: Library of Practical Medicine, i, 95.], Travers, [Footnote: Further Researches on Constitutional Irritation, p. 128], Rigby, and Watson [Footnote: London Medical Gazette, February, 1842] many of whose writings I have already referred to, may have some influence with those who prefer the weight of authorities to the simple deductions of their own reason from the facts aid before them. A few Continental writers have adopted similar conclusions [Footnote: See British and Foreign Medical Review, vol. iil, p. 525, and vol. iv, p. 517. Also Ed. Med. and Surg. Journal for July 1824, and American Journal of Med. Sciences for January, 1841.] It gives me pleasure to remember that, while the doctrine has been unceremoniously discredited in one of the leading journals [Footnote: PIsid. Med. Journal, vol. xii, p. 364], and made very light of by teachers in two of the principal medical schools of this country, Dr. Channing has for many years inculcated, and enforced by examples, the danger to be apprehended and the precautions to be taken in the disease under consideration.
I have no wish to express any harsh feeling with regard to the painful subject which has come before us. If there are any so far excited by the story of these dreadful events that they ask for some word of indignant remonstrance to show that science does not turn the hearts of its followers into ice or stone, let me remind them that such words have been uttered by those who speak with an authority I could not claim [Footnote: Dr. Blundell and Dr. Bigby in the works already cited.] It is as a lesson rather than as a reproach that I call up the memory of these irreparable errors and wrongs. No tongue can tell the heart-breaking calamity they have caused; they have closed the eyes just opened upon a new world of love and happiness; they have bowed the strength of manhood into the dust; they have cast the helplessness of infancy into the stranger's arms, or bequeathed it, with less cruelty, the death of its dying parent. There is no tone deep enough for regret, and no voice loud enough for warning. The woman about to become a mother. or with her new-born infant upon her bosom, should be the object of trembling care and sympathy wherever she bears her tender burden or stretches her aching limbs. The very outcast of the streets has pity upon her sister in degradation when the seal of promised maternity is impressed upon her. The remorseless vengeance of the law, brought down upon its victim by a machinery as sure as destiny, is arrested in its fall at a word which reveals her transient claim for mercy. The solemn prayer of the liturgy singles out her sorrows from the multiplied trials of life, to plead for her in the hour of peril. God forbid that any member of the profession to which she trusts her life, doubly precious at that eventful period, should hazard it negligently, unadvisedly, or selfishly!
There may be some among those whom I address who are disposed to ask the question, What course are we to follow in relation to this matter? The facts are before them, and the answer must be left to their own judgment and conscience. If any should care to know my own conclusions, they are the following; and in taking the liberty to state them very freely and broadly, I would ask the inquirer to examine them as freely in the light of the evidence which has been laid before him.
1. A physician holding himself in readiness to attend cases of midwifery should never take any active part in the post-mortem examination of cases of puerperal fever.
2. If a physician is present at such autopsies, he should use thorough ablution, change every article of dress, and allow twenty-four hours or more to elapse before attending to any case of midwifery. It may be well to extend the same caution to cases of simple peritonitis.
3. Similar precautions should be taken after the autopsy or surgical treatment of cases of erysipelas, if the physician is obliged to unite such offices with his obstetrical duties, which is in the highest degree inexpedient.