Part 7 (2/2)
The Essay was read before the Boston Society for Medical Improvement, and, at the request of the Society, printed in the ”New England Quarterly Journal of Medicine and Surgery” for April, 1843. As this Journal never obtained a large circulation, and ceased to be published after a year's existence, and as the few copies I had struck off separately were soon lost sight of among the friends to whom they were sent, the Essay can hardly be said to have been fully brought before the Profession.
The subject of this Paper has the same profound interest for me at the present moment as it had when I was first collecting the terrible evidence out of which, as it seems to me, the commonest exercise of reason could not help shaping the truth it involved. It is not merely on account of the bearing of the question,--if there is a question,--on all that is most sacred in human life and happiness, that the subject cannot lose its interest. It is because it seems evident that a fair statement of the facts must produce its proper influence on a very large proportion of well-const.i.tuted and unprejudiced minds. Individuals may, here and there, resist the practical bearing of the evidence on their own feelings or interests; some may fail to see its meaning, as some persons may be found who cannot tell red from green; but I cannot doubt that most readers will be satisfied and convinced, to loathing, long before they have finished the dark obituary calendar laid before them.
I do not know that I shall ever again have so good an opportunity of being useful as was granted me by the raising of the question which produced this Essay. For I have abundant evidence that it has made many pract.i.tioners more cautious in their relations with puerperal females, and I have no doubt it will do so still, if it has a chance of being read, though it should call out a hundred counterblasts, proving to the satisfaction of their authors that it proved nothing. And for my part, I had rather rescue one mother from being poisoned by her attendant, than claim to have saved forty out of fifty patients to whom I had carried the disease. Thus, I am willing to avail myself of any hint coming from without to offer this paper once more to the press. The occasion has presented itself, as will be seen, in a convenient if not in a flattering form.
I send this Essay again to the MEDICAL PROFESSION, without the change of a word or syllable. I find, on reviewing it, that it antic.i.p.ates and eliminates those secondary questions which cannot be entertained for a moment until the one great point of fact is peremptorily settled. In its very statement of the doctrine maintained it avoids all discussion of the nature of the disease ”known as puerperal fever,” and all the somewhat stale philology of the word contagion. It mentions, fairly enough, the names of sceptics, or unbelievers as to the reality of personal transmission; of Dewees, of Tonnelle, of Duges, of Baudelocque, and others; of course, not including those whose works were then unwritten or unpublished; nor enumerating all the Continental writers who, in ignorance of the great ma.s.s of evidence acc.u.mulated by British pract.i.tioners, could hardly be called well informed on this subject. It meets all the array of negative cases,--those in which disease did not follow exposure,--by the striking example of small-pox, which, although one of the most contagious of diseases, is subject to the most remarkable irregularities and seeming caprices in its transmission. It makes full allowance for other causes besides personal transmission, especially for epidemic influences. It allows for the possibility of different modes of conveyance of the destructive principle. It recognizes and supports the belief that a series of cases may originate from a single primitive source which affects each new patient in turn; and especially from cases of Erysipelas. It does not undertake to discuss the theoretical aspect of the subject; that is a secondary matter of consideration. Where facts are numerous, and unquestionable, and unequivocal in their significance, theory must follow them as it best may, keeping time with their step, and not go before them, marching to the sound of its own drum and trumpet. Having thus narrowed its area to a limited practical platform of discussion, a matter of life and death, and not of phrases or theories, it covers every inch of it with a ma.s.s of evidence which I conceive a Committee of Husbands, who can count coincidences and draw conclusions as well as a Synod of Accoucheurs, would justly consider as affording ample reasons for an unceremonious dismissal of a pract.i.tioner (if it is conceivable that such a step could be waited for), after five or six funerals had marked the path of his daily visits, while other pract.i.tioners were not thus escorted. To the Profession, therefore, I submit the paper in its original form, and leave it to take care of itself.
To the MEDICAL STUDENTS, into whose hands this Essay may fall, some words of introduction may be appropriate, and perhaps, to a small number of them, necessary. There are some among them who, from youth, or want of training, are easily bewildered and confused in any conflict of opinions into which their studies lead them. They are liable to lose sight of the main question in collateral issues, and to be run away with by suggestive speculations. They confound belief with evidence, often trusting the first because it is expressed with energy, and slighting the latter because it is calm and unimpa.s.sioned. They are not satisfied with proof; they cannot believe a point is settled so long as everybody is not silenced. They have not learned that error is got out of the minds that cherish it, as the taenia is removed from the body, one joint, or a few joints at a time, for the most part, rarely the whole evil at once. They naturally have faith in their instructors, turning to them for truth, and taking what they may choose to give them; babes in knowledge, not yet able to tell the breast from the bottle, pumping away for the milk of truth at all that offers, were it nothing better than a Professor's shrivelled forefinger.
In the earliest and embryonic stage of professional development, any violent impression on the instructor's mind is apt to be followed by some lasting effect on that of the pupil. No mother's mark is more permanent than the mental naevi and moles, and excrescences, and mutilations, that students carry with them out of the lecture-room, if once the teeming intellect which nourishes theirs has been scared from its propriety by any misshapen fantasy. Even an impatient or petulant expression, which to a philosopher would be a mere index of the low state of amiability of the speaker at the moment of its utterance, may pa.s.s into the young mind as an element of its future const.i.tution, to injure its temper or corrupt its judgment. It is a duty, therefore, which we owe to this younger cla.s.s of students, to clear any important truth which may have been rendered questionable in their minds by such language, or any truth-teller against whom they may have been prejudiced by hasty epithets, from the impressions such words have left. Until this is done, they are not ready for the question, where there is a question, for them to decide. Even if we ourselves are the subjects of the prejudice, there seems to be no impropriety in showing that this prejudice is local or personal, and not an acknowledged conviction with the public at large. It may be necessary to break through our usual habits of reserve to do this, but this is the fault of the position in which others have placed us.
Two widely-known and highly-esteemed pract.i.tioners, Professors in two of the largest Medical Schools of the Union, teaching the branch of art which includes the Diseases of Women, and therefore speaking with authority; addressing in their lectures and printed publications large numbers of young men, many of them in the tenderest immaturity of knowledge, have recently taken ground in a formal way against the doctrine maintained in this paper:
On the Non-Contagious Character of Puerperal Fever: An Introductory Lecture. By Hugh L. Hodge, M. D., Professor of Obstetrics in the University of Pennsylvania. Delivered Monday, October 11, 1852.
Philadelphia, 1852.
On the Nature, Signs, and Treatment of Childbed Fevers: in a Series of Letters addressed to the Students of his Cla.s.s. By Charles D. Meigs, M. D., Professor of Midwifery and the Diseases of Women and Children in Jefferson Medical College, Philadelphia, etc., etc. Philadelphia, 1854.
Letter VI.
The first of the two publications, Dr. Hodge's Lecture, while its theoretical considerations and negative experiences do not seem to me to require any further notice than such as lay ready for them in my Essay written long before, is, I am pleased to say, un.o.bjectionable in tone and language, and may be read without offence.
This can hardly be said of the chapter of Dr. Meigs's volume which treats of Contagion in Childbed Fever. There are expressions used in it which might well put a stop to all scientific discussions, were they to form the current coin in our exchange of opinions. I leave the ”very young gentlemen,” whose careful expositions of the results of practice in more than six thousand cases are characterized as ”the jejune and fizenless dreamings of soph.o.m.ore writers,” to the sympathies of those ”dear young friends,” and ”dear young gentlemen,” who will judge how much to value their instructor's counsel to think for themselves, knowing what they are to expect if they happen not to think as he does.
One unpalatable expression I suppose the laws of construction oblige me to appropriate to myself, as my reward for a certain amount of labor bestowed on the investigation of a very important question of evidence, and a statement of my own practical conclusions. I take no offence, and attempt no retort. No man makes a quarrel with me over the counterpane that covers a mother, with her new-born infant at her breast. There is no epithet in the vocabulary of slight and sarcasm that can reach my personal sensibilities in such a controversy. Only just so far as a disrespectful phrase may turn the student aside from the examination of the evidence, by discrediting or dishonoring the witness, does it call for any word of notice.
I appeal from the disparaging language by which the Professor in the Jefferson School of Philadelphia world dispose of my claims to be listened to. I appeal, not to the vote of the Society for Medical Improvement, although this was an unusual evidence of interest in the paper in question, for it was a vote pa.s.sed among my own townsmen; nor to the opinion of any American, for none know better than the Professors in the great Schools of Philadelphia how cheaply the praise of native contemporary criticism is obtained. I appeal to the recorded opinions of those whom I do not know, and who do not know me, nor care for me, except for the truth that I may have uttered; to Copland, in his ”Medical Dictionary,” who has spoken of my Essay in phrases to which the pamphlets of American ”scribblers” are seldom used from European authorities; to Ramsbotham, whose compendious eulogy is all that self-love could ask; to the ”Fifth Annual Report” of the Registrar-General of England, in which the second-hand abstract of my Essay figures largely, and not without favorable comment, in an important appended paper. These testimonies, half forgotten until this circ.u.mstance recalled them, are dragged into the light, not in a paroxysm of vanity, but to show that there may be food for thought in the small pamphlet which the Philadelphia Teacher treats so lightly.
They were at least unsought for, and would never have been proclaimed but for the sake of securing the privilege of a decent and unprejudiced hearing.
I will take it for granted that they have so far counterpoised the depreciating language of my fellow-countryman and fellow-teacher as to gain me a reader here and there among the youthful cla.s.s of students I am now addressing. It is only for their sake that I think it necessary to a.n.a.lyze, or explain, or ill.u.s.trate, or corroborate any portion of the following Essay. But I know that nothing can be made too plain for beginners; and as I do not expect the pract.i.tioner, or even the more mature student, to take the trouble to follow me through an Introduction which I consider wholly unnecessary and superfluous for them, I shall not hesitate to stoop to the most elementary simplicity for the benefit of the younger student. I do this more willingly because it affords a good opportunity, as it seems to me, of exercising the untrained mind in that medical logic which does not seem to have been either taught or practised in our schools of late, to the extent that might be desired.
I will now exhibit, in a series of propositions reduced to their simplest expression, the same essential statements and conclusions as are contained in the Essay, with such commentaries and explanations as may be profitable to the inexperienced cla.s.s of readers addressed.
I. It has been long believed, by many competent observers, that Puerperal Fever (so called) is sometimes carried from patient to patient by medical a.s.sistants.
II. The express object of this Essay is to prove that it is so carried.
III. In order to prove this point, it is not necessary to consult any medical theorist as to whether or not it is consistent with his preconceived notions that such a mode of transfer should exist.
IV. If the medical theorist insists on being consulted, and we see fit to indulge him, he cannot be allowed to a.s.sume that the alleged laws of contagion, deduced from observation in other diseases, shall be cited to disprove the alleged laws deduced from observation in this. Science would never make progress under such conditions. Neither the long incubation of hydrophobia, nor the protecting power of vaccination, would ever have been admitted, if the results of observation in these affections had been rejected as contradictory to the previously ascertained laws of contagion.
V. The disease in question is not a common one; producing, on the average, about three deaths in a thousand births, according to the English Registration returns which I have examined.
VI. When an unusually large number of cases of this disease occur about the same time, it is inferred, therefore, that there exists some special cause for this increased frequency. If the disease prevails extensively over a wide region of country, it is attributed without dispute to an epidemic influence. If it prevails in a single locality, as in a hospital, and not elsewhere, this is considered proof that some local cause is there active in its production.
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