Part 17 (2/2)
In the early part of this inquiry I felt farthe inflammation of the inoculated arreater extent than could be wished is a circumstance sometimes to be expected
As this can be checked, or even entirely subdued, by very simple means, I see no reason why the patient should feel an uneasy hour because an application may not be absolutely necessary About the tenth or eleventh day, if the pustule has proceeded regularly, the appearance of the arm will almost to a certainty indicate whether this is to be expected or not Should it happen, nothing le drop of the aqua lythargyri acetati [Footnote: Extract of Saturn] upon the pustule, and, having suffered it to remain two or threethe pustule with a piece of linen dipped in the aqua lythargyri compos [Footnote: Goulard water For further information on this subject see the first Treatise on the Var Vac, Dr Marshall's letters, etc] The for the day, the latter as often as it reeable to the patient
When the scab is pre children and working people), the application of a little aqua lythargyri acet to the part iulates the surface, which supplies its place, and prevents a sore
In my former treatises on this subject I have remarked that the human constitution frequently retains its susceptibility to the sion (both fro its influence In further corroboration of this declaration many facts have been communicated to me by various correspondents I shall select one of thee must, I think, feel much indebted to you for your Inquiries and Observations on the Nature and Effects of the Variolae Vaccinae, etc, etc As I conceive what I aine it cannot be uninteresting to you, especially as it will serve to corroborate your assertion of the susceptibility of the huh it has previously been made sensible of its action In November, 1793, I was desired to inoculate a person with the smallpox I took the variolous matter froe burthen of distinct pustules Thethe disease by inoculation, after having opened a pustule, I introduced the point of my lancet in the usual way on the back part of ht no more of it until I felt a sensation in the part which reminded me of the transaction This happened upon the third day; on the fourth there were all the appearances common to inoculation, at which I was not at all surprised, nor did I feelthe inflammation continue to increase to the sixth and seventh day, accompanied with a very sht one the disease, and yet would escape any constitutional affection; but I was not so fortunate; for on the eighth day I was seized with all the syree than when I was before inoculated, which was about eighteen years previous to this, when I had a considerable nureatly alar at different times inoculated not less than two thousand persons I was convinced my present indisposition proceeded from the insertion of the variolous matter, and, therefore, anxiously looked for an eruption On the tenth day I felt a very unpleasant sensation of stillness and heat on each side of an to decline The affection in my face soon terminated in three or four pustules attended with inflammation, but which did not maturate, and I was presently well
”I remain, dear sir, etc, ”THOMAS MILES”
This inquiry is not now somore positively than formerly on the important point of scrophula as connected with the smallpox
Every practitioner in medicine who has extensively inoculated with the smallpox, or has attended many of those who have had the distee that he has frequently seen scrophulous affections, in so the this fact to be admitted, as I presume it must be by all who have carefully attended to the subject, eneral introduction of the s thethat for attentively watched the effects of the cow-pox in this respect, I a able to declare that the disease does not appear to have the least tendency to produce this destructivethe htened of medical men when my sentiments on the iated, was highly laudable To have admitted the truth of a doctrine, at once so novel and so unlike any thing that ever had appeared in the annals of id scrutiny, would have bordered upon temerity; but nohen that scrutiny has taken place, not only a ourselves, but in the first professional circles in Europe, and when it has been uniformly found in such abundant instances that the huenuine cow-pox in the way that has been described, is never afterwards at any period of its existence assailable by the sratulate , in the mild for fro its victims; a disease that has ever been considered as the severest scourge of the human race!
THE CONTAGIOUSNESS OF PUERPERAL FEVER BY OLIVER WENDELL HOLMES
INTRODUCTORY NOTE
Oliver Wendell Holust 29, 1809, and educated at Phillips Acaderaduation, he entered the Law School, but soon gave up law for medicine He studied first in Boston, and later spent two years in medical schools in Europe, an to practise in Boston, but in two years he was appointed professor of anatoe, a position which he held froain took up his Boston practise It was soon after this, in 1843, that he published his essay on the ”Contagiousness of Puerperal Fever,”
his only contribution of high distinction to medical science
From 1847 to 1882 he was Parky in the Harvard Medical School He died in Boston, October 7, 1894
In spite of the importance of the paper here printed, Holmes's reputation as a scientist was overshadowed by that won by him as a wit and a man of letters When he was only twenty-one his ”Old Ironsides” brought hih his poetry and fiction, and the sparkling talk of the ”Breakfast Table” series, he took a high place aroup of writers that America has yet produced
THE CONTAGIOUSNESS OF PUERPERAL FEVER
Note--This essay appeared first in 1843, in The New England Quarterly Journal of Medicine, and was reprinted in the ”Medical Essays” in 1855
In collecting, enforcing and adding to the evidence accumulated upon this most serious subject, I would not be understood to imply that there exists a doubt in the mind of any well-informed member of the medical profession as to the fact that puerperal fever is sometimes communicated from one person to another, both directly and indirectly In the present state of our knowledge upon this point I should consider such doubts merely as a proof that the sceptic had either not exa examined it, refused to accept its plain and unavoidable consequences I should be sorry to think, with Dr Rigby, that it was a case of ”oblique vision”; I should be unwilling to force houmentum ad hominem of Dr Blundell, but I would not consent to er to be considered as a subject for trivial discussions, but to be acted upon with silent pro that wise and experienced practitioners have soer in question; no ative facts, no opposing opinions, be they what they may, or whose they may, can form any answer to the series of cases noithin the reach of all who choose to explore the records of medical science
If there are some who conceive that any i such opinions, or by collecting the history of all the cases they could find in which no evidence of the influence of contagion existed, I believe they are in error
Suppose a feriters of authority can be found to profess a disbelief in contagion,--and they are very few compared with those who think differently,--is it quite clear that they formed their opinions on a view of all the facts, or is it not apparent that they relied mostly on their own solitary experience? Still further, of those whose nale one could, by any possibility, have known the half or the tenth of the facts bearing on the subject which have reached such a frightful aain, as to the utility of negative facts, as we may briefly call them,--instances, namely, in which exposure has not been followed by disease,--although, like other truths, they , I do not see that they are like to shed any iht upon the subject before us Every such instance requires a good deal of circumstantial explanation before it can be accepted It is not enough that a practitioner should have had a single case of puerperal fever not followed by others It must be knohether he attended others while this case was in progress, whether he went directly from one chamber to others, whether he took any, and what, precautions It is important to know that several women were exposed to infection derived from the patient, so that allowance ative facts so sifted there could be accumulated a hundred for every one plain instance of communication here recorded, I trust it need not be said that we are bound to guard and watch over the hundredth tenant of our fold, though the ninety and ninethe wolf at its entrance If any one is disposed, then, to take a hundred instances of lives, endangered or sacrificed out of those I have mentioned, and make it reasonably clear that within a similar time and compass TEN THOUSAND escaped the same exposure, I shall, thank him for his industry, but I must be per him to adopt or at least to examine them also Children that walk in calico before open fires are not always burned to death; the instances to the contrary ; but by no ainst woollen frocks and high fenders
I am not sure that this paper will escape another reht be wished were founded in justice It enerally known and acknowledged to require any for new in the positions advanced, and no need of laying additional state to torks, one almost universally, and the other extensively, appealed to as authority in this country, I see ample reason to overlook this objection
In the last edition of Dewees's Treatise on the ”Diseases of Females” it is expressly said, ”In this country, under no circumstance that puerperal fever has appeared hitherto, does it afford the slightest ground for the belief that it is contagious” In the ”Philadelphia Practice of Midwifery” not one word can be found in the chapter devoted to this disease which would lead the reader to suspect that the idea of contagion had ever been entertained It seems proper, therefore, to re to the works for guidance that there hted or oularity of diet, or a confined state of the bowels, and that whatever confidence a physician may have in his own mode of treatment, his services are of questionable value whenever he carries the bane as well as the antidote about his person