Part 18 (1/2)
The practical point to be illustrated is the following: THE DISEASE KNOWN AS PUERPERAL FEVER IS SO FAR CONTAGIOUS AS TO BE FREQUENTLY CARRIED FROM PATIENT TO PATIENT BY PHYSICIANS AND NURSES
Letout certain incidental questions, which, without being absolutely essential, would render the subjectsuch concessions and assumptions as may be fairly supposed to be without the pale of discussion
1 It is granted that all the forms of what is called puerperal fever ious or infectious I do not enter into the distinctions which have been drawn by authors, because the facts do not appear to me sufficient to establish any absolute line of deion and those which are never so propagated This general result I shall only support by the authority of Dr Raives, as the result of his experience, that the sa to what he calls the infectious and the sporadic forinal Essay If others can show any such distinction, I leave it to theh that show the prevalence of the disease ale practitioner when it was in no degree epidemic; in the proper sense of the term I may refer to those of Mr
Roberton and of Dr Peirson, hereafter to be cited, as examples
2 I shall not enter into any dispute about the particular MODE of infection, whether it be by the atmosphere the physician carries about him into the sick-chamber, or by the direct application of the virus to the absorbing surfaces hich his hand comes in contact Many facts and opinions are in favour of each of these modes of transmission But it is obvious that, in the majority of cases, it must be impossible to decide by which of these channels the disease is conveyed, from the nature of the intercourse between the physician and the patient
3 It is not pretended that the contagion of puerperal fever must always be followed by the disease It is true of all contagious diseases that they frequently spare those who appear to be fully submitted to their influence Even the vaccine virus, fresh froitih every precaution is taken to insure its action This is still more remarkably the case with scarlet fever and soranted that the disease may be produced and variously ion, and more especially by epidemic and endemic influences But this is not peculiar to the disease in question There is no doubt that soes through the same records of periodical increase and diminution which have been remarked in puerperal fever If the question is asked hoe are to reconcile the great variations in the mortality of puerperal fever in different seasons and places with the supposition of contagion, I will answer it by another question froistrar-General He makes the statement that ”FIVE die weekly of smallpox in the metropolis when the disease is not epidemic,” and adds, ”The problem for solution is, Why do the five deaths becoressively fall through the saranted that if it can be shown that great nunorance or blindness on this point, no other error of which physicians or nurses ed in palliation of this; but that whenever and wherever they can be shown to carry disease and death instead of health and safety, the common instincts of humanity will silence every attempt to explain away their responsibility
The treatise of Dr Gordon, of Aberdeen, was published in the year 1795, being a the earlier special works upon the disease A part of his testimony has been occasionally copied into other works, but his expressions are so clear, his experience is given with such manly distinctness and disinterested honesty, that it ht have been often folloith advantage
”This disease seized such women only as were visited or delivered by a practitioner, or taken care of by a nurse, who had previously attended patients affected with the disease”
”I had evident proofs of its infectious nature, and that the infection was as readily communicated as that of the smallpox or measles, and operated more speedily than any other infection hich I am acquainted”
”I had evident proofs that every person who had been with a patient in the puerperal fever becaed with an atnant woman who happened to come within its sphere This is not an assertion, but a fact, ad of de table”--referring to a table of seventy-seven cases, in ation was evident
He adds: ”It is a disagreeable declaration forthe infection to a great number of women” He then enumerates a number of instances in which the disease was conveyed by es, and declares that ”these facts fully prove that the cause of the puerperal fever, of which I treat, was a specific contagion, or infection, altogether unconnected with a noxious constitution of the ativen in these words: ”I ARRIVED AT THAT CERTAINTY IN THE MATTER THAT I COULD VENTURE TO FORETELL WHAT WOMEN WOULD BE AFFECTED WITH THE DISEASE, UPON HEARING BY WHAT MIDWIFE THEY WERE TO BE DELIVERED, OR BY WHAT NURSE THEY WERE TO BE ATTENDED, DURING THEIR LYING-IN: AND ALMOST IN EVERY INSTANCE MY PREDICTION WAS VERIFIED”
Even previously to Gordon, Mr White, of Manchester, had said: ”I aentlemen in another tohere the whole business of midwifery is divided betwixt them, and it is very remarkable that one of them loses several patients every year of the puerperal fever, and the other never so much as meets with the disorder”--a difference which he seems to attribute to their various -in Woiven a number of instances in his Essay on Puerperal Fever of the prevalence of the disease ale practitioner At Sunderland, ”in all, forty- three cases occurred from the 1st of January to the 1st of October, when the disease ceased; and of this nuson and his assistant, Mr Gregory, the re been separately seen by three accoucheurs”
There is appended to the London edition of this Essay a letter froentle in his practice, ”The cause of this I cannot pretend fully to explain, but I should be wanting in com that the disease which appeared in ious, and communicable fro the lower and middle ranks of people to make frequent personal visits to puerperal wohborhood, and I have a that the infection of the disease was often carried about in that s, I ion was conveyed, in soh I took every possible care to prevent such a thing fro the moment that I ascertained that the disteoes on to e, in which the disease had at different tiular manner, to the practice of individuals, while it existed scarcely, if at all, aentleion that they withdrew for a time from practice
I find a brief notice, in an American journal, of another series of cases, first entleious
”In the autumn of 1822 he hbourhood did not meet with any, 'or at least very few' He could attribute this circu been present at the examination after death, of two cases, so i every precaution” [Footnote: Philad Med Journal for 1825, p 408]
Dr Gooch says: ”It is not uncoreater number of cases to occur in the practice of one hborhood, who are not more skilful or more busy, meet with few or none A practitioner opened the body of a woman who had died of puerperal fever, and continued to wear the same clothes A lady whom he delivered a few days afterwards was attacked with and died of a si-in patients, in rapid succession, ht have carried contagion in his clothes, he instantly changed them, and met with no more cases of the kind [Footnote: A similar anecdote is related by Sir Benjamin Brodie, of the late Dr John Clark, Lancet, May 2, 1840] A woman in the country as employed as washerwoman and nurse washed the linen of one who had died of puerperal fever; the next lying-in patient she nursed died of the same disease; a third nursed by herafraid of her, ceased to employ her” [Footnote: An Account of Some of the Most Important Diseases Peculiar to Women, p 4]
In the winter of the year 1824, ”several instances occurred of its prevalence a the patients of particular practitioners, whilst others ere equally busy met with few or none One instance of this kind was very ree midwifery practice, lost so many patients from puerperal fever that he determined to deliver no more for some time, but that his partner should attend in his place This plan was pursued for onewhich not a case of the disease occurred in their practice The elder practitioner, being then sufficiently recovered, returned to his practice, but the first patient he attended was attacked by the disease and died A physician who met him in consultation soon afterwards, about a case of a different kind, and who knew nothing of his misfortune, asked hihbourhood, on which he burst into tears, and related the above circu the cases which I saw this season in consultation, four occurred in one month in the practice of one medical man, and all of them terminated fatally” [Footnote: Gooch, op cit, p 71]
Dr Ramsbotham asserted, in a lecture at the London Hospital, that he had known the disease spread through a particular district, or be confined to the practice of a particular person, al attacked with it, while others had not a single case It seeht, of conveyance, not only by coh the dress of the attendants upon the patient [Footnote: Lond Med Gaz, May 2, 1835]
In a letter to be found in the ”London Medical Gazette” for January, 1840, Mr Roberton, of Manchester, ive in a somewhat condensed form
A midwife delivered a woman on the 4th of December, 1830, who died soon after with the symptoms of puerperal fever In one month fro in different parts of an extensive suburb, of which nuht the disease and all died These were the only cases which had occurred for a considerable time in Manchester The other midwives connected with the same charitable institution as the woman already e, ninety wohty a month None of these women had a case of puerperal fever ”Yet all this ti the other midwives in every direction, scores of the patients of the charity being delivered by them in the very sa”
Mr Roberton remarks that littlethis month took the fever; that on some days all escaped, on others only one or more out of three or four; a circumstance similar to what is seen in other infectious maladies
Dr Blundell says: ”Those who have never made the experiment can have but a faint conception how difficult it is to obtain the exact truth respecting any occurrence in which feelings and interests are concerned Oenerally, that from more than one district I have received accounts of the prevalence of puerperal fever in the practice of some individuals, while its occurrence in that of others, in the sahborhood, was not observed
Soreater number of patients, in scarcely broken succession; like their evil genius, the puerperal fever has seemed to stalk behind them wherever they went Some have deemed it prudent to retire for a time from practice In fine, that this fever may occur spontaneously, I admit; that its infectious nature may be plausibly disputed, I do not deny; but I add, considerately, that in my own family I had rather that those I esteemed the erside, than that they should receive the best help, in the fairest apartment, but exposed to the vapors of this pitiless disease
Gossiping friends, wet-nurses, monthly nurses, the practitioner himself, these are the channels by which, as I suspect, the infection is principally conveyed” [Footnote: Lect on Midwifery, p 395]