THE multiform disease which goes by the various names of Childbed Fever, Puerperal Fever and Puerperal Peritonitis, has this double characteristic that it attacks only pregnant and lying-women, the and involves in various degree and genital organs and the viscera more immediately adjacent. scarcely and disorder which the physician is called upon to treat is more insidious or more dangerous; certainly there is none which runs a more rapid course or which may prove more suddenly fatal. And when we reflect that this frightful malady is not necessarily confined to individual cases, that it may become epidemic, and even most virulently contagious, it will be evident that a through understanding of this disease,, at essential to its successful treatment, will at once assume a tenfold importance.
“The breaking out of an epidemic child-bed fever, or even the occurrence of a singles case, commonly excites and feeling of sharp interest and alarm as far as ever the rumor of it extends the public curiosity becomes speedily aroused; and among many physicians whose opinions are taken, how wide is the diversity of their sentiments! If he public do me become greatly alarmed on these occasional, it s because they know that any one of our women, seized with child-bed fever, it s at once placed in a most perilous position and we know it even better then they; and half our distress and anxiety arises from this that we are ourselves uncertain what we have to do, what to contend with, and by what principals toe guided. ( C. D. Meigs, M.D., on Child bed Fevers) These will at once serve to show the dangerous character of this disease and the necessity which therefore exists for a thorough acquaintance with its essential nature and proper treatment.
No single form of disease, or class of diseases, has given rise to greater differences of opinion among medical men, as to its nature and cases; and in no others have serious physiological and pathological errors so manifestly led to erroneous and destructive methods of treatment. And although the Homoeopathic physician, from general principle avoiding some of those untimely interferences which have been seen to lead immediately to child- bed fever, and from selecting his remedies infer the direct guidance of the existing conditions rather than under that of a supposition and often mistaken diagnosis, has in general far greater success tat his Allopathic neighbors;-he own, a clear exposition of the Natural History, Essential Nature, Causes, Symptoms, diagnosis, course and Tendencies, and Treatment of this disease.
NATURAL HISTORY.-Under this title we consider child-bed fever, or the disease commonly so termed, in a general manner only. This disease may appear in one or more isolated cases; and it is then termed sporadic. Such cases are supposed to arise in consequence of influences inherent in the constitution for the individual, or from such as are additionally developed by the incidental circumstances of her confinement. In general the cases of puerperal fever which appear as sporadic, are less difficult of care than those met with in epidemics.
In different countries, and sat different times, child bed fever has assumed an epidemic form; raging with great virulence and fatality, and very extended range of territory, nor lasting more than a few months on may one occasional. Dr. Watson ( Practice of Physic, p.819) states, that puerperal peritonitis” is observed to reign as an epidemic, especially in Lying in Hospitals, and that occurs at irregular intervals, sometimes leaving them quite exempt from its private practice ammoniate Allopathies hospitals this disease has sometimes proved so dreadfully fatal as to communities in which they were situated. Of other one hundred and which occurred, to Dr., Lee, in London, from March, 1827, to he end of April,1835, and of which he gives a tabular view, Plus eighty eight or a little more than fifty per cent recovered. In another author mention is made of thirty one cases being lost of thirty, two; or 96 7/8 per cent while of twenty women in child-bed, in Hotel Dieu Hospital, Paris, in February, 1746, affected with puerperal fever, scarcely one recovered.
The question as to the contagious or non-contagious nature of child bed fever has given rise to the most violent disputes and to the most opposite conclusions among medical men. A frightful carry of facts may be collected from the works of innumerable authors, which seem to prove in the most in contestable and overwhelming manner not only that this disease is contagious, but that in many remarkable instances it has been confined to the practice of a single physician, every woman whom he attended during a course of weeks or months being stricken down with this fell disorder.(*Vide “Puerperal Fever a Private Pestillence, by O. W. Holmes, M.D. Boston, 1855.-Boston Medorrhinum and Surg. Jour., vol.iii.,, pp. 954`0;-Ramsobotham’s Obstetrics, P. 530) Dr. Churchill writes as follows:”It seems impossible to doubt that contagious matter capable exciting puerperal fever may possibly be conveyed by a third party unaffected by it; for example in the cases one cord following the services of medical men and nurses who are too remarkable and too numerous to be regarded as coincidences. nor would even the prevalence of an epidemic of puerperal fever at the same time invalidate our conclusions it might certainly render the case more influential. Dr. West, of Philadelphia, States, that “seven females delivered by Dr. S. Jackson, in rapid succession were all attacked with puerperal fever, and five of them died. These wee the only cases that occurred in that distinct, for the women become alarmed and sent for other assistance. Dr Ramsbotham has known the is disease to spread through a particular distinct, or to be confined to the practice o f a particular person, almost every patient being attacked with it; whilst other practitioner has not a single case; and considers the distemper as being capable of conveyance not only in common modes, though the dress of the attendant of the patients.
At a meeting of the College of Physicians, in Philadelphia, Dr. Warrington stated that, “after assisting at an autopsy of puerperal portents, he was called to deliver here women in rapid succession. All these women were attacked with different forms of what is commonly called puerperal fever. “A young surgeon shortly after examining the body of a sporadic case that had died, delved three the autumn of `822, he met with twelve cases, while his medical friends in the neighborhood did not meet with many, or at least with very few He could attribute this to no other cause than his having been present at the examination of two case, and his having conveyed the infection to his patients, not with standing every precaution. Dr. Roberton, of Manchester, states, that between the 3rd of December, 1839, and January 4th, 1831, a midwife attended thirty patients of a public charity 4th, 1831, a midwife attended thirty patient of a public charity, sixteen of whom had puerperal fever and all died. Other midwives often same institution attended three hundred and eighty women during the same time, a nd none suffers from it.( Churchill’s System of Midwifery, p. 549).
Hitherto we have only adduced proof of he direct communicability of puerperal fever, by physicians or nurse who have been in attendance upon previous case of he disease; or by physicians going to women in labor from autopsies of persons dead with the same complaint. But there are still other modes by which the poison which is capable of exciting this disease in puerperal women has been conveyed, m modes which are necessary to be known in order to a full understanding of the natural history of the disease itself. A practitioner had been attending cases of typhus fever. Within the space of four days he delivered fie women. All these women were attacked with puerperal fever, and all of them died. This was in a country practice, and the cases were remote from each other. Different practices intersected the practice f this medical man at various points, but no other cases were known to have occurred in the neighborhood Again, a patient suffering from typhus fever away admitted into a lying-in hospital, where she remained fro a few hours only. In he beds on the right and left of this patient were two lying in women, both died. A medical man was in constant attendance upon a patient suffering from gangrenous erysipelas, and between the 8th of January and the 22nd of March, he attended the labors of ten women both were attacked almost immediately with puerperal fee, and both died. This was in a town of moderate size, and no other patients in. the place were known to have had puerperal fever. “It has been made out very conclusively by Semelweis and others, that the miasmas, derived from the dissecting room will excite puerperal diseases. Exposure of he puerperal in patients proof against the reception of scarlet fever itself. the mortality amongst child- bed fever will be explained when in a subsequent sections e consider the essential nature of this disease.
But since, as already stated, the opposite opinion, so that of the non-contagiousness of puerperal fever is strongly painted by many able physicians, it is but proper that we allow them also to speak. the most powerful and influential among these ass Dr. C. D. Meigs; were quote his testimony from his already mentioned already and elaborate work;l on page 102, he says: “I had practiced midwifery for many long years I have attended some thousands of women in labor, and passed through repeated epidemics of child-bed fever, both in town and in hospital. After all this experience, however, I d not upon careful reflection and self-examination, find the least reason to suppose I have ever conveyed the disease from place to place, in any microscopic researches of child-bed fever, but did never suspend my ministry as accoucheurs on that account STill, I certainly was never the medium iod its transmission., This statement is indeed remarkable; but it is difficult with any conceivable amount of negative testimony of this kind, to disprove the positive affirmative evidence of many other equally intelligent and no less trustworthy observers; the following words of the Abbe Spellanzani, ( Dissertations relative to the Natural History of Animals and Vegetables, London, 1789.) are very much to the point: “It is the custom of certain dabblers in philosophy to deny facts however particularly described, a and through related by persons of the highest authority, merely because their own endeavors (in her same direction_) fail of successes. But they do not reflect that this is acting indirect opposition to the principles of cannot destroy a single positive fact. Thus the entire sum and substances of D. Meig’s testimony is perfectly expressed in the last phrase quoted from him; he certainly was not :a medium of transmission” of such poison ‘ but this amounts to nothing in disproof of others being such modicums.
The full elucidation of this most important practical subject requires an additional statement in this connection. The statements already given, mostly in. every words of the unfortunate actors intense domestic tragedies, which prove the direct communication of poison sufficient to cause child bed fever, comprise but a very small portion of these prove what may be termed common communicability, by means of which the poison may be directly conveyed from a variety of sources and under a great variety of circumstances The testimony of Dr. Meigs( and that of other, similar, if any such there be,) must be regarded as anomalous and as furnishing an example of most uncommon communicability. But as nature is never one-sided, we shall find in the recorded evidences of medical men some corresponding anomalies on the opposite side. some still more the remarkable instances of most uncommon communicability! Thus Dr. Merriman (*Lancet, May 2, 1840) states: That he has present at the examination of a case of puerperal fever at two P.M. He took care not to touch the body. At nine o’clock the same evening he attended a women in labor; she was so nearly delivered that he had scarcely any thing to do. The next morning she had rigors, and died in fort eighty hours. Dr. Gooch relates the case of a general practitioner in large midwifery practice, who last so many patients from puerperal fever, that he determined to deliver no more or some time, sued for one month, during which not a case occurred in their practice, the else then being sufficiently recovered, returned to his practice, but he first patient the attendant was attacked by the diseases and died.. Very similar was the experience of the unfortunate Dr. Rutter, formerly of Philadelphia, as related by Dr. Meigs. ( Plus Child-bed Fever,, page 105, These gentlemen “seemed to be tracked by the cause of the disease, to judge from the numerous attacks of it sin his lying in patients. He was charged with being a carrier of contagion. Worn out with fatigue, and wounded in spirit by his cares for the unfortunate victims of an epidemic disease, Dr. Rutter left the city for the purpose of regaining some strength, and to escape from the repetition of such disheartening labors. He spent ten days rusticating at a distance of thirty-five miles from the city; and on his return he caused his head to be close-shaved, took a warm bath, dressed throughout in clothes entirely new, leaving behind him even his pencil and his watch and “went out to attend a lady in labor, who had a favorable parturition; yet was next day assailed by a horrible child-bed fever, of which she died! “Dr. Rutter repeated this attempt at personal distinction at a subsequent period, which was two years late, and met with the same il success. For., Gordon, of Aberdeen, Scotland, one of the earliest writers on child bed fever, says: :”I have abundant proofs that every person who had been with a patient in puerperal fever, became charged with an atmosphere if infections which was communicated to every pregnant women who happened to come within its shore. And he acknowledges that he was himself the means of carrying the infection to a great number of women.
Reference has already been made of puerperal fever arising from the effluvia of erysipelas; a few facts will show the constant relation of these two forms of disease, the explanation of the cause of this relation will appeal wherein two come to consider the essential nature of puerperal fever itself, in. he following section. Dr. Drake, in his analyses of the several accounts of epidemic erysipelas in he Interior Valley of North America states that pregnant, and especially lying-in females, were peculiarly liable to the erysipelas inflammation, and the most fatal; case were the puerperal. Dr. Corson, describing a severe epidemic of erysipelatus which occurred in Norristown, Pa. in the autumn of 1847, says: old and young, male and female, bell before it, and yet thee seemed to be one class that it preferred. The mother, as she lay helpless and exhausted from the deadly poison was issued into he veins, and, in many instances, a few hours sealed her doom., In the latter part of March, 1852, epidemic erysipelas made its appearance in Palmyra country, Pa., ‘few lying in women escaped its attack, a nd the ration of mortality was quite large. Of a similar epidemic occurring in Montgomery country, in. he same year, Dr. Geiger states “that it spared neither age, sex, nor condition. It marked the parturient woman for it disease, who was delivered during its prevalence, escaped an attack (*Trans Penna. State Medorrhinum Soc., vols. ii and iii) was found that females advance din pregnancy were especially prone to premature labor, and the period of accouchement was looked to by both patient and physician with the deepest of Dr. Sutton’s information, escaped an attack of puerperal fever, and every one that was attacked died.
Thus we have shown: I. That puerperal fever may be directly communicate from one to another, through the medium of a third person, especially the nurse or physician. That it is very sure to be thus transmitted by persons who have recently been engaged in making autopsies of such as have died of puerperal fever and of peritoneal or erysipelatous inflammation. 3. That it may be caused by the effluvia from dissecting rooms, from typhus fever, from gangrenous and epidemic erysipelas, and from scarlet fever. 4. That no amount of personal ablution, changing clothes, & d., will always prevent such communication of poisonous influenced since even the blood of the person acting as a medium is affected, and by the breath a certain infectious influence is given out which acts upon the blood of the puerperal woman through her lung sand thus carries to her system the germs of the disease. 5. From the various facts of the personal experience of different physicians, it will be seem that some persons, like Dr. Meigs seem to be incapable of thus absorbing and remarkable degree this unfortunate faculty of retaining and importing the poisonous effluvia from months and even years, even as the odor of musk will remain for years in rooms which have once been impregnated with his perfume.
These facts might be deemed to have been introduced with needless prolixity, did they not suffice to exert a controlling influence over the conduct of he physician in such case, s and afford ground of he following admirable advice by Dr. Copland: “A physician or surgeon engaged in obstetric practice upon the occurrence of puerperal females during his attendance on case of this form, or even of erysipelas; or he should change of his clothes, and wash his hands after seeing cases of either of these maladies, before proceeding to a unavailing;a s shown by the cases above given; fumigating himself and his clothes with chlorine gas, and washing his hands, and beneath the finger nails, with a solution of chloride of zinc, m would be more effectual.)
An obstetric practitioner should not make of autopsy of a case of puerperal fever, or of erysipelas or of peritonitis, or of diffusive inflammation of the cellular tissue of disease occasioned by the recroscopic poison; nor even attend, dress, or visit and such cases, without immediately afterwards observing precautions just stated, and allowing two or three days to elapse between such attendance and conducting engagement or visits of puerperal females. In this last paragraph the prohibitions should be deemed absolute; since if they are violated the subsequently advised precautions may prove most disastrously unavailing.
Puerperal fever runs a very rapid course sometimes terminating fatally in a few hours; in other instances, in which the uterus itself is less immediately involved, and the disorder assumes more closely the form of a peritonitis, its duration is much longer, according to the treatment adopted. But in the Homoeopathic, as in the Allopathic practice, it is important to be able to detect the first symptoms of the disease, and to apply the appropriate remedies in its earliest stages and on the very first appearance of the evil.
II. ESSENTIAL NATURE. A correct physiological knowledge forms the indispensable foundation for sound pathology; and sound pathological views of particularly forms of disease are of course absolutely essential to diagnosis and prognosis; nor can they under any circumstances fail to exert some important influence in practice. For by such knowledge alone are we able to understand the relative value and especial significance of many more or less prominent symptoms, and thus to realize which are the most indispensable to be covered in selecting the remedy. No student or physician can be too well informed. And as regards therapeutics, pathology, while like fire a very bad master, may still be made a very useful servant. And indeed to physician in. his age of would, of whatever school, can possibly do justice either to himself, to thus patients and friends, or to society, in relation to puerperal fever, who does not understand the actual pathological changes which transpire in the various forms of disease usually included undo this general name.
The term milk fever, now usually to express the constitution l excitement which precedes or accompanies the secretion of milk in women recently delivered, formerly implied much more, and involved certain physiological absurdities and some consequent pathological errors. In the old humoral pathology, the menstrual flow was supposed to consist of a fermentable mass, which, if retained in the system, except during pregnancy, occasioned various severe disorders. This flow was supposed to be replaced, during pregnancy, by milk which, originally secreted in the mammary glands, was thence in some way transferred and deposited about he uterine placenta, for the nourishment of he foetus. After the birth of the child, the former menstrual necessity was supposed about the uterine placenta, for the nourishment of the foetus. After the birth of the child, the former menstrual necessity was supposed to be supplied at first by the lochia, wand afterwards by the flow of milk directly from the mammae. And this latter process being interrupted, it was believed that the pale or whitish lochia represented the milk again determined towards the uterus and discharged therefrom. And the blood was supposed to be poisoned by such inward revolution of the milk in. the later case, as by that of the menstrual discharge in the instance first mentioned.
Now in order to correct this long train of error we need but to revert to the truly physiological nature of menstruation. In our explanation for the function of ovulation in a preceding chapter., nineteen was made foe the monthly periodic nisus which was at once preliminary to and typical of the grand finale of reproduction. And thus periodic nisus was shown to be accompanied by a certain amount of uterine engorgement, which as relieved by the crisis of the menstrual flow. The whole of this is also still more closely a type of what occurs in pregnancy, and after partition. During pregnancy, and especially in its more advanced stags, the uterine sinuses have become very largely developed, and the entire uterus may be said to have assumed a state of permanent engorgement, which is truly physiological as long as the foetus remains to be nourished in the uterus. But with the expulsion of he foetus remains to be nourished in the uterus. But with the expulsion of the foetus at term all this is chanted;l the after pains proceed to reduce the womb to it original condition, and by such contractions of the uterine walls the extra volumes of blood remaining or still flowing into he uterine sinuses and gradually expelled in the form of the lochia; the open mouths of he sinuses themselves are gradually closed up, and at the same time the former abundant flow of blood into the uterus, now no longe needed in such quantity, is gradually diminished. Thus the lochia are seen to result from the gradual disgorgement of the womb and its restoration to its normal condition before pregnancy. But the open mouths of the vessels upon the utero-placental portion of the parents of the womb may become closed cup before the womb itself is entirely reduced to its natural size, and so before the undue amount of blood is entirely prevented from being thrown into the uterus; under such circumstances the excess of blood flowing into the womb is relieved, not as at first by and actual hemorrhage (purely sanguineous lochia), but by an execution which gradually become more serious and watery till it finally ceases.