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.
