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.
