EACH journal that has been placed upon our desk during the last six months has told us of the World’s Homoeopathic Congress, and now we stand before this body of representative men, and are reminded that the eyes of the physicians of the world are upon us, and that they are asking why we Homoeopathists are given this special auxiliary Congress. The answer must come from us, and if we fail to express here our distinctive opinions, and to show, with reason, what we do as a distinctive school, we can no longer lay claim to distinctive rights and privileges.
Our school has added so much that is original to human knowledge, that we can by right appropriate whatever is of value to science wherever found, and by virtue of our law, can, cast off and discard whatever is worthless in the realm of therapeutics, the science in which we lead.
With this introduction, we wish to call attention to puerperal fever, a disease of especially interest to us as obstetricians, not only because of its reputed fatality, but also because of its various aetiology. The physician who masters the history, cause, progress and results of this disease, has a general knowledge sufficient for, and is equal to the discussion of any febrile disorder. This statement is not surprising, when as an accepted definition, we state that puerperal fever is any continued fever occurring in connection with childbirth.
The history, briefly, is first traditional, Rachel’s death being attributed to that cause. Hippocrates describes isolated cases. In fact there is no doubt that the disease has made its ravages during all ages, though it was not recognized as a positive epidemic fever until lying-in institutions were established. After their establishment, when records were more complete, we have it appearing in epidemic form, always with some years intervening, and travelling over the world, thus: In 1750, in Lyons: in 1760, in London; in 1765, in Copenhagen; in 1767, in Dublin; in 1770, in Germany, etc.
During these epidemics it raged with such intensity that the death rate rose in Vienna, as late as 1842, to almost 16 per cent. of the women confined. The points to be noticed here are, that the disease occurred in the form of an epidemic, as well as a sporadic disease. An old writer from whom we have learned much, divided diseases into sporadic and epidemic. According to that writer, sporadic diseases are those engendered by meteoric or telluric agencies, to the morbific influence of which only a few persons are susceptible at a time. Next to this class come the epidemic diseases, which attack many persons at the same time. They arise from the same cause, and individual cases resemble each other. These diseases usually become infections when they pervade crowded districts.
The disease in question in its manifestations, falls under these definitions, the author referred to is our revered Hahnemann, and there is between the lines of these definitions all that our scientists of to-day have developed.
In 1847, Semmelweiss observed that in the wards in Vienna where the physicians attended, the more fever cases occurred, and that the mortality was greatest, while in those wards attended by midwives the mortality was comparatively small. In the first wards, medical students were allowed to examine the patients regardless of their previous occupation, whether in the dissecting room or in the surgical ward. As a result of these observations Semmelweiss advanced the doctrine that puerperal fever was the result of the introduction of a poison from an external source.
Simpson and others in 1850 claimed and proved to the satisfaction of many, that this fever was identical with surgical fever.
Note here that the physicians and medical students were important factors in the propagation and spread of the disease, and also that it did then, as it does now, come from the introduction into the system of decomposing animal matter. These statements in brief five the history of the disease under discussion.
Time will not allow us to do more than announce our conclusion as to the aetiology of puerperal fever.
1. We believe that there is sufficient evidence for believing that it does occur in the form of an epidemic. When in this form it is contagious and infections, and that it should be placed among the miasmatic contagious diseases. This is the disease of which Noeggerath isolated the germ. This germ may enter the body through the lungs, stomach or vaginal tract, it may be introduced prior to confinement and lay dormant, not developing till after delivery.
We are all justified in being guided by our experience, and in forming our conclusion sin accordance therewith, and we must not ignore evidence from reliable sources. We believe that we have seen a specific form of puerperal fever.
We know that each year many of us have cases of cholera- morbus, cholerine, or severe diarrhoea, which present the symptoms of cholera. Some of these are fatal, and there is no way of distinguishing by symptoms between our cases and those of true cholera excepting that they are single, and that they do not appear in epidemic form. True, the microscope gives us a test, but how many of us use it, or can use it? We believe that cholera does occur in the form of an epidemic, individual cases presenting the same symptoms. Few of us have had personal experience with epidemic cholera. Because many here not had experience with puerperal fever in epidemic form, there is no reason to deny its existence in the face of the history we have.
This form of puerperal fever is contagious in the highest degree. No physician should take other cases of labor while in attendance upon a case of puerperal fever of this variety.
2. Physicians, students, midwives or nurses can infect our patients and so cause puerperal fever. When so infected it is by reason of the introduction of decaying animal matter, or the ptomaines produced during the progress of another diseased condition.
Pregnancy presents a physiological condition which tends to hypertrophy. The puerperal state is a physiological condition tending to atrophy.
After labor as the result of haemorrhage, shock, more or less laceration and traumatism, the patient’s vitality is at the lowest ebb. Consequently they are especially susceptible to disease, and the patient is in a peculiar state, which peculiarity, we can hardly describe. She is exposed to the above described dangers. It is rational also on evidence, to assume that germs which would under other circumstances be harmless, we now poisonous, so that the danger form infection by her attendants is greater than under any other circumstances when the physician is called upon for assistance.
Any interference with the physiological condition of atrophy may cause an auto-infection. This is especially true when traumatism is introduced as a factor. When, under any circumstances, traumatic influences arrest circulation completely or is of such a character or extent to render its return impossible, we have fever, the danger of which depends upon the extent of the injury. Ordinarily the inflammatory condition remains at the seat of the injury, but when in connection with labor it interferes with the process of atrophy, we have as a result, a contained fever.
3. Evidence that we cannot dispute teaches that there is an intimate relation between may cases of puerperal fever and the zymotic diseases; diphtheria, erysipelas, and so forth. Personally we have been able to distinctly trace three cases directly to diphtheria. One case which occurred this winter, a patient who was nearing her confinement period, left her home because of the presence of a case of diphtheria. Ten days after she was delivered, and in thirty hours after delivery, puerperal fever was announced by the initial chill. Her attending physician had not seen the diphtheria case. Our inference is that the poison lay dormant in her system until after delivery.
We do not consider cases belonging to the last two cases contagions in the strict sense of the word, and the physician using especial care need to give up his obstetrical practice, because he is unfortunate enough to have one patient so affected.
The symptoms as observed by us, and of the disease as it has appeared among us are as follows:.
The first is a chill of short duration, occurring from thirty to forty-eight hours after delivery, followed by a fever of great intensity. The chills return at irregular intervals, though the fever never leaves entirely. The temperature in true puerperal fever describes a curve of about forty-eight hours in length, the fever rising the first half and declining the second.
The patient may or may not present any spots of local tenderness, though there is generally some intolerance of touch over the whole abdomen; single spots of tenderness are more frequently found in the ovarian region.
The patient soon reaches a typhoid condition as regards tongue and bowels, though puerperal fever is generally accompanied by profuse sweating, and there is but little delirium. These symptoms are constant regardless of temperature, which frequently reaches 104 1/2 to 105, on the first and third days. There is usually diarrhoea, after the fifth day, the stools being profuse, yellow and gushing, often uncontrollable.
