I send this Essay again to the MEDICAL PROFESSION, without the change of

a word or syllable. I find, on reviewing it, that it anticipates and

eliminates those secondary questions which cannot be entertained for a

moment until the one great point of fact is peremptorily settled. In its

very statement of the doctrine maintained it avoids all discussion of the

nature of the disease "known as puerperal fever," and all the somewhat

stale philology of the word contagion. It mentions, fairly enough, the

names of sceptics, or unbelievers as to the reality of personal

transmission; of Dewees, of Tonnelle, of Duges, of Baudelocque, and

others; of course, not including those whose works were then unwritten or

unpublished; nor enumerating all the Continental writers who, in

ignorance of the great mass of evidence accumulated by British

practitioners, could hardly be called well informed on this subject. It

meets all the array of negative cases,--those in which disease did not

follow exposure,--by the striking example of small-pox, which, although

one of the most contagious of diseases, is subject to the most remarkable

irregularities and seeming caprices in its transmission. It makes full

allowance for other causes besides personal transmission, especially for

epidemic influences. It allows for the possibility of different modes of

conveyance of the destructive principle. It recognizes and supports the

belief that a series of cases may originate from a single primitive

source which affects each new patient in turn; and especially from cases

of Erysipelas. It does not undertake to discuss the theoretical aspect

of the subject; that is a secondary matter of consideration. Where facts

are numerous, and unquestionable, and unequivocal in their significance,

theory must follow them as it best may, keeping time with their step, and

not go before them, marching to the sound of its own drum and trumpet.

Having thus narrowed its area to a limited practical platform of

discussion, a matter of life and death, and not of phrases or theories,

it covers every inch of it with a mass of evidence which I conceive a

Committee of Husbands, who can count coincidences and draw conclusions as

well as a Synod of Accoucheurs, would justly consider as affording ample

reasons for an unceremonious dismissal of a practitioner (if it is

conceivable that such a step could be waited for), after five or six

funerals had marked the path of his daily visits, while other

practitioners were not thus escorted. To the Profession, therefore, I

submit the paper in its original form, and leave it to take care of

itself.

To the MEDICAL STUDENTS, into whose hands this Essay may fall, some words

of introduction may be appropriate, and perhaps, to a small number of

them, necessary. There are some among them who, from youth, or want of

training, are easily bewildered and confused in any conflict of opinions

into which their studies lead them. They are liable to lose sight of the

main question in collateral issues, and to be run away with by suggestive

speculations. They confound belief with evidence, often trusting the

first because it is expressed with energy, and slighting the latter

because it is calm and unimpassioned. They are not satisfied with proof;

they cannot believe a point is settled so long as everybody is not

silenced. They have not learned that error is got out of the minds that

cherish it, as the taenia is removed from the body, one joint, or a few

joints at a time, for the most part, rarely the whole evil at once. They

naturally have faith in their instructors, turning to them for truth, and

taking what they may choose to give them; babes in knowledge, not yet

able to tell the breast from the bottle, pumping away for the milk of

truth at all that offers, were it nothing better than a Professor's

shrivelled forefinger.

In the earliest and embryonic stage of professional development, any

violent impression on the instructor's mind is apt to be followed by some

lasting effect on that of the pupil. No mother's mark is more permanent

than the mental naevi and moles, and excrescences, and mutilations, that

students carry with them out of the lecture-room, if once the teeming

intellect which nourishes theirs has been scared from its propriety by

any misshapen fantasy. Even an impatient or petulant expression, which

to a philosopher would be a mere index of the low state of amiability of

the speaker at the moment of its utterance, may pass into the young mind

as an element of its future constitution, to injure its temper or corrupt

its judgment. It is a duty, therefore, which we owe to this younger

class of students, to clear any important truth which may have been

rendered questionable in their minds by such language, or any

truth-teller against whom they may have been prejudiced by hasty

epithets, from the impressions such words have left. Until this is done,

they are not ready for the question, where there is a question, for them

to decide. Even if we ourselves are the subjects of the prejudice, there

seems to be no impropriety in showing that this prejudice is local or

personal, and not an acknowledged conviction with the public at large.

It may be necessary to break through our usual habits of reserve to do

this, but this is the fault of the position in which others have placed

us.

Two widely-known and highly-esteemed practitioners, Professors in two of

the largest Medical Schools of the Union, teaching the branch of art

which includes the Diseases of Women, and therefore speaking with

authority; addressing in their lectures and printed publications large

numbers of young men, many of them in the tenderest immaturity of

knowledge, have recently taken ground in a formal way against the

doctrine maintained in this paper:

On the Non-Contagious Character of Puerperal Fever: An Introductory

Lecture. By Hugh L. Hodge, M. D., Professor of Obstetrics in the

University of Pennsylvania. Delivered Monday, October 11, 1852.

Philadelphia, 1852.

On the Nature, Signs, and Treatment of Childbed Fevers: in a Series of

Letters addressed to the Students of his Class. By Charles D. Meigs, M.

D., Professor of Midwifery and the Diseases of Women and Children in

Jefferson Medical College, Philadelphia, etc., etc. Philadelphia, 1854.

Letter VI.

The first of the two publications, Dr. Hodge's Lecture, while its

theoretical considerations and negative experiences do not seem to me to

require any further notice than such as lay ready for them in my Essay

written long before, is, I am pleased to say, unobjectionable in tone and

language, and may be read without offence.

This can hardly be said of the chapter of Dr. Meigs's volume which treats

of Contagion in Childbed Fever. There are expressions used in it which

might well put a stop to all scientific discussions, were they to form

the current coin in our exchange of opinions. I leave the "very young

gentlemen," whose careful expositions of the results of practice in more

than six thousand cases are characterized as "the jejune and fizenless

dreamings of sophomore writers," to the sympathies of those "dear young

friends," and "dear young gentlemen," who will judge how much to value

their instructor's counsel to think for themselves, knowing what they are

to expect if they happen not to think as he does.

One unpalatable expression I suppose the laws of construction oblige me

to appropriate to myself, as my reward for a certain amount of labor

bestowed on the investigation of a very important question of evidence,

and a statement of my own practical conclusions. I take no offence, and

attempt no retort. No man makes a quarrel with me over the counterpane

that covers a mother, with her new-born infant at her breast. There is

no epithet in the vocabulary of slight and sarcasm that can reach my

personal sensibilities in such a controversy. Only just so far as a

disrespectful phrase may turn the student aside from the examination of

the evidence, by discrediting or dishonoring the witness, does it call

for any word of notice.

I appeal from the disparaging language by which the Professor in the

Jefferson School of Philadelphia world dispose of my claims to be

listened to. I appeal, not to the vote of the Society for Medical

Improvement, although this was an unusual evidence of interest in the

paper in question, for it was a vote passed among my own townsmen; nor to

the opinion of any American, for none know better than the Professors in

the great Schools of Philadelphia how cheaply the praise of native

contemporary criticism is obtained. I appeal to the recorded opinions of

those whom I do not know, and who do not know me, nor care for me, except

for the truth that I may have uttered; to Copland, in his "Medical

Dictionary," who has spoken of my Essay in phrases to which the pamphlets

of American "scribblers" are seldom used from European authorities; to

Ramsbotham, whose compendious eulogy is all that self-love could ask; to

the "Fifth Annual Report" of the Registrar-General of England, in which

the second-hand abstract of my Essay figures largely, and not without

favorable comment, in an important appended paper. These testimonies,

half forgotten until this circumstance recalled them, are dragged into

the light, not in a paroxysm of vanity, but to show that there may be

food for thought in the small pamphlet which the Philadelphia Teacher

treats so lightly. They were at least unsought for, and would never have

been proclaimed but for the sake of securing the privilege of a decent

and unprejudiced hearing.

I will take it for granted that they have so far counterpoised the

depreciating language of my fellow-countryman and fellow-teacher as to

gain me a reader here and there among the youthful class of students I am

now addressing. It is only for their sake that I think it necessary to

analyze, or explain, or illustrate, or corroborate any portion of the

following Essay. But I know that nothing can be made too plain for

beginners; and as I do not expect the practitioner, or even the more

mature student, to take the trouble to follow me through an Introduction

which I consider wholly unnecessary and superfluous for them, I shall not

hesitate to stoop to the most elementary simplicity for the benefit of

the younger student. I do this more willingly because it affords a good

opportunity, as it seems to me, of exercising the untrained mind in that

medical logic which does not seem to have been either taught or practised

in our schools of late, to the extent that might be desired.

I will now exhibit, in a series of propositions reduced to their simplest

expression, the same essential statements and conclusions as are

contained in the Essay, with such commentaries and explanations as may be

profitable to the inexperienced class of readers addressed.

I. It has been long believed, by many competent observers, that

Puerperal Fever (so called) is sometimes carried from patient to patient

by medical assistants.

II. The express object of this Essay is to prove that it is so carried.

III. In order to prove this point, it is not necessary to consult any

medical theorist as to whether or not it is consistent with his

preconceived notions that such a mode of transfer should exist.

IV. If the medical theorist insists on being consulted, and we see fit

to indulge him, he cannot be allowed to assume that the alleged laws of

contagion, deduced from observation in other diseases, shall be cited to

disprove the alleged laws deduced from observation in this. Science

would never make progress under such conditions. Neither the long

incubation of hydrophobia, nor the protecting power of vaccination, would

ever have been admitted, if the results of observation in these

affections had been rejected as contradictory to the previously

ascertained laws of contagion.

V. The disease in question is not a common one; producing, on the

average, about three deaths in a thousand births, according to the

English Registration returns which I have examined.

VI. When an unusually large number of cases of this disease occur about

the same time, it is inferred, therefore, that there exists some special

cause for this increased frequency. If the disease prevails extensively

over a wide region of country, it is attributed without dispute to an

epidemic influence. If it prevails in a single locality, as in a

hospital, and not elsewhere, this is considered proof that some local

cause is there active in its production.

VII. When a large number of cases of this disease occur in rapid

succession, in one individual's ordinary practice, and few or none

elsewhere, these cases appearing in scattered localities, in patients of

the same average condition as those who escape under the care of others,

there is the same reason for connecting the cause of the disease with the

person in this instance, as with the place in that last mentioned.

VIII. Many series of cases, answering to these conditions, are given in

this Essay, and many others will be referred to which have occurred since

it was written.

IX. The alleged results of observation may be set aside; first, because

the so-called facts are in their own nature equivocal; secondly, because

they stand on insufficient authority; thirdly, because they are not

sufficiently numerous. But, in this case, the disease is one of striking

and well-marked character; the witnesses are experts, interested in

denying and disbelieving the facts; the number of consecutive cases in

many instances frightful, and the number of series of cases such that I

have no room for many of them except by mere reference.

X. These results of observation, being admitted, may, we will suppose,

be interpreted in different methods. Thus the coincidences may be

considered the effect of chance. I have had the chances calculated by a

competent person, that a given practitioner, A., shall have sixteen fatal

cases in a month, on the following data: A. to average attendance upon

two hundred and fifty births in a year; three deaths in one thousand

births to be assumed as the average from puerperal fever; no epidemic to

be at the time prevailing. It follows, from the answer given me, that if

we suppose every one of the five hundred thousand annual births of

England to have been recorded during the last half-century, there would

not be one chance in a million million million millions that one such

series should be noted. No possible fractional error in this calculation

can render the chance a working probability. Applied to dozens of series

of various lengths, it is obviously an absurdity. Chance, therefore, is

out of the question as an explanation of the admitted coincidences.

XI. There is, therefore, some relation of cause and effect between the

physician's presence and the patient's disease.

XII. Until it is proved to what removable condition attaching to the

attendant the disease is owing, he is bound to stay away from his

patients so soon as he finds himself singled out to be tracked by the

disease. How long, and with what other precautions, I have suggested,

without dictating, at the close of my Essay. If the physician does not

at once act on any reasonable suspicion of his being the medium of

transfer, the families where he is engaged, if they are allowed to know

the facts, should decline his services for the time. His feelings on the

occasion, however interesting to himself, should not be even named in

this connection. A physician who talks about ceremony and gratitude, and

services rendered, and the treatment he got, surely forgets himself; it

is impossible that he should seriously think of these small matters where

there is even a question whether he may not carry disease, and death, and

bereavement into any one of "his families," as they are sometimes called.

I will now point out to the young student the mode in which he may

relieve his mind of any confusion, or possibly, if very young, any doubt,

which the perusal of Dr. Meigs's Sixth Letter may have raised in his

mind.

The most prominent ideas of the Letter are, first, that the transmissible

nature of puerperal fever appears improbable, and, secondly, that it

would be very inconvenient to the writer. Dr. Woodville, Physician to the

Small-Pox and Inoculation Hospital in London, found it improbable, and

exceedingly inconvenient to himself, that cow pox should prevent

small-pox; but Dr. Jenner took the liberty to prove the fact,

notwithstanding.

I will first call the young student's attention to the show of negative

facts (exposure without subsequent disease), of which much seems to be

thought. And I may at the same time refer him to Dr. Hodge's Lecture,

where he will find the same kind of facts and reasoning. Let him now

take up Watson's Lectures, the good sense and spirit of which have made

his book a universal favorite, and open to the chapter on Continued

Fever. He will find a paragraph containing the following sentence: "A

man might say, 'I was in the battle of Waterloo, and saw many men around

me fall down and die, and it was said that they were struck down by

musket-balls; but I know better than that, for I was there all the time,

and so were many of my friends, and we were never hit by any

musket-balls. Musket-balls, therefore, could not have been the cause of

the deaths we witnessed.' And if, like contagion, they were not palpable

to the senses, such a person might go on to affirm that no proof existed

of there being any such thing as musket-balls." Now let the student turn

back to the chapter on Hydrophobia in the same volume. He will find that

John Hunter knew a case in which, of twenty-one persons bitten, only one

died of the disease. He will find that one dog at Charenton was bitten

at different times by thirty different mad dogs, and outlived it all. Is

there no such thing, then, as hydrophobia? Would one take no especial

precautions if his wife, about to become a mother, had been bitten by a

rabid animal, because so many escape? Or let him look at "Underwood on

Diseases of Children," [Philadelphia, 1842, p. 244, note.] and he will

find the case of a young woman who was inoculated eight times in thirty

days, at the same time attending several children with smallpox, and yet

was not infected. But seven weeks afterwards she took the disease and

died.

It would seem as if the force of this argument could hardly fail to be

seen, if it were granted that every one of these series of cases were so

reported as to prove that there could have been no transfer of disease.

There is not one of them so reported, in the Lecture or the Letter, as to

prove that the disease may not have been carried by the practitioner. I

strongly suspect that it was so carried in some of these cases, but from

the character of the very imperfect evidence the question can never be

settled without further disclosures.

Although the Letter is, as I have implied, principally taken up with

secondary and collateral questions, and might therefore be set aside as

in the main irrelevant, I am willing, for the student's sake, to touch

some of these questions briefly, as an illustration of its logical

character.

The first thing to be done, as I thought when I wrote my Essay, was to

throw out all discussions of the word contagion, and this I did

effectually by the careful wording of my statement of the subject to be

discussed. My object was not to settle the etymology or definition of a

word, but to show that women had often died in childbed, poisoned in some

way by their medical attendants. On the other point, I, at least, have

no controversy with anybody, and I think the student will do well to

avoid it in this connection. If I must define my position, however, as

well as the term in question, I am contented with Worcester's definition;

provided always this avowal do not open another side controversy on the

merits of his Dictionary, which Dr. Meigs has not cited, as compared with

Webster's, which he has.

I cannot see the propriety of insisting that all the laws of the eruptive

fevers must necessarily hold true of this peculiar disease of puerperal

women. If there were any such propriety, the laws of the eruptive fevers

must at least be stated correctly. It is not true, for instance, as Dr.

Meigs states, that contagion is "no respecter of persons;" that "it

attacks all individuals alike." To give one example: Dr. Gregory, of the

Small-Pox Hospital, who ought to know, says that persons pass through

life apparently insensible to or unsusceptible of the small-pox virus,

and that the same persons do not take the vaccine disease.

As to the short time of incubation, of which so much is made, we have no

right to decide beforehand whether it shall be long or short, in the

cases we are considering. A dissection wound may produce symptoms of

poisoning in six hours; the bite of a rabid animal may take as many

months.

After the student has read the case in Dr. Meigs's 136th paragraph, and

the following one, in which he exclaims against the idea of contagion,

because the patient, delivered on the 26th of December, was attacked in

twenty-four hours, and died on the third day, let him read what happened

at the "Black Assizes" of 1577 and 1750. In the first case, six hundred

persons sickened the same night of the exposure, and three hundred more

in three days. [Elliotson's Practice, p. 298.] Of those attacked in the

latter year, the exposure being on the 11th of May, Alderman Lambert died

on the 13th, Under-Sheriff Cox on the 14th, and many of note before the

20th. But these are old stories. Let the student listen then to Dr.

Gerhard, whose reputation as a cautious observer he may be supposed to

know. "The nurse was shaving a man, who died in a few hours after his

entrance; he inhaled his breath, which had a nauseous taste, and in an

hour afterwards was taken with nausea, cephalalgia, and singing of the

ears. From that moment the attack began, and assumed a severe character.

The assistant was supporting another patient, who died soon afterwards;

he felt the pungent heat upon his skin, and was taken immediately with

the symptoms of typhus." [Am. Jour. Med. Sciences, Feb. 1837, p. 299.]

It is by notes of cases, rather than notes of admiration, that we must

be guided, when we study the Revised Statutes of Nature, as laid down

from the curule chairs of Medicine.

Let the student read Dr. Meigs's 140th paragraph soberly, and then

remember, that not only does he infer, suspect, and surmise, but he

actually asserts (page 154), "there was poison in the house," because

three out of five patients admitted into a ward had puerperal fever and

died. Have I not as much right to draw a positive inference from "Dr.

A.'s" seventy exclusive cases as he from the three cases in the ward of

the Dublin Hospital? All practical medicine, and all action in common

affairs, is founded on inferences. How does Dr. Meigs know that the

patients he bled in puerperal fever would not have all got well if he had

not bled them?

"You see a man discharge a gun at another; you see the flash, you hear

the report, you see the person fall a lifeless corpse; and you infer,

from all these circumstances, that there was a ball discharged from the

gun, which entered his body and caused his death, because such is the

usual and natural cause of such an effect. But you did not see the ball

leave the gun, pass through the air, and enter the body of the slain; and

your testimony to the fact of killing is, therefore, only

inferential,--in other words, circumstantial. It is possible that no

ball was in the gun; and we infer that there was, only because we cannot

account for death on any other supposition." [Chief Justice Gibson, in

Am. Law Journal, vol. vi. p. 123.]

"The question always comes to this: Is the circumstance of intercourse

with the sick followed by the appearance of the disease in a proportion

of cases so much greater than any other circumstance common to any

portion of the inhabitants of the place under observation, as to make it

inconceivable that the succession of cases occurring in persons having

that intercourse should have been the result of chance? If so, the

inference is unavoidable, that that intercourse must have acted as a

cause of the disease. All observations which do not bear strictly on

that point are irrelevant, and, in the case of an epidemic first

appearing in a town or district, a succession of two cases is sometimes

sufficient to furnish evidence which, on the principle I have stated, is

nearly irresistible."

Possibly an inexperienced youth may be awe-struck by the quotation from

Cuvier. These words, or their equivalent, are certainly to be found in

his Introduction. So are the words "top not come down"! to be found in

the Bible, and they were as much meant for the ladies' head-dresses as

the words of Cuvier were meant to make clinical observation wait for a

permit from anybody to look with its eyes and count on its fingers. Let

the inquiring youth read the whole Introduction, and he will see what

they mean.

I intend no breach of courtesy, but this is a proper place to warn the

student against skimming the prefaces and introductions of works for

mottoes and embellishments to his thesis. He cannot learn anatomy by

thrusting an exploring needle into the body. He will be very liable to

misquote his author's meaning while he is picking off his outside

sentences. He may make as great a blunder as that simple prince who

praised the conductor of his orchestra for the piece just before the

overture; the musician was too good a courtier to tell him that it was

only the tuning of the instruments.

To the six propositions in the 142d paragraph, and the remarks about

"specific" diseases, the answer, if any is necessary, seems very simple.

An inflammation of a serous membrane may give rise to secretions which

act as a poison, whether that be a "specific" poison or not, as Dr. Homer

has told his young readers, and as dissectors know too well; and that

poison may produce its symptoms in a few hours after the system has

received it, as any may see in Druitt's "Surgery," if they care to look.

Puerperal peritonitis may produce such a poison, and puerperal women may

be very sensible to its influences, conveyed by contact or exhalation.

Whether this is so or not, facts alone can determine, and to facts we

have had recourse to settle it.

The following statement is made by Dr. Meigs in his 142d paragraph, and

developed more at length, with rhetorical amplifications, in the 134th.

"No human being, save a pregnant or parturient woman, is susceptible to

the poison." This statement is wholly incorrect, as I am sorry to have

to point out to a Teacher in Dr. Meigs's position. I do not object to the

erudition which quotes Willis and Fernelius, the last of whom was

pleasantly said to have "preserved the dregs of the Arabs in the honey of

his Latinity." But I could wish that more modern authorities had not

been overlooked. On this point, for instance, among the numerous facts

disproving the statement, the "American Journal of Medical Sciences,"

published not far from his lecture-room, would have presented him with a

respectable catalog of such cases. Thus he might refer to Mr. Storrs's

paper "On the Contagious Effects of Puerperal Fever on the Male Subject;

or on Persons not Childbearing" (Jan. 1846), or to Dr. Reid's case

(April, 1846), or to Dr. Barron's statement of the children's dying of

peritonitis in an epidemic of puerperal fever at the Philadelphia

Hospital (Oct. 1842), or to various instances cited in Dr. Kneeland's

article (April, 186). Or, if he would have referred to the "New York

Journal," he might have seen Prof. Austin Flint's cases. Or, if he had

honored my Essay so far, he might have found striking instances of the

same kind in the first of the new series of cases there reported and

elsewhere. I do not see the bearing of his proposition, if it were true.

But it is one of those assertions that fall in a moment before a slight

examination of the facts; and I confess my surprise, that a professor who

lectures on the Diseases of Women should have ventured to make it.

Nearly seven pages are devoted to showing that I was wrong in saying I

would not be "understood to imply that there exists a doubt in the mind

of any well-informed member of the medical profession as to the fact that

puerperal fever is sometimes communicated from one person to another,

both directly and indirectly." I will devote seven lines to these seven

pages, which seven lines, if I may say it without offence, are, as it

seems to me, six more than are strictly necessary.

The following authors are cited as sceptics by Dr. Meigs: Dewees.--I

cited the same passage. Did not know half the facts. Robert

Lee.--Believes the disease is sometimes communicable by contagion.

Tonnelle, Baudelocque. Both cited by me. Jacquemier.--Published three

years after my Essay. Kiwisch. " Behindhand in knowledge of Puerperal

Fever." [B. & F. Med. Rev. Jan. 1842.] Paul Dubois.--Scanzoni.

These Continental writers not well informed on this point.[See Dr.

Simpson's Remarks at Meeting of Edin. Med. Chir. Soc. (Am. Jour.

Oct. 1851.)]

The story of Von Busch is of interest and value, but there is nothing in

it which need perplex the student. It is not pretended that the disease

is always, or even, it may be, in the majority of cases, carried about by

attendants; only that it is so carried in certain cases. That it may

have local and epidemic causes, as well as that depending on personal

transmission, is not disputed. Remember how small-pox often disappears

from a community in spite of its contagious character, and the necessary

exposure of many persons to those suffering from it; in both diseases

contagion is only one of the coefficients of the disease.

I have already spoken of the possibility that Dr. Meigs may have been the

medium of transfer of puerperal fever in some of the cases he has briefly

catalogued. Of Dr. Rutter's cases I do not know how to speak. I only

ask the student to read the facts stated by Dr. Condie, as given in my

Essay, and say whether or not a man should allow his wife to be attended

by a practitioner in whose hands "scarcely a female that has been

delivered for weeks past has escaped an attack," "while no instance of

the disease has occurred in the patients of any other accoucheur

practising in the same district." If I understand Dr. Meigs and Dr.

Hodge, they would not warn the physician or spare the patient under such

circumstances. They would "go on," if I understand them, not to seven,

or seventy, only, but to seventy times seven, if they could find

patients. If this is not what they mean, may we respectfully ask them to

state what they do mean, to their next classes, in the name of humanity,

if not of science!

I might repeat the question asked concerning Dr. Rutter's cases, with

reference to those reported by Dr. Roberton. Perhaps, however, the

student would like to know the opinion of a person in the habit of

working at matters of this kind in a practical point of view. To satisfy

him on this ground, I addressed the following question to the President

of one of our principal Insurance Companies, leaving Dr. Meigs's book and

my Essay in his hands at the same time.

Question. "If such facts as Roberton's cases were before you, and the

attendant had had ten, or even five fatal cases, or three, or two even,

would you, or would you not, if insuring the life of the next patient to

be taken care of by that attendant, expect an extra premium over that of

an average case of childbirth?"

Answer. "Of course I should require a very large extra premium, if I

would take take risk at all."

But I do not choose to add the expressions of indignation which the

examination of the facts before him called out. I was satisfied from the

effect they produced on him, that if all the hideous catalogues of cases

now accumulated were fully brought to the knowledge of the public,

nothing, since the days of Burke and Hare, has raised such a cry of

horror as would be shrieked in the ears of the Profession.

Dr. Meigs has elsewhere invoked "Providence" as the alternative of

accident, to account for the "coincidences." ("Obstetrics," Phil. 1852,

p. 631.) If so, Providence either acts through the agency of secondary

causes, as in other diseases, or not. If through such causes, let us

find out what they are, as we try to do in other cases. It may be true

that offences, or diseases, will come, but "woe unto him through whom

they come," if we catch him in the voluntary or careless act of bringing

them! But if Providence does not act through secondary causes in this

particular sphere of etiology, then why does Dr. Meigs take such pains to

reason so extensively about the laws of contagion, which, on that

supposition, have no more to do with this case than with the plague which

destroyed the people after David had numbered them? Above all, what

becomes of the theological aspect of the question, when he asserts that a

practitioner was "only unlucky in meeting with the epidemic cases?" (Op.

cit. p. 633.) We do not deny that the God of battles decides the fate of

nations; but we like to have the biggest squadrons on our side, and we

are particular that our soldiers should not only say their prayers, but

also keep their powder dry. We do not deny the agency of Providence in

the disaster at Norwalk, but we turn off the engineer, and charge the

Company five thousand dollars apiece for every life that is sacrificed.

Why a grand jury should not bring in a bill against a physician who

switches off a score of women one after the other along his private

track, when he knows that there is a black gulf at the end of it, down

which they are to plunge, while the great highway is clear, is more than

I can answer. It is not by laying the open draw to Providence that he is

to escape the charge of manslaughter.

To finish with all these lesser matters of question, I am unable to see

why a female must necessarily be unattended in her confinement, because

she declines the services of a particular practitioner. In all the

series of cases mentioned, the death-carrying attendant was surrounded by

others not tracked by disease and its consequences. Which, I would ask,

is worse,--to call in another, even a rival practitioner, or to submit an

unsuspecting female to a risk which an Insurance Company would have

nothing to do with?

I do not expect ever to return to this subject. There is a point of

mental saturation, beyond which argument cannot be forced without

breeding impatient, if not harsh, feelings towards those who refuse to be

convinced. If I have so far manifested neither, it is well to stop here,

and leave the rest to those younger friends who may have more stomach for

the dregs of a stale argument.

The extent of my prefatory remarks may lead some to think that I attach

too much importance to my own Essay. Others may wonder that I should

expend so many words upon the two productions referred to, the Letter and

the Lecture. I do consider my Essay of much importance so long as the

doctrine it maintains is treated as a question, and so long as any

important part of the defence of that doctrine is thought to rest on its

evidence or arguments. I cannot treat as insignificant any opinions

bearing on life, and interests dearer than life, proclaimed yearly to

hundreds of young men, who will carry them to their legitimate results in

practice.

The teachings of the two Professors in the great schools of Philadelphia

are sure to be listened to, not only by their immediate pupils, but by

the Profession at large. I am too much in earnest for either humility or

vanity, but I do entreat those who hold the keys of life and death to

listen to me also for this once. I ask no personal favor; but I beg to

be heard in behalf of the women whose lives are at stake, until some

stronger voice shall plead for them.

I trust that I have made the issue perfectly distinct and intelligible.

And let it be remembered that this is no subject to be smoothed over by

nicely adjusted phrases of half-assent and half-censure divided between

the parties. The balance must be struck boldly and the result declared

plainly. If I have been hasty, presumptuous, ill-informed, illogical; if

my array of facts means nothing; if there is no reason for any caution in

the view of these facts; let me be told so on such authority that I must

believe it, and I will be silent henceforth, recognizing that my mind is

in a state of disorganization. If the doctrine I have maintained is a

mournful truth; if to disbelieve it, and to practise on this disbelief,

and to teach others so to disbelieve and practise, is to carry

desolation, and to charter others to carry it, into confiding families,

let it be proclaimed as plainly what is to be thought of the teachings of

those who sneer at the alleged dangers, and scout the very idea of

precaution. Let it be remembered that persons are nothing in this

matter; better that twenty pamphleteers should be silenced, or as many

professors unseated, than that one mother's life should be taken. There

is no quarrel here between men, but there is deadly incompatibility and

exterminating warfare between doctrines. Coincidences meaning nothing,

though a man have a monopoly of the disease for weeks or months; or cause

and effect, the cause being in some way connected with the person; this

is the question. If I am wrong, let me be put down by such a rebuke as

no rash declaimer has received since there has been a public opinion in

the medical profession of America; if I am right, let doctrines which

lead to professional homicide be no longer taught from the chairs of

those two great Institutions. Indifference will not do here; our

Journalists and Committees have no right to take up their pages with

minute anatomy and tediously detailed cases, while it is a question

whether or not the "blackdeath" of child-bed is to be scattered broadcast

by the agency of the mother's friend and adviser. Let the men who mould

opinions look to it; if there is any voluntary blindness, any interested

oversight, any culpable negligence, even, in such a matter, and the facts

shall reach the public ear; the pestilence-carrier of the lying-in

chamber must look to God for pardon, for man will never forgive him.

THE CONTAGIOUSNESS OF PUERPERAL FEVER.

In collecting, enforcing, and adding to the evidence accumulated upon

this most serious subject, I would not be understood to imply that there

exists a doubt in the mind of any well-informed member of the medical

profession as to the fact that puerperal fever is sometimes communicated

from one person to another, both directly and indirectly. In the present

state of our knowledge upon this point I should consider such doubts

merely as a proof that the sceptic had either not examined the evidence,

or, having examined it, refused to accept its plain and unavoidable

consequences. I should be sorry to think, with Dr. Rigby, that it was a

case of "oblique vision;" I should be unwilling to force home the

argumentum ad hominem of Dr. Blundell, but I would not consent to make a

question of a momentous fact which is no longer to be considered as a

subject for trivial discussions, but to be acted upon with silent

promptitude. It signifies nothing that wise and experienced

practitioners have sometimes doubted the reality of the danger in

question; no man has the right to doubt it any longer. No negative

facts, no opposing opinions, be they what they may, or whose they may,

can form any answer to the series of cases now within the reach of all

who choose to explore the records of medical science.

If there are some who conceive that any important end would be answered

by recording such opinions, or by collecting the history of all the cases

they could find in which no evidence of the influence of contagion

existed, I believe they are in error. Suppose a few writers of authority

can be found to profess a disbelief in contagion,--and they are very few

compared with those who think differently,--is it quite clear that they

formed their opinions on a view of all the facts, or is it not apparent

that they relied mostly on their own solitary experience? Still further,

of those whose names are quoted, is it not true that scarcely a single

one could by any possibility have known the half or the tenth of the

facts bearing on the subject which have reached such a frightful amount

within the last few years? Again, as to the utility of negative facts,

as we may briefly call them,--instances, namely, in which exposure has

not been followed by disease,--although, like other truths, they may be

worth knowing, I do not see that they are like to shed any important

light upon the subject before us. Every such instance requires a good

deal of circumstantial explanation before it can be accepted. It is not

enough that a practitioner should have had a single case of puerperal

fever not followed by others. It must be known whether he attended

others while this case was in progress, whether he went directly from one

chamber to others, whether he took any, and what precautions. It is

important to know that several women were exposed to infection derived

from the patient, so that allowance may be made for want of

predisposition. Now if of negative facts so sifted there could be

accumulated a hundred for every one plain instance of communication here

recorded, I trust it need not be said that we are bound to guard and

watch over the hundredth tenant of our fold, though the ninety and nine

may be sure of escaping the wolf at its entrance. If any one is

disposed, then, to take a hundred instances of lives endangered or

sacrificed out of those I have mentioned, and make it reasonably clear

that within a similar time and compass ten thousand escaped the same

exposure, I shall thank him for his industry, but I must be permitted to

hold to my own practical conclusions, and beg him to adopt or at least to

examine them also. Children that walk in calico before open fires are not

always burned to death; the instances to the contrary may be worth

recording; but by no means if they are to be used as arguments against

woollen frocks and high fenders.

I am not sure that this paper will escape another remark which it might

be wished were founded in justice. It may be said that the facts are too

generally known and acknowledged to require any formal argument or

exposition, that there is nothing new in the positions advanced, and no

need of laying additional statements before the Profession. But on

turning to two works, one almost universally, and the other extensively

appealed to as authority in this country, I see ample reason to overlook

this objection. In the last edition of Dewees's Treatise on the

"Diseases of Females," it is expressly said, "In this country, under no

circumstance that puerperal fever has appeared hitherto, does it afford

the slightest ground for the belief that it is contagious." In the

"Philadelphia Practice of Midwifery" not one word can be found in the

chapter devoted to this disease which would lead the reader to suspect

that the idea of contagion had ever been entertained. It seems proper,

therefore, to remind those who are in the habit of referring to these

works for guidance, that there may possibly be some sources of danger

they have slighted or omitted, quite as important as a trifling

irregularity of diet, or a confined state of the bowels, and that

whatever confidence a physician may have in his own mode of treatment,

his services are of questionable value whenever he carries the bane as

well as the antidote about his person.

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.

Let me begin by throwing out certain incidental questions, which, without

being absolutely essential, would render the subject more complicated,

and by making such 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

may not be, and probably are not, equally contagious 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 demarcation between such forms as may be propagated by contagion and

those which are never so propagated. This general result I shall only

support by the authority of Dr. Ramsbotham, who gives, as the result of

his experience, that the same symptoms belong to what he calls the

infectious and the sporadic forms of the disease, and the opinion of

Armstrong in his original Essay. If others can show any such

distinction, I leave it to them to do it. But there are cases enough

that show the prevalence of the disease among the patients of a single

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 with which his hand comes in contact. Many facts

and opinions are in favor 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 from the subject, fails every

day to produce its legitimate effect, though every precaution is taken to

insure its action. This is still more remarkably the case with scarlet

fever and some other diseases.

4. It is granted that the disease may be produced and variously modified

by many causes besides contagion, and more especially by epidemic and

endemic influences. But this is not peculiar to the disease in question.

There is no doubt that small-pox is propagated to a great extent by

contagion, yet it goes through the same periods of periodical increase

and diminution which have been remarked in puerperal fever. If the

question is asked how we 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 from Mr.

Farr's letter to the Registrar-General. He makes the statement that

"five die weekly of small-pox in the metropolis when the disease is not

epidemic,"--and adds, "The problem for solution is,--Why do the five

deaths become 10, 15, 20, 31, 58, 88, weekly, and then progressively fall

through the same measured steps?"

5. I take it for granted, that if it can be shown that great numbers of

lives have been and are sacrificed to ignorance or blindness on this

point, no other error of which physicians or nurses may be occasionally

suspected will be alleged 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 among the earlier special works upon the disease. Apart 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 may be quoted as a model

which might have been often followed with 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 small-pox or measles, and

operated more speedily than any other infection with which I am

acquainted."

"I had evident proofs that every person who had been with a patient in

the puerperal fever became charged with an atmosphere of infection, which

was communicated to every pregnant woman who happened to come within its

sphere. This is not an assertion, but a fact, admitting of

demonstration, as may be seen by a perusal of the foregoing

table,"--referring to a table of seventy-seven cases, in many of which

the channel of propagation was evident.

He adds, "It is a disagreeable declaration for me to mention, that I

myself was the means of carrying the infection to a great number of

women." He then enumerates a number of instances in which the disease

was conveyed by midwives and others to the neighboring villages, 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 atmosphere."

But his most terrible evidence is given 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 am

acquainted with two gentlemen in another town, where 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 modes of treatment. [On the

Management of Lying-in Women, p. 120.]

Dr. Armstrong has given a number of instances in his Essay on Puerperal

Fever, of the prevalence of the disease among the patients of a single

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 number forty were witnessed by Mr. Gregson and his assistant, Mr.

Gregory, the remainder having been separately seen by three accoucheurs."

There is appended to the London edition of this Essay, a letter from Mr.

Gregson, in which that gentleman says, in reference to the great number

of cases occurring in his practice, "The cause of this I cannot pretend

fully to explain, but I should be wanting in common liberality if I were

to make any hesitation in asserting, that the disease which appeared in

my practice was highly contagious, and communicable from one puerperal

woman to another." "It is customary among the lower and middle ranks of

people to make frequent personal visits to puerperal women resident in

the same neighborhood, and I have ample evidence for affirming that the

infection of the disease was often carried about in that manner; and,

however painful to my feelings, I must in candor declare, that it is very

probable the contagion was conveyed, in some instances, by myself, though

I took every possible care to prevent such a thing from happening, the

moment that I ascertained that the distemper was infectious." Dr.

Armstrong goes on to mention six other instances within his knowledge, in

which the disease had at different times and places been limited, in the

same singular manner, to the practice of individuals, while it existed

scarcely if at all among the patients of others around them. Two of the

gentlemen became so convinced of their conveying the contagion, that they

withdrew for a time from practice.

I find a brief notice, in an American Journal, of another series of

cases, first mentioned by Mr. Davies, in the "Medical Repository." This

gentleman stated his conviction that the disease is contagious.

"In the autumn of 1822 he met with twelve cases, while his medical

friends in the neighborhood did not meet with any, 'or at least very

few.' He could attribute this circumstance to no other cause than his

having been present at the examination, after death, of two cases, some

time previous, and of his having imparted the disease to his patients,

notwithstanding every precaution."

Dr. Gooch says, "It is not uncommon for the greater number of cases to

occur in the practice of one man, whilst the other practitioners of the

neighborhood, 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 similar

disease; two more of his lying-in patients, in rapid succession, met with

the same fate; struck by the thought, that he might have carried

contagion in his clothes, he instantly changed them, and 'met with no

more cases of the kind.' A woman in the country, who was 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 her met with the same fate, till the neighborhood,

getting afraid of her, ceased to employ her."

In the winter of the year 1824, "Several instances occurred of its

prevalence among the patients of particular practitioners, whilst others

who were equally busy met with few or none. One instance of this kind

was very remarkable. A general practitioner, in large 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 one month, during which 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 him whether puerperal

fever was at all prevalent in his neighborhood, on which he burst into

tears, and related the above circumstances.

"Among 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." [Lond. Med. Gaz. May 2, 1835.]

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, almost every patient being attacked

with it, while others had not a single case. It seemed capable, he

thought, of conveyance, not only by common modes; but through the dress

of the attendants upon the patient.

In a letter to be found in the "London Medical Gazette" for January,

1840, Mr. Roberton of Manchester makes the statement which I here give 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 from this date

the same midwife delivered thirty women, residing in different parts of

an extensive suburb, of which number sixteen caught 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 mentioned are twenty-five in

number, and deliver, on an average, ninety women a week, or about three

hundred and eighty a month. None of these women had a case of puerperal

fever. "Yet all this time this woman was crossing the other midwives in

every direction, scores of the patients of the charity being delivered by

them in the very same quarters where her cases of fever were happening."

Mr. Roberton remarks, that little more than half the women she delivered

during this 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.

Omitting particulars, then, I content myself with remarking, generally,

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 same neighborhood, was not

observed. Some, as I have been told, have lost ten, twelve, or a greater

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 most should be delivered, unaided, in a stable, by the manger-side,

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."

At a meeting of the Royal Medical and Chirurgical Society, Dr. King

mentioned that some years since a practitioner at Woolwich lost sixteen

patients from puerperal fever in the same year. He was compelled to give

up practice for one or two years, his business being divided among the

neighboring practitioners. No case of puerperal fever occurred

afterwards, neither had any of the neighboring surgeons any cases of this

disease.

At the same meeting Mr. Hutchinson mentioned the occurrence of three

consecutive cases of puerperal fever, followed subsequently by two

others, all in the practice of one accoucheur.[Lancet, May 2, 1840.]

Dr. Lee makes the following statement: "In the last two weeks of

September, 1827, five fatal cases of uterine inflammation came under our

observation. All the individuals so attacked had been attended in labor

by the same midwife, and no example of a febrile or inflammatory disease

of a serious nature occurred during that period among the other patients

of the Westminster General Dispensary, who had been attended by the other

midwives belonging to that institution."

The recurrence of long series of cases like those I have cited, reported

by those most interested to disbelieve in contagion, scattered along

through an interval of half a century, might have been thought sufficient

to satisfy the minds of all inquirers that here was something more than a

singular coincidence. But if, on a more extended observation, it should

be found that the same ominous groups of cases clustering about

individual practitioners were observed in a remote country, at different

times, and in widely separated regions, it would seem incredible that any

should be found too prejudiced or indolent to accept the solemn truth

knelled into their ears by the funeral bells from both sides of the

ocean,--the plain conclusion that the physician and the disease entered,

hand in hand, into the chamber of the unsuspecting patient.

That such series of cases have been observed in this country, and in this

neighborhood, I proceed to show.

In Dr. Francis's "Notes to Denman's Midwifery," a passage is cited from

Dr. Hosack, in which he refers to certain puerperal cases which proved

fatal to several lying-in women, and in some of which the disease was

supposed to be conveyed by the accoucheurs themselves.

A writer in the "New York Medical and Physical Journal" for October,

1829, in speaking of the occurrence of puerperal fever, confined to one

man's practice, remarks, "We have known cases of this kind occur, though

rarely, in New York."

I mention these little hints about the occurrence of such cases, partly

because they are the first I have met with in American medical

literature, but more especially because they serve to remind us that

behind the fearful array of published facts there lies a dark list of

similar events, unwritten in the records of science, but long remembered

by many a desolated fireside.

Certainly nothing can be more open and explicit than the account given by

Dr. Peirson of Salem, of the cases seen by him. In the first nineteen

days of January, 1829, he had five consecutive cases of puerperal fever,

every patient he attended being attacked, and the three first cases

proving fatal. In March of the same year he had two moderate cases, in

June, another case, and in July, another, which proved fatal. "Up to

this period," he remarks, "I am not informed that a single case had

occurred in the practice of any other physician. Since that period I

have had no fatal case in my practice, although I have had several

dangerous cases. I have attended in all twenty cases of this disease, of

which four have been fatal. I am not aware that there has been any other

case in the town of distinct puerperal peritonitis, although I am willing

to admit my information may be very defective on this point. I have been

told of some I 'mixed cases,' and 'morbid affections after delivery.'"

In the "Quarterly Summary of the Transactions of the College of

Physicians of Philadelphia" may be found some most extraordinary

developments respecting a series of cases occurring in the practice of a

member of that body.

Dr. Condie called the attention of the Society to the prevalence, at the

present time, of puerperal fever of a peculiarly insidious and malignant

character. "In the practice of one gentleman extensively engaged as an

obstetrician, nearly every female he has attended in confinement, during

several weeks past, within the above limits" (the southern sections and

neighboring districts), "had been attacked by the fever."

"An important query presents itself, the Doctor observed, in reference to

the particular form of fever now prevalent. Is it, namely, capable of

being propagated by contagion, and is a physician who has been in

attendance upon a case of the disease warranted in continuing, without

interruption, his practice as an obstetrician? Dr. C., although not a

believer in the contagious character of many of those affections

generally supposed to be propagated in this manner, has nevertheless

become convinced by the facts that have fallen under his notice, that the

puerperal fever now prevailing is capable of being communicated by

contagion. How otherwise can be explained the very curious circumstance

of the disease in one district being exclusively confined to the practice

of a single physician, a Fellow of this College, extensively engaged in

obstetrical practice,--while no instance of the disease has occurred in

the patients under the care of any other accoucheur practising within the

same district; scarcely a female that has been delivered for weeks past

has escaped an attack?"

Dr. Rutter, the practitioner referred to, "observed that, after the

occurrence of a number of cases of the disease in his practice, he had

left the city and remained absent for a week, but on returning, no

article of clothing he then wore having been used by him before, one of

the very first cases of parturition he attended was followed by an attack

of the fever, and terminated fatally; he cannot, readily, therefore,

believe in the transmission of the disease from female to female, in the

person or clothes of the physician."

The meeting at which these remarks were made was held on the 3d of May,

1842. In a letter dated December 20, 1842, addressed to Dr. Meigs, and

to be found in the "Medical Examiner," he speaks of "those horrible

cases of puerperal fever, some of which you did me the favor to see with

me during the past summer," and talks of his experience in the disease,

"now numbering nearly seventy cases, all of which have occurred within

less than a twelvemonth past."

And Dr. Meigs asserts, on the same page, "Indeed, I believe that his

practice in that department of the profession was greater than that of

any other gentleman, which was probably the cause of his seeing a greater

number of the cases." This from a professor of midwifery, who some time

ago assured a gentleman whom he met in consultation, that the night on

which they met was the eighteenth in succession that he himself had been

summoned from his repose, seems hardly satisfactory.

I must call the attention of the inquirer most particularly to the

Quarterly Report above referred to, and the letters of Dr. Meigs and Dr.

Rutter, to be found in the "Medical Examiner." Whatever impression they

may produce upon his mind, I trust they will at least convince him that

there is some reason for looking into this apparently uninviting subject.

At a meeting of the College of Physicians just mentioned, Dr. Warrington

stated, that a few days after assisting at an autopsy of puerperal

peritonitis, in which he laded out the contents of the abdominal cavity

with his hands, he was called upon to deliver three women in rapid

succession. All of these women were attacked with different forms of

what is commonly called puerperal fever. Soon after these he saw two

other patients, both on the same day, with the same disease. Of these

five patients two died.

At the same meeting, Dr. West mentioned a fact related to him by Dr.

Samuel Jackson of Northumberland. Seven females, delivered by Dr.

Jackson in rapid succession, while practising in Northumberland County,

were all attacked with puerperal fever, and five of them died. "Women,"

he said, "who had expected me to attend upon them, now becoming alarmed,

removed out of my reach, and others sent for a physician residing several

miles distant. These women, as well as those attended by midwives; all

did well; nor did we hear of any deaths in child-bed within a radius of

fifty miles, excepting two, and these I afterwards ascertained to have

been caused by other diseases." He underwent, as he thought, a thorough

purification, and still his next patient was attacked with the disease

and died. He was led to suspect that the contagion might have been

carried in the gloves which he had worn in attendance upon the previous

cases. Two months or more after this he had two other cases. He could

find nothing to account for these, unless it were the instruments for

giving enemata, which had been used in two of the former cases, and were

employed by these patients. When the first case occurred, he was

attending and dressing a limb extensively mortified from erysipelas, and

went immediately to the accouchement with his clothes and gloves most

thoroughly imbued with its efluvia. And here I may mention, that this

very Dr. Samuel Jackson of Northumberland is one of Dr. Dewees's

authorities against contagion.

The three following statements are now for the first time given to the

public. All of the cases referred to occurred within this State, and two

of the three series in Boston and its immediate vicinity.

I. The first is a series of cases which took place during the last

spring in a town at some distance from this neighborhood. A physician of

that town, Dr. C., had the following consecutive cases.

No. 1, delivered March 20, died March 24.

" 2, " April 9, " April 14.

" 3, " " 10, " " 14.

" 4, " " 11, " " 18.

" 5, " " 27, " May 3.

" 6, " " 28, had some symptoms,(recovered.)

" 7, " May 8, had some symptoms,(also recovered.)

These were the only cases attended by this physician during the period

referred to. "They were all attended by him until their termination,

with the exception of the patient No. 6, who fell into the hands of

another physician on the 2d of May. (Dr. C. left town for a few days at

this time.) Dr. C. attended cases immediately before and after the

above-named periods, none of which, however, presented any peculiar

symptoms of the disease."

About the 1st of July he attended another patient in a neighboring

village, who died two or three days after delivery.

The first patient, it is stated, was delivered on the 20th of March. "On

the 19th, Dr. C. made the autopsy of a man who died suddenly, sick only

forty-eight hours; had oedema of the thigh, and gangrene extending from a

little above the ankle into the cavity of the abdomen." Dr. C. wounded

himself, very slightly, in the right hand during the autopsy. The hand

was quite painful the night following, during his attendance on the

patient No. 1. He did not see this patient after the 20th, being

confined to the house, and very sick from the wound just mentioned, from

this time until the 3d of April.

Several cases of erysipelas occurred in the house where the autopsy

mentioned above took place, soon after the examination. There were also

many cases of erysipelas in town at the time of the fatal puerperal cases

which have been mentioned.

The nurse who laid out the body of the patient No. 3 was taken on the

evening of the same day with sore throat and erysipelas, and died in ten

days from the first attack.

The nurse who laid out the body of the patient No. 4 was taken on the day

following with symptoms like those of this patient, and died in a week,

without any external marks of erysipelas.

"No other cases of similar character with those of Dr. C. occurred in the

practice of any of the physicians in the town or vicinity at the time.

Deaths following confinement have occurred in the practice of other

physicians during the past year, but they were not cases of puerperal

fever. No post-mortem examinations were held in any of these puerperal

cases."

Some additional statements in this letter are deserving of insertion.

"A physician attended a woman in the immediate neighborhood of the cases

numbered 2, 3, and 4. This patient was confined the morning of March

1st, and died on the night of March 7th. It is doubtful whether this

should be considered a case of puerperal fever. She had suffered from

canker, indigestion, and diarrhoea for a year previous to her delivery.

Her complaints were much aggravated for two or three months previous to

delivery; she had become greatly emaciated, and weakened to such an

extent that it had not been expected that she would long survive her

confinement, if indeed she reached that period. Her labor was easy

enough; she flowed a good deal, seemed exceedingly prostrated, had

ringing in the ears, and other symptoms of exhaustion; the pulse was

quick and small. On the second and third day there was some tenderness

and tumefaction of the abdomen, which increased somewhat on the fourth

and fifth. He had cases in midwifery before and after this, which

presented nothing peculiar."

It is also mentioned in the same letter, that another physician had a

case during the last summer and another last fall, both of which

recovered.

Another gentleman reports a case last December, a second case five weeks,

and another three weeks since. All these recovered. A case also

occurred very recently in the practice of a physician in the village

where the eighth patient of Dr. C. resides, which proved fatal. "This

patient had some patches of erysipelas on the legs and arms. The same

physician has delivered three cases since, which have all done well.

There have been no other cases in this town or its vicinity recently.

There have been some few cases of erysipelas." It deserves notice that

the partner of Dr. C., who attended the autopsy of the man above

mentioned and took an active part in it; who also suffered very slightly

from a prick under the thumb-nail received during the examination, had

twelve cases of midwifery between March 26th and April 12th, all of which

did well, and presented no peculiar symptoms. It should also be stated,

that during these seventeen days he was in attendance on all the cases of

erysipelas in the house where the autopsy had been performed.

I owe these facts to the prompt kindness of a gentleman whose

intelligence and character are sufficient guaranty for their accuracy.

The two following letters were addressed to my friend Dr. Scorer, by the

gentleman in whose practice the cases of puerperal fever occurred. His

name renders it unnecessary to refer more particularly to these

gentlemen, who on their part have manifested the most perfect freedom and

courtesy in affording these accounts of their painful experience.

"January 28, 1843.

II. . . . "The time to which you allude was in 1830. The first case

was in February, during a very cold time. She was confined the 4th, and

died the 12th. Between the 10th and 28th of this month, I attended six

women in labor, all of whom did well except the last, as also two who

were confined March 1st and 5th. Mrs. E., confined February 28th,

sickened, and died March 8th. The next day, 9th, I inspected the body,

and the night after attended a lady, Mrs. B., who sickened, and died

16th. The 10th, I attended another, Mrs. G., who sickened, but

recovered. March 16th, I went from Mrs. G.'s room to attend a Mrs. H.,

who sickened, and died 21st. The 17th, I inspected Mrs. B. On the 19th,

I went directly from Mrs. H.'s room to attend another lady, Mrs. G., who

also sickened, and died 22d. While Mrs. B. was sick, on 15th, I went

directly from her room a few rods, and attended another woman, who was

not sick. Up to 20th of this month I wore the same clothes. I now

refused to attend any labor, and did not till April 21st, when, having

thoroughly cleansed myself, I resumed my practice, and had no more

puerperal fever.

"The cases were not confined to a narrow space. The two nearest were

half a mile from each other, and half that distance from my residence.

The others were from two to three miles apart, and nearly that distance

from my residence. There were no other cases in their immediate vicinity

which came to my knowledge. The general health of all the women was

pretty good, and all the labors as good as common, except the first.

This woman, in consequence of my not arriving in season, and the child

being half-born at some time before I arrived, was very much exposed to

the cold at the time of confinement, and afterwards, being confined in a

very open, cold room. Of the six cases you perceive only one recovered.

"In the winter of 1817 two of my patients had puerperal fever, one very

badly, the other not so badly. Both recovered. One other had swelled

leg, or phlegmasia dolens, and one or two others did not recover as well

as usual.

"In the summer of 1835 another disastrous period occurred in my practice.

July 1st, I attended a lady in labor, who was afterwards quite ill and

feverish; but at the time I did not consider her case a decided puerperal

fever. On the 8th, I attended one who did well. On the 12th, one who was

seriously sick. This was also an equivocal case, apparently arising from

constipation and irritation of the rectum. These women were ten miles

apart and five from my residence. On 15th and 20th, two who did well. On

25th, I attended another. This was a severe labor, and followed by

unequivocal puerperal fever, or peritonitis. She recovered. August 2d

and 3d, in about twenty-four hours I attended four persons. Two of them

did very well; one was attacked with some of the common symptoms, which

however subsided in a day or two, and the other had decided puerperal

fever, but recovered. This woman resided five miles from me. Up to this

time I wore the same coat. All my other clothes had frequently been

changed. On 6th, I attended two women, one of whom was not sick at all;

but the other, Mrs. L., was afterwards taken ill. On 10th, I attended a

lady, who did very well. I had previously changed all my clothes, and

had no garment on which had been in a puerperal room. On 12th, I was

called to Mrs. S., in labor. While she was ill, I left her to visit Mrs.

L., one of the ladies who was confined on 6th. Mrs. L. had been more

unwell than usual, but I had not considered her case anything more than

common till this visit. I had on a surtout at this visit, which, on my

return to Mrs. S., I left in another room. Mrs. S. was delivered on

13th with forceps. These women both died of decided puerperal fever.

"While I attended these women in their fevers, I changed my clothes, and

washed my hands in a solution of chloride of lime after each visit. I

attended seven women in labor during this period, all of whom recovered

without sickness.

"In my practice I have had several single cases of puerperal fever, some

of whom have died and some have recovered. Until the year 1830 I had no

suspicion that the disease could be communicated from one patient to

another by a nurse or midwife; but I now think the foregoing facts

strongly favor that idea. I was so much convinced of this fact, that I

adopted the plan before related.

"I believe my own health was as good as usual at each of the above

periods. I have no recollections to the contrary.

"I believe I have answered all your questions. I have been more

particular on some points perhaps than necessary; but I thought you could

form your own opinion better than to take mine. In 1830 I wrote to Dr.

Charming a more particular statement of my cases. If I have not answered

your questions sufficiently, perhaps Dr. C. may have my letter to him,

and you can find your answer there." [In a letter to myself, this

gentleman also stated, "I do not recollect that there was any erysipelas

or any other disease particularly prevalent at the time."]

"BOSTON, February 3, 1843.

III. "MY DEAR SIR,--I received a note from you last evening, requesting

me to answer certain questions therein proposed, touching the cases of

puerperal fever which came under my observation the past summer. It

gives me pleasure to comply with your request, so far as it is in my

power so to do, but, owing to the hurry in preparing for a journey, the

notes of the cases I had then taken were lost or mislaid. The principal

facts, however, are too vivid upon my recollection to be soon forgotten.

I think, therefore, that I shall be able to give you all the information

you may require.

"All the cases that occurred in my practice took place between the 7th of

May and the 17th of June 1842.

"They were not confined to any particular part of the city. The first

two cases were patients residing at the South End, the next was at the

extreme North End, one living in Sea Street and the other in Roxbury.

The following is the order in which they occurred:

"Case 1. Mrs._____ was confined on the 7th of May, at 5 o'clock, P. M.,

after a natural labor of six hours. At 12 o'clock at night, on the 9th

(thirty-one hours after confinement), she was taken with severe chill,

previous to which she was as comfortable as women usually are under the

circumstances. She died on the 10th.

"Case 2. Mrs._____ was confined on the 10th of June (four weeks after

Mrs. C.), at 11 A. M., after a natural, but somewhat severe labor of

five hours. At 7 o'clock, on the morning of the 11th, she had a chill.

Died on the 12th.

"Case 3. Mrs._____ , confined on the 14th of June, was comfortable until

the 18th, when symptoms of puerperal fever were manifest. She died on

the 20th.

"Case 4. Mrs._____ , confined June 17th, at 5 o'clock, A. M., was doing

well until the morning of the 19th. She died on the evening of the 21st.

"Case 5. Mrs._____ was confined with her fifth child on the 17th of

June, at 6 o'clock in the evening. This patient had been attacked with

puerperal fever, at three of her previous confinements, but the disease

yielded to depletion and other remedies without difficulty. This time, I

regret to say, I was not so fortunate. She was not attacked, as were the

other patients, with a chill, but complained of extreme pain in abdomen,

and tenderness on pressure, almost from the moment of her confinement.

In this as in the other cases, the disease resisted all remedies, and she

died in great distress on the 22d of the same month. Owing to the

extreme heat of the season, and my own indisposition, none of the

subjects were examined after death. Dr. Channing, who was in attendance

with me on the three last cases, proposed to have a post-mortem

examination of the subject of case No. 5, but from some cause which I do

not now recollect it was not obtained.

"You wish to know whether I wore the same clothes when attending the

different cases. I cannot positively say, but I should think I did not,

as the weather became warmer after the first two cases; I therefore think

it probable that I made a change of at least a part of my dress. I have

had no other case of puerperal fever in my own practice for three years,

save those above related, and I do not remember to have lost a patient

before with this disease. While absent, last July, I visited two

patients sick with puerperal fever, with a friend of mine in the country.

Both of them recovered.

"The cases that I have recorded were not confined to any particular

constitution or temperament, but it seized upon the strong and the weak,

the old and the young,--one being over forty years, and the youngest

under eighteen years of age . . . . If the disease is of an

erysipelatous nature, as many suppose, contagionists may perhaps find

some ground for their belief in the fact, that, for two weeks previous to

my first case of puerperal fever, I had been attending a severe case of

erysipelas, and the infection may have been conveyed through me to the

patient; but, on the other hand, why is not this the case with other

physicians, or with the same physician at all times, for since my return

from the country I have had a more inveterate case of erysipelas than

ever before, and no difficulty whatever has attended any of my midwifery

cases?"

I am assured, on unquestionable authority, that "About three years since,

a gentleman in extensive midwifery business, in a neighboring State, lost

in the course of a few weeks eight patients in child-bed, seven of them

being undoubted cases of puerperal fever. No other physician of the town

lost a single patient of this disease during the same period." And from

what I have heard in conversation with some of our most experienced

practitioners, I am inclined to think many cases of the kind might be

brought to light by extensive inquiry.

This long catalogue of melancholy histories assumes a still darker aspect

when we remember how kindly nature deals with the parturient female, when

she is not immersed in the virulent atmosphere of an impure lying-in

hospital, or poisoned in her chamber by the unsuspected breath of

contagion. From all causes together, not more than four deaths in a

thousand births and miscarriages happened in England and Wales during the

period embraced by the first "Report of the Registrar-General." In the

second Report the mortality was shown to be about five in one thousand.

In the Dublin Lying-in Hospital, during the seven years of Dr. Collins's

mastership, there was one case of puerperal fever to 178 deliveries, or

less than six to the thousand, and one death from this disease in 278

cases, or between three and four to the thousand a yet during this period

the disease was endemic in the hospital, and might have gone on to rival

the horrors of the pestilence of the Maternite, had not the poison been

destroyed by a thorough purification.

In private practice, leaving out of view the cases that are to be

ascribed to the self-acting system of propagation, it would seem that the

disease must be far from common. Mr. White of Manchester says, "Out of

the whole number of lying-in patients whom I have delivered (and I may

safely call it a great one), I have never lost one, nor to the best of my

recollection has one been greatly endangered, by the puerperal, miliary,

low nervous, putrid malignant, or milk fever." Dr. Joseph Clarke informed

Dr. Collins, that in the course of forty-five years' most extensive

practice he lost but four patients from this disease. One of the most

eminent practitioners of Glasgow, who has been engaged in very extensive

practice for upwards of a quarter of a century, testifies that he never

saw more than twelve cases of real puerperal fever.[Lancet, May 4, 1833]

I have myself been told by two gentlemen practising in this city, and

having for many years a large midwifery business, that they had neither

of them lost a patient from this disease, and by one of them that he had

only seen it in consultation with other physicians. In five hundred

cases of midwifery, of which Dr. Storer has given an abstract in the

first number of this Journal, there was only one instance of fatal

puerperal peritonitis.

In the view of these facts, it does appear a singular coincidence, that

one man or woman should have ten, twenty, thirty, or seventy cases of

this rare disease following his or her footsteps with the keenness of a

beagle, through the streets and lanes of a crowded city, while the scores

that cross the same paths on the same errands know it only by name. It

is a series of similar coincidences which has led us to consider the

dagger, the musket, and certain innocent-looking white powders as having

some little claim to be regarded as dangerous. It is the practical

inattention to similar coincidences which has given rise to the

unpleasant but often necessary documents called indictments, which has

sharpened a form of the cephalotome sometimes employed in the case of

adults, and adjusted that modification of the fillet which delivers the

world of those who happen to be too much in the way while such striking

coincidences are taking place.

I shall now mention a few instances in which the disease appears to have

been conveyed by the process of direct inoculation.

Dr. Campbell of Edinburgh states that in October, 1821, he assisted at

the post-mortem examination of a patient who died with puerperal fever.

He carried the pelvic viscera in his pocket to the class-room. The same

evening he attended a woman in labor without previously changing his

clothes; this patient died. The next morning he delivered a woman with

the forceps; she died also, and of many others who were seized with the

disease within a few weeks, three shared the same fate in succession.

In June, 1823, he assisted some of his pupils at the autopsy of a case of

puerperal fever. He was unable to wash his hands with proper care, for

want of the necessary accommodations. On getting home he found that two

patients required his assistance. He went without further ablution, or

changing his clothes; both these patients died with puerperal fever.

This same Dr. Campbell is one of Dr. Churchill's authorities against

contagion.

Mr. Roberton says that in one instance within his knowledge a

practitioner passed the catheter for a patient with puerperal fever late

in the evening; the same night he attended a lady who had the symptoms of

the disease on the second day. In another instance a surgeon was called

while in the act of inspecting the body of a woman who had died of this

fever, to attend a labor; within forty-eight hours this patient was

seized with the fever.'

On the 16th of March, 1831, a medical practitioner examined the body of a

woman who had died a few days after delivery, from puerperal peritonitis.

On the evening of the 17th he delivered a patient, who was seized with

puerperal fever on the 19th, and died on the 24th. Between this period

and the 6th of April, the same practitioner attended two other patients,

both of whom were attacked with the same disease and died.

In the autumn of 1829 a physician was present at the examination of a

case of puerperal fever, dissected out the organs, and assisted in sewing

up the body. He had scarcely reached home when he was summoned to attend

a young lady in labor. In sixteen hours she was attacked with the

symptoms of puerperal fever, and narrowly escaped with her life.

In December, 1830, a midwife, who had attended two fatal cases of

puerperal fever at the British Lying-in Hospital, examined a patient who

had just been admitted, to ascertain if labor had commenced. This patient

remained two days in the expectation that labor would come on, when she

returned home and was then suddenly taken in labor and delivered before

she could set out for the hospital. She went on favorably for two days,

and was then taken with puerperal fever and died in thirty-six hours.

"A young practitioner, contrary to advice, examined the body of a patient

who had died from puerperal fever; there was no epidemic at the time; the

case appeared to be purely sporadic. He delivered three other women

shortly afterwards; they all died with puerperal fever, the symptoms of

which broke out very soon after labor. The patients of his colleague did

well, except one, where he assisted to remove some coagula from the

uterus; she was attacked in the same manner as those whom he had

attended, and died also." The writer in the "British and Foreign Medical

Review," from whom I quote this statement,--and who is no other than Dr.

Rigby, adds, "We trust that this fact alone will forever silence such

doubts, and stamp the well-merited epithet of 'criminal,' as above

quoted, upon such attempts." [Brit. and For. Medical Review for Jan.

1842, p. 112.]

From the cases given by Mr. Ingleby, I select the following. Two

gentlemen, after having been engaged in conducting the post-mortem

examination of a case of puerperal fever, went in the same dress, each

respectively, to a case of midwifery. "The one patient was seized with

the rigor about thirty hours afterwards. The other patient was seized

with a rigor the third morning after delivery. One recovered, one died."

[Edin. Med. and Surg. Journal, April, 1838.]

One of these same gentlemen attended another woman in the same clothes

two days after the autopsy referred to. "The rigor did not take place

until the evening of the fifth day from the first visit. Result fatal."

These cases belonged to a series of seven, the first of which was thought

to have originated in a case of erysipelas. "Several cases of a mild

character followed the foregoing seven, and their nature being now most

unequivocal, my friend declined visiting all midwifery cases for a time,

and there was no recurrence of the disease." These cases occurred in

1833. Five of them proved fatal. Mr. Ingleby gives another series of

seven eases which occurred to a practitioner in 1836, the first of which

was also attributed to his having opened several erysipelatous abscesses

a short time previously.

I need not refer to the case lately read before this Society, in which a

physician went, soon after performing an autopsy of a case of puerperal

fever, to a woman in labor, who was seized with the same disease and

perished. The forfeit of that error has been already paid.

At a meeting of the Medical and Chirurgical Society before referred to,

Dr. Merriman related an instance occurring in his own practice, which

excites a reasonable suspicion that two lives were sacrificed to a still

less dangerous experiment. He was at the examination of a case of

puerperal fever at two o'clock in the afternoon. He took care not to

touch the body. At nine o'clock the same evening he attended a woman in

labor; she was so nearly delivered that he had scarcely anything to do.

The next morning she had severe rigors, and in forty-eight hours she was

a corpse. Her infant had erysipelas and died in two days. [Lancet, May

2, 1840.]

In connection with the facts which have been stated, it seems proper to

allude to the dangerous and often fatal effects which have followed from

wounds received in the post-mortem examination of patients who have died

of puerperal fever. The fact that such wounds are attended with peculiar

risk has been long noticed. I find that Chaussier was in the habit of

cautioning his students against the danger to which they were exposed in

these dissections. [Stein, L'Art d'Accoucher, 1794; Dict. des Sciences

Medicales, art. "Puerperal."] The head pharmacien of the Hotel Dieu, in

his analysis of the fluid effused in puerperal peritonitis, says that

practitioners are convinced of its deleterious qualities, and that it is

very dangerous to apply it to the denuded skin. [Journal de Pharmacie,

January, 1836.] Sir Benjamin Brodie speaks of it as being well known

that the inoculation of lymph or pus from the peritoneum of a puerperal

patient is often attended with dangerous and even fatal symptoms. Three

cases in confirmation of this statement, two of them fatal, have been

reported to this Society within a few months.

Of about fifty cases of injuries of this kind, of various degrees of

severity, which I have collected from different sources, at least twelve

were instances of infection from puerperal peritonitis. Some of the

others are so stated as to render it probable that they may have been of

the same nature. Five other cases were of peritoneal inflammation; three

in males. Three were what was called enteritis, in one instance

complicated with erysipelas; but it is well known that this term has been

often used to signify inflammation of the peritoneum covering the

intestines. On the other hand, no case of typhus or typhoid fever is

mentioned as giving rise to dangerous consequences, with the exception of

the single instance of an undertaker mentioned by Mr. Travers, who seems

to have been poisoned by a fluid which exuded from the body. The other

accidents were produced by dissection, or some other mode of contact with

bodies of patients who had died of various affections. They also

differed much in severity, the cases of puerperal origin being among the

most formidable and fatal. Now a moment's reflection will show that the

number of cases of serious consequences ensuing from the dissection of

the bodies of those who had perished of puerperal fever is so vastly

disproportioned to the relatively small number of autopsies made in this

complaint as compared with typhus or pneumonia (from which last disease

not one case of poisoning happened), and still more from all diseases put

together, that the conclusion is irresistible that a most fearful morbid

poison is often generated in the course of this disease. Whether or not

it is sui generis, confined to this disease, or produced in some others,

as, for instance, erysipelas, I need, not stop to inquire.

In connection with this may be taken the following statement of Dr.

Rigby. "That the discharges from a patient under puerperal fever are in

the highest degree contagious we have abundant evidence in the history of

lying-in hospitals. The puerperal abscesses are also contagious, and may

be communicated to healthy lying-in women by washing with the same

sponge; this fact has been repeatedly proved in the Vienna Hospital; but

they are equally communicable to women not pregnant; on more than one

occasion the women engaged in washing the soiled bed-linen of the General

Lying-in Hospital have been attacked with abscess in the fingers or

hands, attended with rapidly spreading inflammation of the cellular

tissue."

Now add to all this the undisputed fact, that within the walls of

lying-in hospitals there is often generated a miasm, palpable as the

chlorine used to destroy it, tenacious so as in some cases almost to defy

extirpation, deadly in some institutions as the plague; which has killed

women in a private hospital of London so fast that they were buried two

in one coffin to conceal its horrors; which enabled Tonnelle to record

two hundred and twenty-two autopsies at the Maternite of Paris; which has

led Dr. Lee to express his deliberate conviction that the loss of life

occasioned by these institutions completely defeats the objects of their

founders; and out of this train of cumulative evidence, the multiplied

groups of cases clustering about individuals, the deadly results of

autopsies, the inoculation by fluids from the living patient, the

murderous poison of hospitals,--does there not result a conclusion that

laughs all sophistry to scorn, and renders all argument an insult?

I have had occasion to mention some instances in which there was an

apparent relation between puerperal fever and erysipelas. The length to

which this paper has extended does not allow me to enter into the

consideration of this most important subject. I will only say, that the

evidence appears to me altogether satisfactory that some most fatal

series of puerperal fever have been produced by an infection originating

in the matter or effluvia of erysipelas. In evidence of some connection

between the two diseases, I need not go back to the older authors, as

Pouteau or Gordon, but will content myself with giving the following

references, with their dates; from which it will be seen that the

testimony has been constantly coming before the profession for the last

few years.

"London Cyclopaedia of Practical Medicine," article Puerperal Fever,

1833.

Mr. Ceeley's Account of the Puerperal Fever at Aylesbury. "Lancet,"

1835.

Dr. Ramsbotham's Lecture. "London Medical Gazette," 1835.

Mr. Yates Ackerly's Letter in the same Journal, 1838.

Mr. Ingleby on Epidemic Puerperal Fever. "Edinburgh Medical and Surgical

Journal," 1838.

Mr. Paley's Letter. "London Medical Gazette," 1839.

Remarks at the Medical and Chirurgical Society. "Lancet," 1840.

Dr. Rigby's "System of Midwifery." 1841.

"Nunneley on Erysipelas,"--a work which contains a large number of

references on the subject. 1841.

"British and Foreign Quarterly Review," 1842.

Dr. S. Jackson of Northumberland, as already quoted from the Summary of

the College of Physicians, 1842.

And lastly, a startling series of cases by Mr. Storrs of Doncaster, to

be, found in the "American Journal of the Medical Sciences" for January,

1843.

The relation of puerperal fever with other continued fevers would seem to

be remote and rarely obvious. Hey refers to two cases of synochus

occurring in the Royal Infirmary of Edinburgh, in women who had attended

upon puerperal patients. Dr. Collins refers to several instances in

which puerperal fever has appeared to originate from a continued

proximity to patients suffering with typhus.

Such occurrences as those just mentioned, though most important to be

remembered and guarded against, hardly attract our notice in the midst of

the gloomy facts by which they are surrounded. Of these facts, at the

risk of fatiguing repetitions, I have summoned a sufficient number, as I

believe, to convince the most incredulous that every attempt to disguise

the truth which underlies them all is useless.

It is true that some of the historians of the disease, especially Hulme,

Hull, and Leake, in England; Tonnelle, Duges, and Baudelocque, in France,

profess not to have found puerperal fever contagious. At the most they

give us mere negative facts, worthless against an extent of evidence

which now overlaps the widest range of doubt, and doubles upon itself in

the redundancy of superfluous demonstration. Examined in detail, this and

much of the show of testimony brought up to stare the daylight of

conviction out of countenance, proves to be in a great measure unmeaning

and inapplicable, as might be easily shown were it necessary. Nor do I

feel the necessity of enforcing the conclusion which arises spontaneously

from the facts which have been enumerated, by formally citing the

opinions of those grave authorities who have for the last half-century

been sounding the unwelcome truth it has cost so many lives to establish.

"It is to the British practitioner," says Dr. Rigby, "that we are

indebted for strongly insisting upon this important and dangerous

character of puerperal fever."

The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton,

Haighton, Good, Waller; Blundell, Gooch, Ramsbotham, Douglas, Lee,

Ingleby, Locock, Abercrombie, Alison; Travers, Rigby, and Watson, many of

whose writings I have already referred to, may have some influence with

those who prefer the weight of authorities to the simple deductions of

their own reason from the facts laid before them. A few Continental

writers have adopted similar conclusions. It gives me pleasure to

remember, that while the doctrine has been unceremoniously discredited in

one of the leading Journals, and made very light of by teachers in two of

the principal Medical Schools, of this country, Dr. Channing has for many

years inculcated, and enforced by examples, the danger to be apprehended

and the precautions to be taken in the disease under consideration.

I have no wish to express any harsh feeling with regard to the painful

subject which has come before us. If there are any so far excited by the

story of these dreadful events that they ask for some word of indignant

remonstrance to show that science does not turn the hearts of its

followers into ice or stone, let me remind them that such words have been

uttered by those who speak with an authority I could not claim. It is as

a lesson rather than as a reproach that I call up the memory of these

irreparable errors and wrongs. No tongue can tell the heart-breaking

calamity they have caused; they have closed the eyes just opened upon a

new world of love and happiness; they have bowed the strength of manhood

into the dust; they have cast the helplessness of infancy into the

stranger's arms, or bequeathed it, with less cruelty, the death of its

dying parent. There is no tone deep enough for regret, and no voice loud

enough for warning. The woman about to become a mother, or with her

new-born infant upon her bosom, should be the object of trembling care

and sympathy wherever she bears her tender burden, or stretches her

aching limbs. The very outcast of the streets has pity upon her sister in

degradation, when the seal of promised maternity is impressed upon her.

The remorseless vengeance of the law, brought down upon its victim by a

machinery as sure as destiny, is arrested in its fall at a word which

reveals her transient claim for mercy. The solemn prayer of the liturgy

singles out her sorrows from the multiplied trials of life, to plead for

her in the hour of peril. God forbid that any member of the profession

to which she trusts her life, doubly precious at that eventful period,

should hazard it negligently, unadvisedly, or selfishly!

There may be some among those whom I address who are disposed to ask the

question, What course are we to follow in relation to this matter? The

facts are before them, and the answer must be left to their own judgment

and conscience. If any should care to know my own conclusions, they are

the following; and in taking the liberty to state them very freely and

broadly, I would ask the inquirer to examine them as freely in the light

of the evidence which has been laid before him.

1. A physician holding himself in readiness to attend cases of midwifery

should never take any active part in the post-mortem examination of cases

of puerperal fever.

2. If a physician is present at such autopsies, he should use thorough

ablution, change every article of dress, and allow twenty-four hours or

more to elapse before attending to any case of midwifery. It may be well

to extend the same caution to cases of simple peritonitis.

3. Similar precautions should be taken after the autopsy or surgical

treatment of cases of erysipelas, if the physician is obliged to unite

such offices with his obstetrical duties, which is in the highest degree

inexpedient.

4. On the occurrence of a single case of puerperal fever in his

practice, the physician is bound to consider the next female he attends

in labor, unless some weeks at least have elapsed, as in danger of being

infected by him, and it is his duty to take every precaution to diminish

her risk of disease and death.

5. If within a short period two cases of puerperal fever happen close to

each other, in the practice of the same physician, the disease not

existing or prevailing in the neighborhood, he would do wisely to

relinquish his obstetrical practice for at least one month, and endeavor

to free himself by every available means from any noxious influence he

may carry about with him.

6. The occurrence of three or more closely connected cases, in the

practice of one individual, no others existing in the neighborhood, and

no other sufficient cause being alleged for the coincidence, is prima

facie evidence that he is the vehicle of contagion.

7. It is the duty of the physician to take every precaution that the

disease shall not be introduced by nurses or other assistants, by making

proper inquiries concerning them, and giving timely warning of every

suspected source of danger.

8. Whatever indulgence may be granted to those who have heretofore been

the ignorant causes of so much misery, the time has come when the

existence of a private pestilence in the sphere of a single physician

should be looked upon, not as a misfortune, but a crime; and in the

knowledge of such occurrences the duties of the practitioner to his

profession should give way to his paramount obligations to society.

ADDITIONAL REFERENCES AND CASES.

Fifth Annual Report of the Registrar-General of England.

1843. Appendix. Letter from William Farr, Esq.--Several new series of

cases are given in the Letter of Mr. Stows, contained in the Appendix to

this Report. Mr. Stows suggests precautions similar to those I have laid

down, and these precautions are strongly enforced by Mr. Farr, who is,

therefore, obnoxious to the same criticisms as myself.

Hall and Dexter, in Am. Journal of Med. Sc. for January, 1844.--Cases

of puerperal fever seeming to originate in erysipelas.

Elkington, of Birmingham, in Provincial Med. Journal, cited in Am.

Journ. Med. Se. for April, 1844.--Six cases in less than a fortnight,

seeming to originate in a case of erysipelas.

West's Reports, in Brit. and For. Med. Review for October, 1845, and

January, 1847.--Affection of the arm, resembling malignant pustule, after

removing the placenta of a patient who died from puerperal fever.

Reference to cases at Wurzburg, as proving contagion, and to Keiller's

cases in the Monthly Journal for February, 1846, as showing connection of

puerperal fever and erysipelas.

Kneeland.--Contagiousness of Puerperal Fever. Am. Jour. Med. Se.,

January, 1846. Also, Connection between Puerperal Fever and Epidemic

Erysipelas. Ibid., April, 1846.

Robert Storrs.--Contagious Effects of Puerperal Fever on the Male

Subject; or on Persons not Child-bearing. (From Provincial Med. and

Surg. Journal.) Am. Jour. Med. Sc., January, 184,6. Numerous cases.

See also Dr. Reid's case in same Journal for April, 1846.

Routh's paper in Proc. of Royal Med. Chir. Soc., Am. Jour. Med. Sc.,

April, 1849, also in B. and F. Med. Chir. Review, April, 1850.

Hill, of Leuchars.--A Series of Cases illustrating the Contagious Nature

of Erysipelas and of Puerperal Fever, and their Intimate Pathological

Connection. (From Monthly Journal of Med. Sc.) Am. Jour. Med. Se.,

July, 1850.

Skoda on the Causes of Puerperal Fever. (Peritonitis in rabbits, from

inoculation with different morbid secretions.) Am. Jour. Med. Se.,

October, 1850.

Arneth. Paper read before the National Academy of Medicine. Annales

d'Hygiene, Tome LXV. 2e Partie. (Means of Disinfection proposed by M.

"Semmeliveis" (Semmelweiss.) Lotions of chloride of lime and use of

nail-brush before admission to lying-in wards. Alleged sudden and great

decrease of mortality from puerperal fever. Cause of disease attributed

to inoculation with cadaveric matters.) See also Routh's paper, mentioned

above.

Moir. Remarks at a meeting of the Edinburgh Medico-Chirurgical Society.

Refers to cases of Dr. Kellie, of Leith. Sixteen in succession, all

fatal. Also to several instances of individual pupils having had a

succession of cases in various quarters of the town, while others,

practising as extensively in the same localities, had none. Also to

several special cases not mentioned elsewhere. Am. Jour. Med. Se. for

October, 1851. (From New Monthly Journal of Med. Science.)

Simpson.--Observations at a Meeting of the Edinburgh Obstetrical Society.

(An "eminent gentleman," according to Dr. Meigs, whose "name is as well

known in America as in (his) native land." Obstetrics. Phil. 1852, pp.

368, 375.) The student is referred to this paper for a valuable resume of

many of the facts, and the necessary inferences, relating to this

subject. Also for another series of cases, Mr. Sidey's, five or six in

rapid succession. Dr. Simpson attended the dissection of two of Dr.

Sidey's cases, and freely handled the diseased parts. His next four

child-bed patients were affected with puerperal fever, and it was the

first time he had seen it in practice. As Dr. Simpson is a gentleman

(Dr. Meigs, as above), and as "a gentleman's hands are clean" (Dr. Meigs'

Sixth Letter), it follows that a gentleman with clean hands may carry the

disease. Am. Jour. Med. Sc., October, 1851.

Peddle.--The five or six cases of Dr. Sidey, followed by the four of Dr.

Simpson, did not end the series. A practitioner in Leith having examined

in Dr. Simpson's house, a portion of the uterus obtained from one of the

patients, had immediately afterwards three fatal cases of puerperal

fever. Dr. Veddie referred to two distinct series of consecutive cases

in his own practice. He had since taken precautions, and not met with

any such cases. Am. Jour. Med. Sc., October, 1851.

Copland. Considers it proved that puerperal fever maybe propagated by

the hands and the clothes, or either, of a third person, the bed-clothes

or body-clothes of a patient. Mentions a new series of cases, one of

which he saw, with the practitioner who had attended them. She was the

sixth he had had within a few days. All died. Dr. Copland insisted that

contagion had caused these cases; advised precautionary measures, and the

practitioner had no other cases for a considerable time. Considers it

criminal, after the evidence adduced,--which he could have

quadrupled,--and the weight of authority brought forward, for a

practitioner to be the medium of transmitting contagion and death to his

patients. Dr. Copland lays down rules similar to those suggested by

myself, and is therefore entitled to the same epithet for so doing.

Medical Dictionary, New York, 1852. Article, Puerperal States and

Diseases.

If there is any appetite for facts so craving as to be yet

unappeased,--Lesotho, necdum satiata,--more can be obtained. Dr. Hodge

remarks that "the frequency and importance of this singular circumstance

(that the disease is occasionally more prevalent with one practitioner

than another) has been exceedingly overrated." More than thirty strings

of cases, more than two hundred and fifty sufferers from puerperal fever,

more than one hundred and thirty deaths appear as the results of a

sparing estimate of such among the facts I have gleaned as could be

numerically valued. These facts constitute, we may take it for granted,

but a small fraction of those that have actually occurred. The number of

them might be greater, but "'t is enough, 't will serve," in Mercutio's

modest phrase, so far as frequency is concerned. For a just estimate of

the importance of the singular circumstance, it might be proper to

consult the languid survivors, the widowed husbands, and the motherless

children, as well as "the unfortunate accoucheur."

III

CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE

An Address delivered before the Massachusetts Medical Society, at the

Annual Meeting, May 30, 1860.

"Facultate magis quam violentia."

HIPPOCRATES.

Our Annual Meeting never fails to teach us at least one lesson. The art

whose province it is to heal and to save cannot protect its own ranks

from the inroads of disease and the waste of the Destroyer.

Seventeen of our associates have been taken from us since our last

Anniversary. Most of them followed their calling in the villages or

towns that lie among the hills or along the inland streams. Only those

who have lived the kindly, mutually dependent life of the country, can

tell how near the physician who is the main reliance in sickness of all

the families throughout a thinly settled region comes to the hearts of

the people among whom he labors, how they value him while living, how

they cherish his memory when dead. For these friends of ours who have

gone before, there is now no more toil; they start from their slumbers no

more at the cry of pain; they sally forth no more into the storms; they

ride no longer over the lonely roads that knew them so well; their wheels

are rusting on their axles or rolling with other burdens; their watchful

eyes are closed to all the sorrows they lived to soothe. Not one of

these was famous in the great world; some were almost unknown beyond

their own immediate circle. But they have left behind them that loving

remembrance which is better than fame, and if their epitaphs are

chiselled briefly in stone, they are written at full length on living

tablets in a thousand homes to which they carried their ever-welcome aid

and sympathy.

One whom we have lost, very widely known and honored, was a leading

practitioner of this city. His image can hardly be dimmed in your

recollection, as he stood before you only three years ago, filling the

same place with which I am now honored. To speak of him at all worthily,

would be to write the history of professional success, won without

special aid at starting, by toil, patience, good sense, pure character,

and pleasing manners; won in a straight uphill ascent, without one

breathing-space until he sat down, not to rest, but to die. If prayers

could have shielded him from the stroke, if love could have drawn forth

the weapon, and skill could have healed the wound, this passing tribute

might have been left to other lips and to another generation.

Let us hope that our dead have at last found that rest which neither

summer nor winter, nor day nor night, had granted to their unending

earthly labors! And let us remember that our duties to our brethren do

not cease when they become unable to share our toils, or leave behind

them in want and woe those whom their labor had supported. It is

honorable to the Profession that it has organized an Association a for

the relief of its suffering members and their families; it owes this

tribute to the ill-rewarded industry and sacrifices of its less fortunate

brothers who wear out health and life in the service of humanity. I have

great pleasure in referring to this excellent movement, which gives our

liberal profession a chance to show its liberality, and serves to unite

us all, the successful and those whom fortune has cast down, in the bonds

of a true brotherhood.

A medical man, as he goes about his daily business after twenty years of

practice, is apt to suppose that he treats his patients according to the

teachings of his experience. No doubt this is true to some extent; to

what extent depending much on the qualities of the individual. But it is

easy to prove that the prescriptions of even wise physicians are very

commonly founded on something quite different from experience.

Experience must be based on the permanent facts of nature. But a glance

at the prevalent modes of treatment of any two successive generations

will show that there is a changeable as well as a permanent element in

the art of healing; not merely changeable as diseases vary, or as new

remedies are introduced, but changeable by the going out of fashion of

special remedies, by the decadence of a popular theory from which their

fitness was deduced, or other cause not more significant. There is no

reason to suppose that the present time is essentially different in this

respect from any other. Much, therefore, which is now very commonly

considered to be the result of experience, will be recognized in the

next, or in some succeeding generation, as no such result at all, but as

a foregone conclusion, based on some prevalent belief or fashion of the

time.

There are, of course, in every calling, those who go about the work of

the day before them, doing it according to the rules of their craft, and

asking no questions of the past or of the future, or of the aim and end

to which their special labor is contributing. These often consider and

call themselves practical men. They pull the oars of society, and have

no leisure to watch the currents running this or that way; let theorists

and philosophers attend to them. In the mean time, however, these

currents are carrying the practical men, too, and all their work may be

thrown away, and worse than thrown away, if they do not take knowledge of

them and get out of the wrong ones and into the right ones as soon as

they may. Sir Edward Parry and his party were going straight towards the

pole in one of their arctic expeditions, travelling at the rate of ten

miles a day. But the ice over which they travelled was drifting straight

towards the equator, at the rate of twelve miles a day, and yet no man

among them would have known that he was travelling two miles a day

backward unless he had lifted his eyes from the track in which he was

plodding. It is not only going backward that the plain practical workman

is liable to, if he will not look up and look around; he may go forward

to ends he little dreams of. It is a simple business for a mason to

build up a niche in a wall; but what if, a hundred years afterwards when

the wall is torn down, the skeleton of a murdered man drop out of the

niche? It was a plain practical piece of carpentry for a Jewish artisan

to fit two pieces of timber together according to the legal pattern in

the time of Pontius Pilate; he asked no questions, perhaps, but we know

what burden the cross bore on the morrow! And so, with subtler tools

than trowels or axes, the statesman who works in policy without

principle, the theologian who works in forms without a soul, the

physician who, calling himself a practical man, refuses to recognize the

larger laws which govern his changing practice, may all find that they

have been building truth into the wall, and hanging humanity upon the

cross.

The truth is, that medicine, professedly founded on observation, is as

sensitive to outside influences, political, religious, philosophical,

imaginative, as is the barometer to the changes of atmospheric density.

Theoretically it ought to go on its own straightforward inductive path,

without regard to changes of government or to fluctuations of public

opinion. But look a moment while I clash a few facts together, and see

if some sparks do not reveal by their light a closer relation between the

Medical Sciences and the conditions of Society and the general thought of

the time, than would at first be suspected.

Observe the coincidences between certain great political and intellectual

periods and the appearance of illustrious medical reformers and teachers.

It was in the age of Pericles, of Socrates, of Plato, of Phidias, that

Hippocrates gave to medical knowledge the form which it retained for

twenty centuries. With the world-conquering Alexander, the

world-embracing Aristotle, appropriating anatomy and physiology, among

his manifold spoils of study, marched abreast of his royal pupil to wider

conquests. Under the same Ptolemies who founded the Alexandrian Library

and Museum, and ordered the Septuagint version of the Hebrew Scriptures,

the infallible Herophilus ["Contradicere Herophilo in anatomicis, est

contradicere evangelium," was a saying of Fallopius.] made those six

hundred dissections of which Tertullian accused him, and the sagacious

Erasistratus introduced his mild antiphlogistic treatment in opposition

to the polypharmacy and antidotal practice of his time. It is significant

that the large-minded Galen should have been the physician and friend of

the imperial philosopher Marcus Aurelius. The Arabs gave laws in various

branches of knowledge to those whom their arms had invaded, or the terror

of their spreading dominion had reached, and the point from which they

started was, as Humboldt acknowledges, "the study of medicine, by which

they long ruled the Christian Schools," and to which they added the

department of chemical pharmacy.

Look at Vesalius, the contemporary of Luther. Who can fail to see one

common spirit in the radical ecclesiastic and the reforming

court-physician? Both still to some extent under the dominion of the

letter: Luther holding to the real presence; Vesalius actually causing to

be drawn and engraved two muscles which he knew were not found in the

human subject, because they had been described by Galen, from dissections

of the lower animals. Both breaking through old traditions in the search

of truth; one, knife in hand, at the risk of life and reputation, the

other at the risk of fire and fagot, with that mightier weapon which all

the devils could not silence, though they had been thicker than the tiles

on the house-tops. How much the physician of the Catholic Charles V. had

in common with the great religious destructive, may be guessed by the

relish with which he tells the story how certain Pavian students exhumed

the body of an "elegans scortum," or lovely dame of ill repute, the

favorite of a monk of the order of St. Anthony, who does not seem to have

resisted temptation so well as the founder of his order. We have always

ranked the physician Rabelais among the early reformers, but I do not

know that Vesalius has ever been thanked for his hit at the morals of the

religious orders, or for turning to the good of science what was intended

for the "benefit of clergy."

Our unfortunate medical brother, Michael Servetus, the spiritual patient

to whom the theological moxa was applied over the entire surface for the

cure of his heresy, came very near anticipating Harvey. The same

quickened thought of the time which led him to dispute the dogma of the

Church, opened his mind to the facts which contradicted the dogmas of the

Faculty.

Harvey himself was but the posthumous child of the great Elizabethan

period. Bacon was at once his teacher and his patient. The founder of

the new inductive philosophy had only been dead two years when the

treatise on the Circulation, the first-fruit of the Restoration of

Science, was given to the world.

And is it to be looked at as a mere accidental coincidence, that while

Napoleon was modernizing the political world, Bichat was revolutionizing

the science of life and the art that is based upon it; that while the

young general was scaling the Alps, the young surgeon was climbing the

steeper summits of unexplored nature; that the same year read the

announcement of those admirable "Researches on Life and Death," and the

bulletins of the battle of Marengo?

If we come to our own country, who can fail to recognize that Benjamin

Rush, the most conspicuous of American physicians, was the intellectual

offspring of the movement which produced the Revolution? "The same hand,"

says one of his biographers, "which subscribed the declaration of the

political independence of these States, accomplished their emancipation

from medical systems formed in foreign countries, and wholly unsuitable

to the state of diseases in America."

Following this general course of remark, I propose to indicate in a few

words the direction of the main intellectual current of the time, and to

point out more particularly some of the eddies which tend to keep the

science and art of medicine from moving with it, or even to carry them

backwards.

The two dominant words of our time are law and average, both pointing to

the uniformity of the order of being in which we live. Statistics have

tabulated everything,--population, growth, wealth, crime, disease. We

have shaded maps showing the geographical distribution of larceny and

suicide. Analysis and classification have been at work upon all tangible

and visible objects. The Positive Philosophy of Comte has only given

expression to the observing and computing mind of the nineteenth century.

In the mean time, the great stronghold of intellectual conservatism,

traditional belief, has been assailed by facts which would have been

indicted as blasphemy but a few generations ago. Those new tables of the

law, placed in the hands of the geologist by the same living God who

spoke from Sinai to the Israelites of old, have remodelled the beliefs of

half the civilized world. The solemn scepticism of science has replaced

the sneering doubts of witty philosophers. The more positive knowledge

we gain, the more we incline to question all that has been received

without absolute proof.

As a matter of course, this movement has its partial reactions. The

province of faith is claimed as a port free of entry to unsupported

individual convictions. The tendency to question is met by the

unanalyzing instinct of reverence. The old church calls back its

frightened truants. Some who have lost their hereditary religious belief

find a resource in the revelations of Spiritualism. By a parallel

movement, some of those who have become medical infidels pass over to the

mystic band of believers in the fancied miracles of Homoeopathy.

Under these influences transmitted to, or at least shared by, the medical

profession, the old question between "Nature," so called, and "Art," or

professional tradition, has reappeared with new interest. I say the old

question, for Hippocrates stated the case on the side of "Nature" more

than two thousand years ago. Miss Florence Nightingale,--and if I name

her next to the august Father of the Healing Art, its noblest daughter

well deserves that place of honor,--Miss Florence Nightingale begins her

late volume with a paraphrase of his statement. But from a very early

time to this there has always been a strong party against "Nature."

Themison called the practice of Hippocrates "a meditation upon death."

Dr. Rush says: "It is impossible to calculate the mischief which

Hippocrates, has done, by first marking Nature with his name and

afterwards letting her loose upon sick people. Millions have perished by

her hands in all ages and countries." Sir John Forbes, whose defence of

"Nature" in disease you all know, and to the testimonial in whose honor

four of your Presidents have contributed, has been recently greeted, on

retiring from the profession, with a wish that his retirement had been

twenty years sooner, and the opinion that no man had done so much to

destroy the confidence of the public in the medical profession.

In this Society we have had the Hippocratic and the Themisonic side

fairly represented. The treatise of one of your early Presidents on the

Mercurial Treatment is familiar to my older listeners. Others who have

held the same office have been noted for the boldness of their practice,

and even for partiality to the use of complex medication.