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.
