Essays on the Puerperal Fever, and other diseases peculiar to
Women ; selected from the writings of British Authors previous
to the close of the eighteenth century. Edited by Fleetwood
Churchill, M. D., M. R. I. A., &c. &c. Philadelphia : Lea &
Blanchard, 1850. (Reprint from the Sydenham Society’s last
publication.')
Dr. Churchill’s collection of essays, taken from the written ex-
perience of seven distinguished physicians, on the subject of puer-
peral fever, is in every way worthy the respect of the profession.
The author has not only given us the various monographs on the
disease, commencing with that of Dr. Denman on the sickness of
1768, and terminating with Dr. Gordon’s well known essay on
the epidemic puerperal fever which occurred at Aberdeen in 1789,
but he has greatly enhanced the value of the work by adding to
the selected matter a short, condensed, but very interesting histo-
rical sketch of the different epidemics of puerperal fever which
have at different periods swept off the unfortunate inmates of the
various lying-in hospitals of Europe. He commences with a des-
cription of the fatal effects of this disease, and the mournful im-
pression produced upon his mind by witnessing its ravages ; “ a
picture,” he adds, “ whose gloom is heightened by the inutility of
all precautions to guard against its attacks, and, in the majority of
cases, the utter failure of all attempts to arrest its progress, or to
prevent its fatal termination.”
Impelled by such feelings, Dr. Churchill has presented to the
reader a selection of such works upon the subject as in his judge-
ment is best calculated to afford a complete view of the disease in
itself, and especially of the aspect it presents when it occurs
epidemically ; and not only so, but by selecting descriptions of the
various epidemics of England, Ireland and Scotland, the various
characters of the disease, and its particular modifications are illus-
trated by those who witnessed them.
Dr. C. disclaims all intention of compiling a treatise on puerpe-
ral fever, his sole object is to collect the principal facts connected
with its history as given by persons who witnessed its desolating
course, and thereby afford the student and physician of our own
time an opportunity of comparing the symptoms, treatment and
mortality of the different epidemics, in order, if possible to do
away with that one sided view of the disease which persists in as-
serting that child-bed fever is inflammation and nothing but inflam-
mation, an infatuation which we sincerely hope has nearly satiated
itself wflth human blood.
However, we will not anticipate our author, but suffer him in due
time to speak for himself, not having the vanity to suppose, though
we have often felt as he feels, that we can write upon the subject
with the same force and clearness.
According to our author, the first undoubted epidemic of puer-
peral fever on record is that which prevailed in Paris during the
winter of 1746; it was extremely fatal, attacking the poor, and
proving much more fatal to those in hospital, than to those who
were delivered at their own houses. Of twenty women, in Feb-
ruary of that year, in the Hotel Dieu, scarcely one recovered ; they
died between the 5th and 17th days after their confinement. As
the post mortem appearances described afford nothing particularly
new to the instructed physician of the present day, we do not
think it desirable to consume our necessarily confined space by
quoting them.
The treatment of the disease is not given.
After this we have a long list of successive epidemics, as they
have occurred in the different lying-in hospitals of Europe, but as
they are little more than a list of dates without detail, either of
symptoms or of treatment, of course it would be useless, in a
general review, to do more than allude to them as a portion of the
history, though their perusal, we make no doubt, would greatly
interest the enthusiastic student of the result.
The author, however, quotes largely from a M. Tenon of Paris,
who says that “ two distinct forms of the disease were successively
observed in the years 1774-5. One a simple form, which was
cured by ipecacuanha,” which we should be inclined to suspect
was not the disease at all; “ the other, a complicated form for
which there was no remedy, so that there perished one of every
seven of those who were attacked, and death took place from the
sixth to the eighth day, and often much earlier.
The following quotation is a good description of the symptoms
of the milder cases :
“The first symptoms manifested themselves twenty-four, thirty-six,
or forty-eight hours after delivery, and sometimes, but rarely, in
the space of twelve hours. The symptoms of the simple puerperal
fever are developed in the following order: rigor, slight pain in the
kidneys, intestinal colic, which in two hours affects the whole hy-
pogastrium, and gradually becomes more acute, pulse concentrated,
fever moderate, lochia not suppressed, mammae flaccid, tongue dry
in the middle, covered with a yellow mucous on the edges, hiccup
and vomiting of green colored matter. There wTas sometimes com-
bined with these constant and characteristic symptoms, a diarrhoea
of a bilious glairy matter, a considerable swelling of the hypogas-
trium, thirst, and remarkable retention of urine.
“ In the complicated puerperal fever the pyrexia is more intense,
with exacerbations; the tongue is black and dry, the belly-is tense,
distended and tympanitic and slightly painful. In some women the
lochia have been either wholly suppressed or only diminished,
others have experienced attacks of ophthalmia, in some the respira-
tion was difficult, in general the blood showed the buffy coat.
“ On opening the abdomen, the stomach, and intestines, particu-
larly the small intestines, were inflamed, adhering to one another,
distended with air and a yellow fluid matter. The uterus was con-
tracted to its ordinary dimensions, and was seldom inflamed. I had
occasion to dissect two; in one, the uterus contained a coagulum of
blood ; an infiltration of a milky appearance, or whey-like fluid, ex-
isted in certain women, in the cellular tissue surrounding the kid-
neys. Sometimes also a thick white cheesy matter was met with.
When the lungs were gorged with blood, or inflamed, or emphyse-
matous, an effusion of serum was found on each side of the chest.
We did not observe the hemorrhages which occurred in the epidemic
of 1664, and the uterus was not found dry and hard, and tumefied,
as in that of 1746. In the epidemic of 1774 the lochia flowed, but
they did not flow in 1746.”
This valuable description blends together more than one epi-
demic, but as the disease is stated to have presented the same
characters, the author has chosen to quote it in this place.
In the year 1782 the Royal Medical Society of Paris made a re-
port to the French government on M. Doulcet’s method of treat-
ment, whose remedy it appears was an emetic of ipecacuanha, fol-
lowed by a gentle purgative, which is said to have been very suc-
cessful. This certainly leads us to infer that most of his cases must
have been of a very mild character.
From the year 1765 to 1775, puerperal fever appears to have
prevailed in Derbyshire and the adjacent counties. Butler de-
scribes it, but its course must have been unusually mild, as Dr.
Butler states that “ten grains of rhubarb and ten of aromatic con-
fection, given every day until the stools became natural, never failed
to effect a cure.” He objects to bleeding, very naturally, as the
affection he describes must have been comparatively trifling. Dr.
Gordon’s cases in the epidemic at Aberdeen, 1789, are mentioned,
with the treatment, which every body knows was bleeding—prompt
and decided bleeding—irrespective of the state of the pulse ; but as
Gordon’s valuable treatise has been for years in the hands of every
practitioner in the United States, and as it is reprinted in the book,
we shall make no further comment on it.
“ Dr. Gooch has furnished us,” says the author, “ with the expe-
rience of Dr. Lowder, who practiced in London about this time.”
He, Dr. Lowder, “thought that the inflammation was erysipelatous,
and the fever typhoid. When the inflammatory symptoms were
well marked, he permitted a few ounces of blood to be drawn, but
if the symptoms were typhoid, bleeding was positively injurious, he
mentioned it as the assertion of many medical men that all the
patients who were bled died. When the fever was typhoid, here-
commended bark, and mentioned two cases apparently hopeless
which recovered by taking daily a gallon of the decoction.”
In 1809-10 Hey lost eleven patients out of fourteen, only three
recovering ; this was before Mr. Hey adopted Dr. Gordon’s plan of
taking blood largely at the beginning ; he afterwards by the blood-
letting practice saved fourteen out of seventeen. This was certainly
being very successful, but we are much inclined to suspect, (though
we approve highly of the sanguineous depletion in some cases)
that he had to deal with a much less fatal form of the disease than
when he saved but three out of fourteen ; medical gentlemen are
very fond of parading their successes, but they are not always so
ingenuous as to tell us all the causes of their success.
We must apologise for the length of this list of epidemics, but
though it may weary the mind with its monotony, it has the advan-
tage of showing us what an amount of difference of opinion exists in
the treatment of this disease ; how different the various epidemics
are in character; and that although large abstractions of blood may
in one case be the only means of saving our patient, yet in another,
so far from being beneficial, they will only hurry the miserable suf-
ferer to her grave.
The author makes frequent quotations from Dr. Douglas, who has
given a good account of the epidemic of 1810-11, as presenting it-
self in the Dublin Lying-in Hospital.
Dr. Douglas describes three varieties of puerperal fever, 1st, the
synochal; 2d, the gastro-bilious; and 3d, the epidemic or con-
tagious puerperal fever. Dr. Churchill observes, “ that he (Dr.
Douglas) has drawn a marked distinction between ordinary and
epidemic puerperal,” and as his description serves to illustrate in a
measure our author’s views on this subject, we make the following
extract of his quotation from Dr. Douglas.
“ That form of the disease which I arrange under the third head,
is really the contagious, or epidemical puerperal fever, and though
agreeing with the others in the great leading symptoms, inflamma-
tion, pain, tumefaction, and tension of the abdomen, yet .differing
from them in many material characters. The sensorium here is
seldom in any degree disturbed, whereas, in others, it is so fre-
quently, and even sometimes is excited to a high degree of deli-
rium. The pulse here is usually from the moment of attack, soft,
weak and yielding, and in frequency often exceeds 160; whereas,
in the first species it is full, bounding, and incompressible, and in
the second, small, hard and concentrated, and in both moderately
frequent. The eye, instead of being suffused with a reddish or
yellow tint, as in the others, is here generally pellucid, with dilated
pupil ; the countenance, instead of being flushed as in the others,
is here pale and shrunk, with an indescribable expression of anxiety ;
an expression altogether so peculiar that the disease could, on many
occasions, be pronounced or inferred from the countenance alone.
The surface of the body, instead of being, as in the others, of a high
pyrexia! heat, is here usually soft and clammy, and of heat not
above the natural temperature; and not only is the skin cool, with
clammy exudation, but the muscles to the impression of the finger,
feel soft and flaccid, as if deprived of their vis insita by the influ-
ence of the contagion. Indeed, there is such prostration of strength
and depression of vital principle from the very onset of the attack,
that I must suppose the contagion to act on the human frame, pro-
bably through the medium of the nervous system.”
The author again quotes Dr. D. as follows :
“ The contagious puerperal fever of Dublin is, I venture to pro-
nounce, neither more nor less, than a malignant fever of a typhoid
type, accompanied with an erysipelatous inflammation of the perito-
neal covering of the stomach, intestines and other abdominal
viscera.”
The history, or more properly, the sketch of the different epide-
mics, proceeds from one to the other with great rapidity; that
which occurred in 1813, in the northern countries of England, so
ably described by the late Dr. Armstrong, is alluded to as closely
resembling the Aberdeen and Leeds epidemics, all the cases pre-
sented the same incontestible proofs of inflammation, and blood-
letting—early and copious blood-letting—seems to have been the
only successful mode of treatment. “ All who were seized with
the disease died,—who were not bled at the beginning.” This is
in accordance with the recorded statements of Hey and Gordon,
and was doubtless excellent practice in those epidemics which dis-
played a strong inflammatory type.
The experience of Dr. Gooch is next adduced. Dr. Gooch
agrees in all the principal points of treatment, but makes, however,
a quotation from Dr. Farre, who states that “ At the east end of
London, not far from the river, this disease proved still more fatal.
During the month of March, 1825, one surgeon lost seven, another
four cases, in all of which the disease was treated at the instant of
its formation by active blood-letting. A physician accoucheur
who attended in consultation, told him (Dr. Farre) that, out of thir-
teen cases eleven died, that all which had been bled, died, and that
the only two that recovered had not been bled, but were treated
with turpentine.
Mr. Labatt’s account of the epidemic that prevailed in Dublin
in the years 1819-20, is highly interesting, and is well worthy of
attentive perusal, both from its intrinsic merits and the high charac-
ter of the author.
Mr. Labatt used every effort to prevent the spreading of the con-
tagion ; the sick patients were separated from the sound ones,
scourings, fumigations, and whitewashings were called in requisi-
tion, but all to no purpose, neither cleanliness, nor ventilation,
nor the destruction of the utensils and furniture that had been used
by those already smitten, seems to have checked the march of the
disease, nor lessened its frightful mortality. Dr. Labatt says :
“ That from sad experience of this epidemic, I am satisfied that
the contagion of typhus fever is capable of giving rise to puerpe-
ral fever; that puerperal fever is communicable from one patient
to another, and also that it can be carried from the sick by an
attendant to women in child-bed who were previously free from
disease.”
This statement is strongly confirmatory of the opinion that there
is a contagious form of puerperal fever. Such, we believe, is the
opinion of most physicians of the present day.
An epidemic puerperal fever occurred in Vienna in the year
1819. The patients were attacked on the first, second, or third
day after delivery ; symptoms of inflammation of the peritoneum
and uterus were always present. One patient died in six hours
after she was attacked, others in twelve or twenty-four hours.
When the disease presents itself in so malignant a form, one
mode of treatment is as good as another, or to speak more cor-
rectly, all treatment is equally useless, the powers of life give way
at once, and we should imagine a man would as soon think of
plunging his lancet into such a patient as he would of b.leeding a
corpse. “ The very rapid putrefaction after death, the dissolved
state of the blood, the strikingly soft and tender state of the whole
bowels, the heart, lungs, liver, spleen, kidneys, and particularly
of the uterus, indicated a colliquative, putrescent condition of the
whole system induced by the disease.”
Dr. Robert Ferguson’s experience is given by one Methor, who
states that in the general lying-in hospital, in the years 1835-38,
every plan of treatment was tried—bleeding early and copiously,
amongst the rest, without producing any good effect, or lessening
in the smallest degree the mortality. Seeing that no treatment
was of avail, the hospital was closed from May to November. Dr.
Ferguson adds, “ That the present year, 1838, has exercised an
exceedingly fatal influence in every species of fever, all of which
were of the low, or typhoid type.”
An epidemic prevailed in Paris in the year 1829, in the practice
of M. Desormeaux. Mr. Tonnelie, who has described the epidemic,
traced the morbid lesions with great care in no fewer than 222
cases. We insert the following condensed summary of M. Ton-
nelles statements given by the author, not because they contain
any pathological novelty, but to show how perfectly they agree
with the post mortem observations of our own country.
“ In 193 there were traces of peritonitis ; in twenty-nine, or
about one-eighth there were none.
“ In 197 cases, or about nine-tenths, he found morbid lesions in
the uterus e. g., simple inflammation of the uterine veins and lym-
phatics, and softening and putrescence of the uterine parietes.
“ In 62 cases the ovaries were inflamed.
“ In 90 cases there was inflammation of the veins ; in forty of the
lymphatics alone.
11 In 49 cases the uterus was softened, superficially in 29, deeply
in 20.
“ In 29 cases there were the usual evidences of pleurisy ; in six
others an effusion of blood, and in eight of serum into the pleural
cavities.
“ In 27 cases the lungs were affected, viz., in ten there was pneu-
monia ; in eight, abscess; in four, tubercles; in three, gangrene ;
in two apoplexy.
“ There were purulent collections in the muscles in fourteen cases ;
in the joints in ten; and in the cellular tissue of the pelvis in six
cases.
“ Abcess of the liver existed in three cases, and of the pancreas
in two cases.”
The author adds, that “ M. Tonnelle divides puerperal fever
into three varieties ; the inflammatory, the typhoid, which was the
most frequent, and the anomalous or ataxic. “ The more active
remedies were general bleeding, leeches, ipecacuanha and mercu-
rial salivation.” It appears that fully one-third of the cases died.
Next we have the observations of Mr. Ceely of Aylesbury, who
has described an epidemic which occurred in that city and its
neighborhood in the year 1831, during the prevalence of erysipelas,
which exhibited a mild, a phlegmonoid, and a typhoid form, the
puerperal seems to have assumed analogous characteristics.
Mr. Ceely says that he had no opportunity of making a post-
mortem in the acute cases, from which we presume that they all
recovered, which, under active treatment, as far as our experience
goes, they generally will. He examined some of the typhoid cases,
and found most of the usual appearances, which have been des-
cribed so often that it would be waste of space and time to repeat
them.
“ A report of the secondary midwifery institution at Vienna, by
Dr. Bartsch, was published in the Lancet, in which it is stated that
of 2218 women delivered at that institution between October 15th,
1833, and December 31st, 1834, 175 had puerperal fever, of whom
109 died.”
In this report puerperal fever is distinguished from peritonitis
and metritis as will be seen from the following quotation.
“ The cases of puerperal fever occurred seldom under the form
of puerperal peritonitis, but generally as inflammation of the uterine
veins, giving rise to the production of puss in these vessels, and the
general symptoms accompanying its absorption.”
We confess that we are glad to see this distinction made be-
tween peritonitis and malignant puerperal fever; it is most rational,
and will at once account for the different success of different modes
of practice, point out in what cases we ought to bleed without
hesitation, and where it would be advisable to use a discriminating
judgment, and spare the vital power which is already sinking but
too rapidly.
The following quotation is from Dr. Beatty’s Report of the
Lying-in Hospital, South Cumberland street, Dublin.
“ The hospital was visited by this terrible malady twice during
the period embraced by the present report. Both attacks took place
in the month of January, and at each time erysipelas was raging as
an epidemic in the surgical hospitals, and diseases of a typhoid
type were very prevalent in the city.”
Dr. Beatty lost eight patients out of thirteen. M. Voillemier,
Paris, 1838, describes two forms of the disease, the inflammatory
and typhoid. The inflammatory form generally yielded to active
antiphlogistic treatment, though occasionally it terminated fatally.
In the typhoid form the patients rapidly sank at the end of a few
days or hours. There was no regularity in either lochia or milk.
In a few cases M. Voillemier thought he could trace the origin of
the disease to contagion.
“ Epidemics of puerperal fever occurred at Rennes in 1842 and
1844, and have been described by M. Betral. The. lymphatics
were principally implicated, the veins being unaffected. The dis-
ease sometimes terminated in forty hours, but generally not before
the fifth day. The mortality in the first epidemic was tw’enty out
of twenty-four, and in the second, twenty out of twenty-two. There
were purulent deposite in the lungs.”
The disease also appeared in the Westminster Lying-in Hospital
in the year 1842, an account of which has been given by M.
Buddy.
A slight sketch of some other epidemics is then given, but as
we labor under the apprehension of making our article too long,
we omit them, and proceed to give an extract by our author, from
Dr. McClintock, Rotunda Lying-in Hospital, 1845. The Dr. thus
enumerates the peculiarities of the outbreak :
“ 1st. The very sudden and unexpected manner in which the
epidemic appeared, without any of those precursory warnings which
have usually preceded its invasion. 2d. The remarkable circum-
stance, that of the fourteen children of the women attacked, five
died: one of rapid trismus, one of erysipelas, and three of convul-
sions. 3d. That out of the ten fatal cases, nine were examined
post mortem, which examination revealed the most extensive morbid
appearances, quite adequate to account for death. 4th. During the
same period that puerperal fever was in our wards, erysipelas was
very prevalent in some of the surgical hospitals throughout our city.
5th. It is worthy of remark what a small detraction of blood was
sufficient to bring on syncope in this epidemic. Nearly every case
was bled as soon as the system had rallied from the rigor; but only
one woman (who recovered) bore the loss of so much as fifteen
ounces, whilst from six to eight ounces was about the average.”
There are some other epidemics historically mentioned, but we
presume that enough has been given to show the nature, and even
to convey some slight idea of the merits of the article which can-
not be appreciated too highly ; though short, it must have cost the
author much labour and research ; and though he admits that the
list is in all probability imperfect, yet we agree with him cordially
that, so far, it is more complete than any with which we are ac-
quainted. We recommend the careful perusal of it to all practi-
tioners, along with the tables of the various epidemics, wffiich the
author has been at the pains to give us, in order to render it more
intelligible, but which for obvious reasons could not be inserted
here.
Having finished his summary, the author concludes writh some
few observations, rather as suggestions, to induce his readers to
follow up the subject than as absolute inferences. They appear
to us to be so judicious, that we shall make no apology for giving
some of them, and as we before gave our readers a promise to
that effect, we shall give them in Dr. Churchill’s own words.
“ I would remark then, in the first place, that there appears some
especial connection between the epidemics of puerperal fever, and
lying-in hospitals. I do not mean exactly to assert that these epide-
mics always originate with, and are kept up by, the hospitals; but
I refer to the fact that we have no record of any epidemic inde-
pendent of them in early times. The first in France, England and
Ireland, occurred in the Hotel Dieu of the former, and the lying-in
hospitals of the latter countries, and though our earlier authors
allude to inflammation of the womb, &c., occurring in child-bed,
they make no mention of its prevailing extensively as an epidemic.’’
The author then alludes to the almost universally admitted fact,
that puerperal fever is always, or almost always, connected with
local diseases, but adds that Dr. Copland, in an excellent article,
has denied the universal presence of inflammation in the malady,
and states that in one epidemic the only pathological characteris-
tics observable were a remarkable alteration of the blood, general
lacerability of the tissues, or loss of their vital cohesion soon after
death. He adds, however, that such cases are rare.
We proceed with the author’s remarks :
“ I repeat my conviction that there are few if any cases of puer-
peral fever without local disease of the organs employed in parturi-
tion or the neighboring tissues; but are we therefore justified in
asserting with Dr. Lee that puerperal fever is simply a local affec-
tion ?
“ I have latterly seen reason to doubt the truth of the view I for-
merly took, which was in accordance with that of Dr. Lee, and
though I would wish to express myself cautiously and guardedly, I
must honestly avow, that whilst I fully admit the existence of local
disease, I do think that epidemic puerperal fever is something more
than that, although I may not be able to define exactly what it is.
“ We should be justified in this supposition I think on several
grounds. First, the very remarkable variety of opinion as to its
nature, would go far to prove that it cannot be the simple local dis-
ease Dr. Lee believes. For example, by some it is regarded as an
inflammation of the uterus; by others inflammation of the omentum
and intestines; by a third party as peritonitis; by a fourth erysipela-
tous inflammation ; by a fifth and sixth as a fever sui generis, or
with biliary disorder; by a seventh as a disease of a putrid charac-
ter, &c. Such different views are hardly reconcilable with the
notion of a simple inflammation.”
We have long been of precisely the author’s opinion, but he
does not appear to have any very distinctly defined idea on the
subject, and indeed the difference of opinion is so great, that it is
hard for a man who seeks truth and not the gratification of his
vanity, by the exemplification of some favorite dogma, to bring his
mind to a conclusion. The arguments remind us forcibly of the
history of the cameleon. The author proceeds with the following
remarks.
“ Then again look at the prevailing characters of different epi-
demics, and see how varied they are; in one the lochia are sup-
pressed, in another they are profuse, in a third unaltered ; diarrhoea
is common in one epidemic, constipation in another ; typhoid symp-
toms in one, ordinary fever in another. And as to remedies we find
even a greater diversity: one very high authority recommends saline
purgatives; another loses all his patients until he bleeds largely at
the commencement; another loses those who are so bled. Calomel
is the universal remedy in one epidemic, opium in another.
“ Lastly, let any one compare a case of simple inflammation of
the womb or peritoneum in child-bed, with a case of epidemic
puerperal fever, their symptoms, course, and the effect of remedies,
and I do not think that a doubt will remain upon his mind that,
although the latter is a local disease, it is not exclusively so.”
The author then enquires, what more is it than a local disease ?
discusses the peculiar effects of uterine phlebitis, states Mr. John
Hunter’s opinion that phlebitis destroys life by the extension of
inflammation to the heart, a position which Dr. Arnott’s investi-
gations disproved, showing that it was probably owing to an
alteration in the quality of the blood. “ M. Bouillaud, in 1825,
attributed the typhoid symptoms in phlebitis to the mixture of pus
with the blood.” Analagous results have been produced by in-
jecting putrid matter into the system, and “ Guthrie’s descrip-
tions,” says Dr. Churchill, “ of the characteristics of irritative
phlebitis symptoms, &c., are very like those of puerperal fever.”
Many authorities are quoted in support of the plausibility of
the position that puerperal fever, occurring as an epidemic, is
neither more nor less than typhus, modified by the peculiar condi-
tion of the female at the parturient time, and it is natural enough
to suppose that those organs and their investments more imme-
diately concerned in the process of labor, should, be most
liable to be affected by the vitiated condition of the general sys-
tem, and take on an unhealthy inflammatory action, producing all
that local mischief which Dr. Lee and others have maintained is
the whole disease.
When we take into consideration the fact that typhus and ery-
sipelas frequently appear together, and during the same atmosphe-
ric conditions, the supposition that the local affection is of an
erysipelatous character, is extremely plausible.
The following quotation from Mr. Nunnelly, is corroborative of
the author’s opinion on this subject.
“ It is highly probable, if not certain, that there is some change
produced in the state of the blood, which change may depend upon
alterations we are unable at present to appreciate, but which it is
likely occur in many tissues, and may thus affect the mass of the
blood more or less quickly, and to a greater or less extent, accord-
ing to the influence they have upon, and the connection they have
with the blood in a state of health.”
The important subject of contagion is then discussed—various
high authorities, both for and against the contagiousness of child-
bed fever, are quoted : the author does not seem to be fully satisfied
on this subject, but all that he says has been before the medical
public so often, that we think it unnecessary to trouble our readers
by calling their attention particularly to his opinions. They are,
nevertheless, worthy of great respect, and may be read with ad-
vantage. One observation we quote as follows :
“As in all cases where a disease is epidemic, it is and must be a
difficult thing to decide as to the contagiousness of puerperal fever:
still I confess that the facts would lead me to the inference that, at
least, it is communicable from a woman laboring under it to others
in the same ward.”
These remarks naturally lead to the consideration whether puer-
peral fever can or cannot be conveyed by a third party in health,
from a person laboring under it to another person in child-bed.
This is a subject of momentous importance to the practitioner of
midwifery, and one which we heartily wish could be determinately
settled; if it be as some have thought, (Gordon amongst the rest)
that the medical attendant himself carries death into the chamber
of his confiding patient, every conscientious man who meets with
a case of puerperal fever, of a typhoid character, must be subjected
to a fearful anxiety, for he must either continue his practice at the
conscious hazard of destroying those entrusted to his care, or he
must impoverish himself by abandoning his professional duties, a
hard alternative to a man dependent for his living on such
exertions.
Dr. Churchill does not seem to have settled this question either
way to his own satisfaction, and certainly does not satisfy his
readers; he says :
“ So far as the weight of opinion goes, it is in favor of contagion,
but I think we are scarcely yet in a position to speak quite
positively.”
After quoting many anecdotes of cases, in which the authors
(men of high repute) assert that in their judgment the epidemic
was conveyed by the attending physicians from the sick to healthy
women, he makes the following commentary : “ ‘ Post hoc ’ is not
always ‘ propter hoc,’ however, and we must not forget that puer-
peral fever was epidemic at the time.” This remark has particular
reference to some cases which occurred in Edinburgh in 1821-2.
The author winds up with the following remarks:
“ The evidence and proofs thus adduced are of extreme import-
ance, and I fear we must conclude, however reluctantly, in favor,
not only of the contagiousness of puerperal fever, but of the possi-
bility of its contagion being carried by an intermediate party. This
makes the practice of midwifery doubly distressing during the pre-
valence of an epidemic, and ought deeply to impress us with the
necessity of the utmost care and caution.”
The article closes with the following quotation from Dr.
Copland.
“ An obstetric physician should not make an autopsy of a case
of puerperal fever or of erysipelas, or of peritonitis, or of diffusive
inflammation of the cellular tissue, or of the disease occasioned by
the necroscopic poison; nor even attend, dress, nor visit any of such
cases without observing the utmost precaution with regard to ablu-
tion and change of clothing, and allowing two or three days to
elapse between such attendance and midwifery engagements, or
visits to puerperal females.”
We have thus traced, as connectedly as our space would admit
of, the original portion of Dr. Churchill’s book, viz., the histori-
cal sketch of puerperal fever. The essays, though never before
published together, have been in the hands of the profession many
years, and have been reviewed and commented on so frequently,
that further notice of them would be
“As tedious as a thrice told tale
Vexing the dull ear of a drowsy man.”
We will only add that the work as a book of reference is invalu-
able, and ought to form a part of every medical library.