Booth Tarkington - "The Guest of Quesnay"

E. P. Roe - "Miss Lou"

Emile Zola - "The Three Cities Trilogy: Lourdes, Vol. 4"

George W. Caldwell - "The Legends of San Francisco"

New Philadelphia Book Publisher Highlights Local Talent
Book and Publishing News from Publishers Newswire(tm)

Looking for Child to be on Cover of a New Book, 'The Model Child'
PHILADELPHIA, Pa. -- The Philadelphia literary world will celebrate the launch of two new players today, April 10th: Kay Square Press, a new publishing company focused on Philadelphia-area artists, their stories, and their art; and Kay Square's first release, 'With the Rich and Mighty: Emlen Etting of Philadelphia' (ISBN: 978-0-9815129-0-7), a critical biography by Kenneth C. Kaleta.

FlatSigned Press Alleges Don Imus Remarks Damage Legacy of President Gerald R. Ford
NEW YORK, N.Y. -- Nathan Yungerberg, an accomplished model scout and professional child photographer is launching a nation-wide casting call to find the cover model for his highly anticipated book release, 'The Model Child: A Parents Guide to the Child Modeling Industry' (ISBN: 978-0-9817018-0-6).

Books: The Harvard Classics Volume 38

V >> Various >> The Harvard Classics Volume 38




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 the 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 favour 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 smallpox is
propagated to a great extent by contagion, yet it goes through
the same records 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 smallpox 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. A part 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 smallpox 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. [Footnote: 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 candour 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 neighbourhood 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." [Footnote: Philad. Med. Journal for 1825, p. 408.]

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. [Footnote: A similar anecdote is related by Sir
Benjamin Brodie, of the late Dr. John Clark, Lancet, May 2,
1840.] 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 the same fate, till the neighbourhood,
getting afraid of her, ceased to employ her." [Footnote: An
Account of Some of the Most Important Diseases Peculiar to Women,
p. 4].

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
neighbourhood, 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." [Footnote: Gooch, op. cit., p. 71.]

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. [Footnote: Lond. Med. Gaz., May 2, 1835.]

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 mangerside,
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." [Footnote: Lect. on
Midwifery, p. 395.]

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. [Footnote:
Lancet, May 3, 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."
[Footnote: Lond. Cyc. of Pract. Med., art., "Fever, Puerperal"]

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 clusterings 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. [Footnote: Denman's Midwifery, p. 673, third Am. ed.]

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 'mixed
cases,' and 'morbid affections after delivery.'" [Footnote:
Remarks on Puerperal Fever, pp. 12 and 13.]

In the "Quarterly Summary of the Transactions of the College of
Physicians of Philadelphia" [Footnote: For May, June, and July,
1842.] 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," [Footnote:
For January 21, 1843.] 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 twelve-month 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, [Footnote: Medical Examiner for December 10, 1842.]
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 effluvia. And here I may mention
that this very Dr. Samael Jackson, of Northumberland, is one of
Dr. Dewees's authorities against contagion.