medical essays-第23部分

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　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　t