medical essays-第25部分

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aken　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　case