medical essays-第26部分

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s's　book　and　my　Essay　in　his　hands　at　the　same　time。

Question。　　〃If　such　facts　as　Roberton's　cases　were　before　you；　and　the　attendant　had　had　ten；　or　even　five　fatal　cases；　or　three；　or　two　even；　would　you；　or　would　you　not；　if　insuring　the　life　of　the　next　patient　to　be　taken　care　of　by　that　attendant；　expect　an　extra　premium　over　that　of　an　average　case　of　childbirth？〃

Answer。　　〃　Of　course　I　should　require　a　very　large　extra　premium；　if　I　would　take　take　risk　at　all。〃

But　I　do　not　choose　to　add　the　expressions　of　indignation　which　the　examination　of　the　facts　before　him　called　out。　　I　was　satisfied　from　the　effect　they　produced　on　him；　that　if　all　the　hideous　catalogues　of　cases　now　accumulated　were　fully　brought　to　the　knowledge　of　the　public；　nothing；　since　the　days　of　Burke　and　Hare；　has　raised　such　a　cry　of　horror　as　would　be　shrieked　in　the　ears　of　the　Profession。

Dr。　Meigs　has　elsewhere　invoked　〃Providence〃　as　the　alternative　of　accident；　to　account　for　the　〃coincidences。〃　　（〃Obstetrics；〃　Phil。　1852；　p。　　631。）　If　so；　Providence　either　acts　through　the　agency　of　secondary　causes；　as　in　other　diseases；　or　not。　　If　through　such　causes；　let　us　find　out　what　they　are；　as　we　try　to　do　in　other　cases。　　It　may　be　true　that　offences；　or　diseases；　will　come；　but　〃woe　unto　him　through　whom　they　come；〃　if　we　catch　him　in　the　voluntary　or　careless　act　of　bringing　them！　　But　if　Providence　does　not　act　through　secondary　causes　in　this　particular　sphere　of　etiology；　then　why　does　Dr。　Meigs　take　such　pains　to　reason　so　extensively　about　the　laws　of　contagion；　which；　on　that　supposition；　have　no　more　to　do　with　this　case　than　with　the　plague　which　destroyed　the　people　after　David　had　numbered　them？　　Above　all；　what　becomes　of　the　theological　aspect　of　the　question；　when　he　asserts　that　a　practitioner　was　〃only　unlucky　in　meeting　with　the　epidemic　cases？〃　（　Op。　　cit。　　p。　　633。）　We　do　not　deny　that　the　God　of　battles　decides　the　fate　of　nations；　but　we　like　to　have　the　biggest　squadrons　on　our　side；　and　we　are　particular　that　our　soldiers　should　not　only　say　their　prayers；　but　also　keep　their　powder　dry。　　We　do　not　deny　the　agency　of　Providence　in　the　disaster　at　Norwalk；　but　we　turn　off　the　engineer；　and　charge　the　Company　five　thousand　dollars　apiece　for　every　life　that　is　sacrificed。

Why　a　grand　jury　should　not　bring　in　a　bill　against　a　physician　who　switches　off　a　score　of　women　one　after　the　other　along　his　private　track；　when　he　knows　that　there　is　a　black　gulf　at　the　end　of　it；　down　which　they　are　to　plunge；　while　the　great　highway　is　clear；　is　more　than　I　can　answer。　　It　is　not　by　laying　the　open　draw　to　Providence　that　he　is　to　escape　the　charge　of　manslaughter。

To　finish　with　all　these　lesser　matters　of　question；　I　am　unable　to　see　why　a　female　must　necessarily　be　unattended　in　her　confinement；　because　she　declines　the　services　of　a　particular　practitioner。　　In　all　the　series　of　cases　mentioned；　the　death…carrying　attendant　was　surrounded　by　others　not　tracked　by　disease　and　its　consequences。　Which；　I　would　ask；　is　worse；to　call　in　another；　even　a　rival　practitioner；　or　to　submit　an　unsuspecting　female　to　a　risk　which　an　Insurance　Company　would　have　nothing　to　do　with？

I　do　not　expect　ever　to　return　to　this　subject。　　There　is　a　point　of　mental　saturation；　beyond　which　argument　cannot　be　forced　without　breeding　impatient；　if　not　harsh；　feelings　towards　those　who　refuse　to　be　convinced。　　If　I　have　so　far　manifested　neither；　it　is　well　to　stop　here；　and　leave　the　rest　to　those　younger　friends　who　may　have　more　stomach　for　the　dregs　of　a　stale　argument。

The　extent　of　my　prefatory　remarks　may　lead　some　to　think　that　I　attach　too　much　importance　to　my　own　Essay。　　Others　may　wonder　that　I　should　expend　so　many　words　upon　the　two　productions　referred　to；　the　Letter　and　the　Lecture。　　I　do　consider　my　Essay　of　much　importance　so　long　as　the　doctrine　it　maintains　is　treated　as　a　question；　and　so　long　as　any　important　part　of　the　defence　of　that　doctrine　is　thought　to　rest　on　its　evidence　or　arguments。　　I　cannot　treat　as　insignificant　any　opinions　bearing　on　life；　and　interests　dearer　than　life；　proclaimed　yearly　to　hundreds　of　young　men；　who　will　carry　them　to　their　legitimate　results　in　practice。

The　teachings　of　the　two　Professors　in　the　great　schools　of　Philadelphia　are　sure　to　be　listened　to；　not　only　by　their　immediate　pupils；　but　by　the　Profession　at　large。　　I　am　too　much　in　earnest　for　either　humility　or　vanity；　but　I　do　entreat　those　who　hold　the　keys　of　life　and　death　to　listen　to　me　also　for　this　once。　　I　ask　no　personal　favor；　but　I　beg　to　be　heard　in　behalf　of　the　women　whose　lives　are　at　stake；　until　some　stronger　voice　shall　plead　for　them。

I　trust　that　I　have　made　the　issue　perfectly　distinct　and　intelligible。　　And　let　it　be　remembered　that　this　is　no　subject　to　be　smoothed　over　by　nicely　adjusted　phrases　of　half…assent　and　half…　censure　divided　between　the　parties。　　The　balance　must　be　struck　boldly　and　the　result　declared　plainly。　　If　I　have　been　hasty；　presumptuous；　ill…informed；　illogical；　if　my　array　of　facts　means　nothing；　if　there　is　no　reason　for　any　caution　in　the　view　of　these　facts；　let　me　be　told　so　on　such　authority　that　I　must　believe　it；　and　I　will　be　silent　henceforth；　recognizing　that　my　mind　is　in　a　state　of　disorganization。　　If　the　doctrine　I　have　maintained　is　a　mournful　truth；　if　to　disbelieve　it；　and　to　practise　on　this　disbelief；　and　to　teach　others　so　to　disbelieve　and　practise；　is　to　carry　desolation；　and　to　charter　others　to　carry　it；　into　confiding　families；　let　it　be　proclaimed　as　plainly　what　is　to　be　thought　of　the　teachings　of　those　who　sneer　at　the　alleged　dangers；　and　scout　the　very　idea　of　precaution。　　Let　it　be　remembered　that　persons　are　nothing　in　this　matter；　better　that　twenty　pamphleteers　should　be　silenced；　or　as　many　professors　unseated；　than　that　one　mother's　life　should　be　taken。　　There　is　no　quarrel　here　between　men；　but　there　is　deadly　incompatibility　and　exterminating　warfare　between　doctrines。　Coincidences；　meaning　nothing；　though　a　man　have　a　monopoly　of　the　disease　for　weeks　or　months；　or　cause　and　effect；　the　cause　being　in　some　way　connected　with　the　person；　this　is　the　question。　　If　I　am　wrong；　let　me　be　put　down　by　such　a　rebuke　as　no　rash　declaimer　has　received　since　there　has　been　a　public　opinion　in　the　medical　profession　of　America；　if　I　am　right；　let　doctrines　which　lead　to　professional　homicide　be　no　longer　taught　from　the　chairs　of　those　two　great　Institutions。　　Indifference　will　not　do　here；　our　Journalists　and　Committees　have　no　right　to　take　up　their　pages　with　minute　anatomy　and　tediously　detailed　cases；　while　it　is　a　question　whether　or　not　the　〃blackdeath〃　of　child…bed　is　to　be　scattered　broadcast　by　the　agency　of　the　mother's　friend　and　adviser。　　Let　the　men　who　mould　opinions　look　to　it；　if　there　is　any　voluntary　blindness；　any　interested　oversight；　any　culpable　negligence；　even；　in　such　a　matter；　and　the　facts　shall　reach　the　public　ear；　the　pestilence…carrier　of　the　lying…in　chamber　must　look　to　God　for　pardon；　for　man　will　never　forgive　him。


　　　　　　　　　　　　　　　THE　CONTAGIOUSNESS　OF　PUERPERAL　FEVER。

In　collecting；　enforcing；　and　adding　to　the　evidence　accumulated　upon　this　most　serious　subject；　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。　　In　the　present　state　of　our　knowledge　upon　this　point　I　should　consider　such　doubts　merely　as　a　proof　that　the　sceptic　had　either　not　examined　the　evidence；　or；　having　examined　it；　refused　to　accept　its　plain　and　unavoidable　consequences。　　I　should　be　sorry　to　think；　with　Dr。　Rigby；　that　it　was　a　case　of　〃oblique　vision；〃　I　should　be　unwilling　to　force　home　the　argumentum　ad　hominem　of　Dr。　Blundell；　but　I　would　not　consent　to　make　a　question　of　a　momentous　fact　which　is　no　longer　to　be　considered　as　a　subject　for　trivial　discussions；　but　to　be　acted　upon　with　silent　promptitude。　　It　signifies　nothing　that　wise　and　experienced　practitioners　have　sometimes　doubted　the　reality　of　the　danger　in　question；　no　man　has　the　right　to　doubt　it　any　longer。　　No　negative　facts；　no　opposing　opinions；　be　they　what　they　may；　or　whose　they　may；　can　form　any　answer　to　the　series　of　cases　now　within　the　reach　of　all　who　choose　to　explore　the　records　of　medical　science。

If　there　are　some　who　conceive　that　any　important　end　would　be　answered　by　recording　such　opinions；　or　by　collecting　the　history　of　all　the　cases　they　could　find　in　which　no　evidence　of　the　influence　of　contagion　existed；　I　believe　they　are　in　error。　　Suppose　a　few　writers　of　authority　can　be　found　to　profess　a　disbelief　in　contagion；and　they　are　very　few　compared　with　those　who　think　differently；is　it　quite　clear　that　they　formed　their　opinions　on　a　view　of　all　the　facts；　or　is　it　not　apparent　that　they　relied　mostly　on　their　own　solitary　experience？　　Still　further；　of　those　whose　names　are　quoted；　is　it　not　true　that　scarcely　a　single　one　could　by　any　possibility　have　known　the　half　or　the　tenth　of　the　facts　bearing　on　the　subject　which　have　reached