III. On puerperal fever.–First observation. On the twelfth of
March, 1878, Dr. Hervieux was good enough to admit me to his
service in the Maternity to visit a woman delivered some days
before and seriously ill with puerperal fever. The lochia were
extremely fetid. I found them full of micro-organisms of many
kinds. A small amount of blood was obtained from a puncture on
the index finger of the left hand, (the finger being first
properly washed and dried with a STERILE towel,) and then sowed
in chicken bouillon. The culture remained sterile during the
following days.
observed, should be, to learn how to distinguish with accuracy
between that peculiar pustule which is the true cow pock, and
that which is spurious
One of the first objects then of this pursuit, as I have
observed, should be, to learn how to distinguish with accuracy
between that peculiar pustule which is the true cow pock, and
that which is spurious. Until experience has determined this, we
view our object through a mist. Let us, for instance, suppose
that the smallpox and the chicken-pox were at the same time to
spread among the inhabitants of a country which had never been
visited by either of these distempers, and where they were quite
unknown before: what confusion would arise! The resemblance
between the symptoms of the eruptive fever and between the
pustules in either case would be so striking that a patient who
had gone through the chicken-pox to any extent would feel equally
easy with regard to his future security from the smallpox as the
person who had actually passed through that disease. Time and
future observation would draw the line of distinction.
this history, they would have had no hesitation in pronouncing it
a case of spurious cow-pox; considering its deviation in the
NUMEROUS blisters which appeared on the girl”s hands; their
termination without ulceration; its not proving more generally
contagious at the farm, either among the cattle or those employed
in milking; and considering also that THE PATIENT FELT NO GENERAL
INDISPOSITION, ALTHOUGH THERE WAS SO GREAT A NUMBER OF VESICLES
Now had any one conversant with the habits of the disease heard
this history, they would have had no hesitation in pronouncing it
a case of spurious cow-pox; considering its deviation in the
NUMEROUS blisters which appeared on the girl”s hands; their
termination without ulceration; its not proving more generally
contagious at the farm, either among the cattle or those employed
in milking; and considering also that THE PATIENT FELT NO GENERAL
INDISPOSITION, ALTHOUGH THERE WAS SO GREAT A NUMBER OF VESICLES.
smallpox is morbid matter of a peculiar kind, generated by a
disease in the horse, and that accidental circumstances may have
again and again arisen, still working new changes upon it until
it has acquired the contagious and malignant form under which we
now commonly see it making its devastations amongst us? And, from
a consideration of the change which the infectious matter
undergoes from producing a disease on the cow, may we not
conceive that many contagious diseases, now prevalent among us,
may owe their present appearance not to a simple, but to a
compound, origin? For example, is it difficult to imagine that
the measles, the scarlet fever, and the ulcerous sore throat with
a spotted skin have all sprung from the same source, assuming
some variety in their forms according to the nature of their new
combinations? The same question will apply respecting the origin
of many other contagious diseases which bear a strong analogy to
each other
May it not then be reasonably conjectured that the source of the
smallpox is morbid matter of a peculiar kind, generated by a
disease in the horse, and that accidental circumstances may have
again and again arisen, still working new changes upon it until
it has acquired the contagious and malignant form under which we
now commonly see it making its devastations amongst us? And, from
a consideration of the change which the infectious matter
undergoes from producing a disease on the cow, may we not
conceive that many contagious diseases, now prevalent among us,
may owe their present appearance not to a simple, but to a
compound, origin? For example, is it difficult to imagine that
the measles, the scarlet fever, and the ulcerous sore throat with
a spotted skin have all sprung from the same source, assuming
some variety in their forms according to the nature of their new
combinations? The same question will apply respecting the origin
of many other contagious diseases which bear a strong analogy to
each other.
received opinions, that the diastole of the arteries corresponds
with the time of the heart”s systole; and that the arteries are
filled and distended by the blood forced into them by the
contraction of the ventricles; the arteries, therefore, are
distended, because they are filled like sacs or bladders, and are
not filled because they expand like bellows
From these facts it is manifest, in opposition to commonly
received opinions, that the diastole of the arteries corresponds
with the time of the heart”s systole; and that the arteries are
filled and distended by the blood forced into them by the
contraction of the ventricles; the arteries, therefore, are
distended, because they are filled like sacs or bladders, and are
not filled because they expand like bellows. It is in virtue of
one and the same cause, therefore, that all the arteries of the
body pulsate, viz., the contraction of the left ventricle; in the
same way as the pulmonary artery pulsates by the contraction of
the right ventricle.
languid: the ratio obtained is very nearly the same that ordinary
fungoid growths would give
Under these conditions the fermentation of sugar is extremely
languid: the ratio obtained is very nearly the same that ordinary
fungoid growths would give. The carbonic acid evolved is
principally formed by the decompositions which result from the
assimilation of atmospheric oxygen. The yeast, therefore, lives
and performs its functions after the manner of ordinary fungi: so
far it is no longer a ferment, so to say; moreover, we might
expect to find it to cease to be a ferment at all if we could
only surround each cell separately with all the air that it
required. This is what the preceding phenomena teach us; we shall
have occasion to compare them later on with others which relate
to the vital action exercised on yeast by the sugar of milk.
treatment is that of abscesses
The next class of cases to which I have applied the antiseptic
treatment is that of abscesses. Here also the results have been
extremely satisfactory, and in beautiful harmony with the
pathological principles indicated above. The pyogenic membrane,
like the granulations of a sore, which it resembles in nature,
forms pus, not from any inherent disposition to do so, but only
because it is subjected to some preternatural stimulation. In an
ordinary abscess, whether acute or chronic, before it is opened
the stimulus which maintains the suppuration is derived from the
presence of pus pent up within the cavity. When a free opening is
made in the ordinary way, this stimulus is got rid of, but the
atmosphere gaining access to the contents, the potent stimulus of
decomposition comes into operation, and pus is generated in
greater abundance than before. But when the evacuation is
effected on the antiseptic principle, the pyogenic membrane,
freed from the influence of the former stimulus without the
substitution of a new one, ceases to suppurate (like the
granulations of a sore under metallic dressing), furnishing
merely a trifling amount of clear serum, and, whether the opening
be dependent or not, rapidly contracts and coalesces. At the same
time any constitutional symptoms previously occasioned by the
accumulation of the matter are got rid of without the slightest
risk of the irritative fever or hectic hitherto so justly dreaded
in dealing with large abscesses.
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.
puerperal fever at the British Lying-in Hospital, examined a
patient who had just been admitted, to ascertain if labor had
commenced
In December, 1830, a midwife, who had attended two fatal cases of
puerperal fever at the British Lying-in Hospital, examined a
patient who had just been admitted, to ascertain if labor had
commenced. This patient remained two days in the expectation that
labor would come on, when she returned home and was then suddenly
taken in labor and delivered before she could set out for the
hospital. She went on favorably for two days, and was then taken
with puerperal fever and died in thirty-six hours. [Footnote:
Ibid.]