The history, pathology, and treatment of puerperal fever and crural phlebitis.

Date:
1842
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Licence: Public Domain Mark

Credit: The history, pathology, and treatment of puerperal fever and crural phlebitis. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

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    which the experience of the last few years has taught us about peritoneal fevers is, that they may occur in their most malignant and fatal form, and yet leave few or no vestiges in the peritoneum after death. The state of this membrane, indicated by pain and tenderness of the abdomen, with a rapid pulse, appears to be not one uniform state, but one which varies so much in different cases, that a scale might be formed of its several varieties; this scale would begin with little more than a nervous affection, often re- movable by soothing remedies, and, when terminating fatally, leaving no morbid appearances discoverable after death. Next above this, a state in which this nervous affection is combined with some congestion, indicated in the cases which recover by the relief afforded by leeches, and in the cases which die by slight redness in parts of the peritoneum, and a slight effusion of serum, sometimes colourless, sometimes stained with blood. Above this might be placed those cases in which there are in the peritoneum the effusions of inflammation without its redness; namely, a pale peritoneum and no adhesions, tymph like a thin layer of soft cus- tard, and a copious effusion of serum, rendered turbid by soft lymph. Lastly, the vestiges of acute inflammation of the perito- neum, viz., redness of the membrane, adhesion of its contiguous surfaces, a copious effusion of serum, and large masses of lymph.* Dr. Gooch affirms, that symptoms and dissections cannot settle the question respecting the pathology of puerperal fever. The effects of remedies on a disease, he says, if accurately observed, form the most important part of the history. They are like che- mical tests, frequently detecting important differences in objects which previously appeared exactly similar. Symptoms and dis- sections can never do more than suggest probabilities about the nature of a disease, and the effects of a remedy on it. A trial of the remedies themselves is the only conclusive proof. I might confidently appeal to the works of all the most eminent writers on puerperal fever, since the middle of the seventeenth century, to prove that this opinion is equally erroneous as it is dangerous; and it would be easy to show, from the contradictory statements they have made of the results of the various modes of treatment adopted during the last fifty years, that we must have forever remained ignorant of the true nature of the disease, had we reasoned from the effects of remedies alone, without investi- gating symptoms, raid the morbid changes of structure. That a diffused pain of the abdomen, with a rapid soft pulse, not unfrequently occurs without inflammation of the uterus, or of any other part, or with a very slight degree of inflammation, in delicate nervous women after parturition, and that these symptoms are relieved by opiates and warm fomentations, without either general or local bloodletting, will readily be admitted by all who are con- * An Account of some of the most Important Diseases peculiar to Women, bg Robert Gooch, M.D. 2.0*