The principles and practice of obstetricy, as at present taught, by James Blundell ... To which are added, notes and illustrations. By Thomas Castle.

  • Blundell, Dr., 1790-1878.
Date:
1834
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of obstetricy, as at present taught, by James Blundell ... To which are added, notes and illustrations. By Thomas Castle. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    declarations it is their intention to deceive, but there is a curious phenomenon of the human mind, well known to those who have studied it, and which consists in fancying that we believe that to which we give no credence, and the contrary; a state of mind which is soon discovered to ourselves and others, by placing ourselves in a position which calls for the operation of the faith or belief, when infidelity becomes manifest.* Wavering the question of its precise character, I content myself with remarking, generally, that from more than one district I have received ac- counts of the prevalence of puerperal fever in the practice of some individuals, while its occurrence in that of others in the same neighborhood, was not observed. Some, as I have been told, have lost ten, twelve, or a greater number of patients in scarcely broken succession ;t like their evil genius, the puerperal fever has seemed to stalk behind them wherever they went. Some nave deemed it prudent to retire for a time from practice. In fine, that this fever may occur spontaneously I admit, that its infectious nature may be plausibly disputed I do not deny, but I add, considerately, that in my own family, I had rather that those I esteemed the most should be delivered, un- aided, in a stable, than that they should receive the best help in the fairest apartments, but exposed to the vapors of this pitiless disease. Gossipping friends, wet nurses, monthly nurses, and the practitioner himself, are the channels by which, I suspect, the infection is principally conveyed. As to its prevention, I know of nothing certain. Moderate purging after delivery can do no injury. As flooding, during delivery, seems to dispose to the fever, I think it very doubtful whether venesection possesses any pre- ventive power. To guard solicitously against the infection is, of course of the first importance. Is bracing the abdomen of importance ? Post-mortem Appearances. On examining the body after the more malignant attacks of the puerperal fever, as when the patient for example is dead within a day or two after the chill, on opening the abdomen, scarcely a trace of inflammation has been observed; a little bloody serum, a few dubious adhesions, a difference of * Conversing with an obstetric friend, who contended that the puerperal fever was not infec- tious, I heard him, for he was my elder, with respectful attention, till at length, after he had delivered his sentiments somewhat at large— Notwithstanding all this, said I, my dear Sir, I cannot help thinking that the fever may be infectious, and, pardon the freedom, but I fancy you think so too. I! said he, in an accent of surprise, 1 think so ! why I have just been telling you to the contrary ! Well, said I, will you allow me to bring your belief to the test? He nodded assent. It so happened that this gentleman had a favorite niece recently confined, the only immediate representative of his very respectable family. Come then, I proceeded, you tell me your niece has just been confined, and I offer my congratu- lations ; but, permit me to ask, if you had been to see one or two patients laboring under thia terrible disease, would you like to take her by the hand and to sit down at the bed-side ?— He started gently, and hesitated; then, in a subdued tone of voice, Why, really, said he, I should not like to do that. And thus, it seems, even in the midst of denials, there may be on the mind a suspicion of infection ; and on this suspicion, of course, it becomes our duty to act.—Dr. Blundell. f Mr. Robertson, of Manchester, has stated that, From December 3d 1830, to January 4th 1831, a midwife attended thirty patients for a public charity; sixteen of these were attacked with puerperal fever, and they all ultimately died. In the same month three hundred and eighty women were delivered by midwives for the institution, but none of the other patients suffered in the slightest degree.—Medical Gazette, No. 214. Dr. Armstrong observes that most (forty out of fifty) of the cases at Sunderland, occurred in the practice of one surgeon and his assistant.—Dr. Lee's Researches.