THE LANCET

1874 The Lancet  
who took for his subject Puerperal Pyaemia. It would be impossible for Dr. MATTHEWS DUNCAN to deliver an address on this momentous topic, occupying twelve closely-printed columns of the Association Journal, without disclosing great stores of thought and information; and the address should be carefully read. But we could wish that Dr. DuNcAN had kept more closely to the matter in hand, and not allowed himself to yield to a certain tendency to descant on collateral subjects and to indulge in
more » ... to indulge in occasional moralisings. We must also object to obstetricians speaking of the 11 fearful ordeal of marriage and childbearing" to young women, and making other statements "awful to women and men." There never was a time when parturition was so safe a process as it is now, or when obstetricians had a right to speak so comfortably and assuringly on the subject. A certain amount of risk, no doubt, attaches to the ordeal of pregnancy and parturition. But the same is true of the estate of celibacy; and it seems to us that men in authority, speaking in a semi-public position, should be careful to avoid using strong adjectives to describe dangers which are being steadily minimised, which must be incurred, and which are borne as cheerfully and courageously as men bear the hardships incident to their calling. Dr. MATTHEWS DUNCAN strongly objects to the term "puerperal fever," and proposes to replace it by the name of Ct puerperal pyaemia," not using pyoemia in its crude sense to imply purulent blood, but as a comprehensive word to include septicmia, ichorrsemia, &c. " Pyaemia," Dr. Duncan says, 11 occurs in several forms, which are characterised each by more or less peculiar symptoms, but most distinctly by the pathological appearances discovered post mortem. There is that most widely 'known where you have septic embola, and scattered abscesses caused by them, and perhaps otherwise also. There is that where you have inflammation of the peritoneum and other serous cavities, including the synovial and endocardial. There-is that where the mucous membranes are chiefly affected-the muco-enteritic. And, lastly, there is that where the only results found after death are-alteration of the blood, enlargement of the spleen, the liver, and degenerations of their most important tissues, with similar degenerations in other organs. It is this last which, often rapidly fatal, was described by Helm, and is now often called acute septicaemia. These are the cases which the superficial pathology of our young days described as having no post-mortem appearances at all. An autopsy in those days was made by any practitioner, occupied only a few minutes, and the observations made were of corresponding value. Now an autopsy is a matter understood to demand the labour for a long time, often for hours or even days, of an eipert. On these fruitless necropsies, where no appearances were discovered and none supposed to be discoverable, was founded, as you will remember, an argument supposed to be of clinching potency in favour of the essential fever character of the disease." Dr. DuNCAN observes that the recent doctrine of puerperal fever rather militates against its being, in the language of FORDYCE BABRBR, " an essential fever peculiar to puerperal women, as much a distinct disease as typhus or typhoid." " The doctrine is antithetical to the essential-fever notion, for it states that pyaemia or so-called puerperal fever, does not essentially differ from ordinary inflammatory fever, such as is called healthy, except in degree ; and that the modes of induction of these feverish states are identical, or nearly so. From the slightest pyrogenous effect or merest evidence of morbility, as discovered by the thermometer, up to the most rapid of Helm's cases of acute septicaemia, we have one disease in different degrees or forms, all depending on a chemical poison of Schmiedeberg and Panum, or on the bacterium of Mayrhofer, of Lister, of Klebs, of Waldeyer, of Heiberg, and of Orth, whether this bacterium be the poison or only its carrier. That there are weighty reasons for entertaining this view must be admitted, and among them not the least is the wonderful results of the antiseptic system of treatment, as not only preventing pyeemia, but as preventing ordinary inflammatory fever." Dr. DUNCAN, without being able to adhere to the doctrine of the practical identity of puerperal and pyaemic fevers with so-called inflammatory fevers, seems to lean to it, and makes much of the absence of specific notes by which puerperal fever may be distinguished, as typhus and typhoid may be distinguished. We are still old-fashioned enough to believe in a difference between puerperal fever and common inflammatory fever. Whether the difference be merely one of degree of septic element in the materies morbi, or in the receptivity of lying-in women, may be a matter of question; but the propagability of puerperal fever will for a long time to come be a belief of practitioners, as it is of Dr. MATTHEWS DuNCAN's, and will sufficiently differentiate it from all forms of common inflammatory fever. In this connexion, it is remarkable, and deserves to be remembered, that SmMPSON, duly estimating the importance of the putrid element in the etiology of puerperal fever, held clearly its association with an inflammatory condition. "He believed that generally, if not always, the material which, when can led from one subject to another, could produce puerperal or surgical fever in a really inoculable subject, was an inflammatory secretion, just as the inoculable matter of small-pox, cow-pox, syphilis, &c., was an inflammatory secretion." Dr. MATTHEWS DUNCAN does not believe in puerperal fever taking epidemic forms, and speaks contemptuously of the evidence to this effect. He thinks it would be difficult to find proof of a miasma even in the air of a pestilential hospital, and that the disease prevails according to more or less direct communication with cases of the disease. He does not condemn hospitals, but urges that, whether surgical or lying' in, they can and should be kept wholesome. That puerperal fever is something different from scarlatina or any of the other specific diseases he considers proved
doi:10.1016/s0140-6736(02)40825-2 fatcat:b5iysembcjgcnathxtsz4hozjm