The Hunterian oration on the etiology of puerperal fever : delivered at the Annual Meeting of the Hunterian Society / by Alfred Lewis Galabin.

  • Alfred Lewis Galabin
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: The Hunterian oration on the etiology of puerperal fever : delivered at the Annual Meeting of the Hunterian Society / by Alfred Lewis Galabin. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    19/20 page 17
    tice of one medical man and his assistant.26 A midwife delivered a woman who shortly died with symptoms of puerperal fever. Within one month, the same midwife delivered thirty other women, of whom sixteen caught the disease, and all died.27 I know of no such propa- gation of surgical septicaemia in the private practice of a surgeon, al- though something similar has occurred when wounded men have been crowded in an insanitary hospital. It has generally been held that the so-called autogenetic form of the disease is little, if at all, contagious. The following case, which I have met with, appears to me to indicate the probability that organisms commonly present may acquire an increased infective virulence. A woman miscarried about the third month, and a portion of the ovum was retained. This decomposed, and produced an offensive discharge from the uterus. Pyrexia and general peritonitis were developed, and the patient died in a few days with symptoms resembling those of ordinary puerperal septicaemia. Notwithstanding free use of carbolic acid, this case appeared to be the starting-point of a series of cases of puerperal septicaemia in women attended within the next few days by the practitioner in charge, and his assistant who had also seen the patient. Two of these proved fatal, and both the practitioner and his assistant had to give up midwifery practice for some time. The point which chiefly comes out in the Collective Investigation Record as to the danger of contagion is, that it is from fatal cases that danger is most to be feared. Out of the 356 cases, there were nineteen in which there was a probable conveyance of contagion. In eight, this was to other puerperal women ; in nine, to the infant. All but one of the nineteen cases which were the source of contagion proved fatal. In only two of them was there a probable autogenetic source for the original disease. In conclusion, I have to say that the Collective Investigation Com- mittee still hope for more evidence, and will be grateful to any who may furnish it.23 I may indicate two points of special interest: 1. In what forms of the disease is contagion most to be feared ? 2. Can, not only erysipelas and scarlatina, but other zymotic diseases— typhoid fever, diphtheria, small-pox, pneumonia—give rise to a disease in the puerperal woman closely resembling septicaemia ? Of special interest would be an instance, if any such occur, in which an apparent puerperal septicaemia is itself traced to the contagion of a zymotic disease, and reproduces the original zymotic disease again by contagion to the infant, or to some other person. 26 Armstrong, Facts and Observations Relative to Ptierperal Fever. London. 1814. 27 Robertson, London Medical Gazette, January, 1840. 28 Forms of return can be obtained from Dr. Isambard Owen, Secretary to the Collective Investigation Committee. London : Printed by the British Medical Association. 429, Strand, W.C.
    digitised image 1
    digitised image 2
    digitised image 3