Remarks on puerperal fever : before the New York Academy of Medicine, October 6, 1858 / by Fordyce Barker and A.K. Gardner.

  • Barker, Fordyce, 1819-1891.
Date:
1858
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Licence: Public Domain Mark

Credit: Remarks on puerperal fever : before the New York Academy of Medicine, October 6, 1858 / by Fordyce Barker and A.K. Gardner. 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.

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    in reality the results of poison, stirring np its peculiar excitement wherever it finds the proper amount of combined irritation and ex- haustion to insure it a nidus, just as the poison of typhus fever awakens its pseudo-inflammations in the intestines, the lungs, and the brain. I will only express my belief parenthetically, that the lesions commonly found in puerperal fever are not due at all to inflammation, but to a pathological process entirely dissimilar and in many respects antago- nistic to inflammation. The whole doctrine of inflammation is now in a transition state. Whether the essential characteristics of inflammation be, as Professor Bennett says, an exudation of the normal liquor sanguinis, or iu the words of Professor Alison, inflammation is altered nutrition, it seems to me that the lesions found in puerperal fever, indicating destructive disorganization, are of an entirely different character. I should not allude to this point were it not for a strong conviction that pathologi- cal errors in these particulars have led to g*ave therapeutical errors. There has been one striking difference between the discussion in the Academy of France and this body, and that is, that in the former the great majority who have spoken have advocated the doctrine that the phenomena characteristic of puerperal fever are the results of a local phlegmasia, while this view has not found a single advocate here. Holding the views I do, I must regard this as a matter of mutual con- gratulation. But there is another point which has not only an impor- tant bearing on this question, but on general pathology, and is equally interesting to the obstetrician, the surgeon, and the physician, on which I beg leave to dwell for a few moments—and that is the question of purulent or putrid infection, or of pya3mia and of septicemia. As regards this subject, there is a great harmony of view between one of our members, who has taken the most prominent part in this discussion, and several of the distinguished speakers in the French Academy. In order that I may do full justice to Dr. Clark, I quote from the New York Journal of Medicine. Dr. Clark said, It was his object, on a former occasion, to show that these cases (the cases which, in the belief of Simpson, Gooch, and others, were without lesion of any kind—a simple fever, the poison of which overwhelmed the vital powers,) were no exceptions to the general rule, but that they were really marked by inflammation, like the others, but that the inflamma- tion was one that had escaped detection; that it was an endometritis, and that the inflammation affecting the inner surface of the uterns in- volved the open or valvular mouths of the uterine veins, and niig^^ produce purulent contamination of the system, while no pus ^•as found