LETTER XXXIV.. Of Childbed Fever.

OF CHILDBED FEVER.

Milk Fever as distinguished from Puerperal Fever—The great Danger of Childbed Fever—Its Symptoms and Nature—Modes of Treatment—Is it a Contagious Disease?

In the course of two or three days usually after the birth of the child, the woman experiences more or less febrile excitement of the system. This is what is termed milk fever, it being connected with the coming on of the lacteal secretion. The attack sometimes amounts to a “smart febrile fit, preceded by shivering, and going off with a perspiration.” It is not dangerous, seldom lasts over twenty-four hours, and during the time of its appearance the breasts are full, hard, and painful, which distinguishes this from more dangerous fevers.

Puerperal or childbed fever is a very different thing from the foregoing, and is reckoned by physicians as being one of the most fearful of maladies.

According to the celebrated Dr. Blundell, “women after their delivery in general do pretty well, although no attentions are paid to them;” and it is the testimony of the same distinguished author, that “when the constitution is good, and the circumstances are not extraordinary, the less they are interfered with the better;” and yet it must be admitted by every candid and reflecting mind, that, do what we may in all the known possible ways of fortifying and invigorating the general health, woman must, ever in childbirth be subject to some of the most fearful diseases and accidents to which the human frame is liable. Suppose it be only one in fifty, one hundred, or one thousand, that is to be attacked under such circumstances with a threatening and most dangerous malady, who is there that wishes his wife, sister, or friend to be that one—and that one, too, to be subjected to the treatment of an ignorant or unprincipled quack, whether of the male or female stamp? It is for the cases of exception, then, and not the rule, that physicians should toil long and hard in their efforts to remedy the ills to which human nature now is and ever must be subject.

I am led to these remarks, partly from the necessity of the case, but more from the fact, that there are those in modern times who, through ignorance, as we must charitably conclude, would mislead the public on this most important subject. I will go as far as any one in encouraging woman to pursue a rational course in the preparation for, and the consummation of, childbirth. Those who have read my humble efforts at authorship on this subject hitherto, must, I am confident, be aware of this. At the same time, while I would encourage woman—encourage her even more than any of us have yet done—I would have her to understand that there are dangers, fearful and imminent dangers, always attending the parturient state. Be these dangers only one in a hundred or thousand cases, they are yet dangers; and who among us, even of the most experienced, can tell who is to be the subject of them, and who is not? It behooves to be ever watchful in these important matters of the healing art.

I propose, then, here to speak of that most formidable, most fearful of all diseases to which the puerperal condition is liable, the puerperal fever—the puerperal plague, as it has been called—so sudden in its attack, so rapid in its progress, and so fatal in its effects—fatal, that is, according to the old methods of treatment—sanctioned, as they are, by the usage of ages.

Time of Occurrence.—The puerperal or childbed fever comes on usually within the fourth day, reckoning that of delivery the first. It happens oftenest the second or third day. It may come on the first day, or it may, though rarely, attack the patient eight, ten, or more days after delivery. The later the day, the less the danger, as a general fact.

Symptoms.—Childbed fever is more commonly ushered in by a chill, which is not, however, long in duration. This is experienced most along the back, and sometimes about the shoulders and neck. The chill varies in degree of intensity in different cases; with some patients there is a degree of chattering, such as occurs in a severe ague fit; with others there is very little of the symptom; and in some cases no chill whatever is experienced. These last, however, must be the exception to the rule. In almost every conceivable case, a degree of chilliness, greater or less, is experienced. As in other inflammations, this chill is followed by fever. The intensity of the chill is considered no measure of the vehemence of the subsequent fever; the most terrific fever may follow very mild chills, and the contrary. Some regard that there is most danger to be apprehended when the chills are of a mild character.

Here I ought to remark, that patients should not be frightened at every little chill they may experience. The coming on of the milk—the milk fever, as it is called—heat in the breast, and a variety of circumstances other than those of childbed fever, may be preceded by or attended with chills. Indeed, almost every mother with a new-born child experiences more or less of chilly symptoms; and yet fortunately but few are attacked with that terrible malady of which we are treating. So much by way of encouragement in regard to the matter of chills.

In connection with the rigors before mentioned, the patient complains of pains in the abdomen; these may be so slight as to be scarcely perceptible to pressure on the part, or they may be so violent and severe that the gentlest touch of the finger is regarded with apprehension, and the weight of the bed-clothes proves a burden that cannot be borne. “Sometimes the pain,” says Professor Meigs, “which is, at the onset of puerperal fever, felt in the hypogastric region, is too intense to be borne by any human patience; and no exhortation or recommendation can prevent the woman from crying out aloud, or even screaming with her agony. All over the abdomen these pains may be felt, above, below, to the right, to the left, in the region of the diaphragm, and in the lumbar region; this diffusion, however, is neither constant nor frequent, and it is found, especially in the less malignant varieties of the disease, that it is in the region of the navel, and more especially below it, that the patient complains.” Severe after-pains may be experienced in connection with the disease, or the reverse. Little or no fever may occur in connection with severe pain, and so the contrary. If the pain is circumscribed, as we say—confined mostly to one spot—it is far more favorable; but if the pain and tenderness are spread over a large surface, beware, lest there be mischief at hand. If the pain be even slight, and yet diffused extensively over the surface of the abdomen, we must take heed lest we get into trouble that will imminently endanger the patient’s life.

The pulse always rises high in childbed fever. This is one of the most distinctive features of the disease. It is seldom lower than 115 or 120 per minute, except when it is giving way before the power of remedial means. More commonly it rises to from 130 to 140 beats per minute, and it has been known to rise as high as 160 or 170. These last, however, are extreme cases—exceptions to the general rule.

Besides the symptoms enumerated, there sometimes occurs headache, sometimes vomiting, and at others purging, which last symptom is probably in general a good omen.

Duration of the Disease,—Puerperal fever, like most other diseases, is not very uniform in its duration. It is, however, in general short. It may last for a number of days—for many days, if we reckon the convalescence a part of the disease. On the other hand, it may, like the plague itself carry the patient off within the first twenty-four hours of the attack. Three or four days is reckoned to be the average duration of childbed fever, when it occurs in the epidemic form.

Professor Meigs has well explained why it is that childbed or peritoneal fever is so serious and dangerous a malady as it is. He observes:

“The peritoneum (the lining, membrane of the abdomen), a serous membrane, known for ages as one of the tissues most ready to take on inflammation, undergoes in labor, and during lying-in, changes of the greatest importance. Its great extent may be known by computing the superficial contents of that portion of the serous membrane which invests the alimentary canal. This canal is about forty feet in length, and its outer coat is composed of peritoneum. If cut up by the enterotome, it would be at least four inches wide and forty feet long, affording a superficies of more than thirteen feet, to which should be added the superficial contents of the remainder of the membrane, where it invests the liver, the epiploon, the mesentery and mesocolon, besides the ligamenta lata, and all the other parts which derive from it their serous covering. This vast surface inflames rapidly and totally, and passes through the stage of inflammation with extraordinary speed. It cannot happen that it shall ever be extensively inflamed without a coincident exhibition of the greatest disorder in the functions of the nervous organs directly implicated in its structure, or possessing with it physiological relations that could not be safely disturbed. The peritoneum is the investiture of the abdominal organs; the peritoneal coat of the stomach is as truly a part of the organ as its muscular or mucous coat; the same is true as to the peritoneum that invests the liver, that of the spleen, and the same truth is of the utmost import when it is stated with regard to the peritoneal coat of the whole alimentary apparatus. It is clear that extensive or universal inflammation of the peritoneal membrane is inflammation of all or many of the organs contained within the cavity of the abdomen. A great puerperal peritonitis, therefore, may be properly regarded as a complex inflammation of a vast number of organs indispensable to existence. Why should we be astonished, then, to see the power of the nervous mass sink under the invasion of causes of destruction so great and so pervading?

“Seeing that the superficies of the peritoneum is equal, probably, to thirteen or fourteen feet, we should have abundant reason to dread so extensive an inflammation from the constitutional irritation which it alone would produce; but when, in addition to that consideration, we take into view the great affusions which may ensue, the suppurations, the interruption of the intestinal functions, the depravation of the actions of the liver, etc., which are occasioned by it, we have still greater reason to deprecate its attack, and to seek for the justest views of its nature, and of the remedies most appropriate for its cure.”

Professor Meigs elsewhere judiciously remarks, that, considering the changes that take place in the reproductive tissues at childbirth, “there is, in fact, greater reason for surprise, when we find it not followed by inflammation, than when we meet with the most violent and destructive cases of that affection.”

Treatment.—In the year 1846, I treated (in connection with a missionary friend and physician, who is now in Siam) a premature case of childbirth, which, to say the least, threatened to become one of severe puerperal fever. The case was an important one, and as such I here present it to the reader. It was written out with great care and accuracy at the time by the medical friend referred to. I give it in his own words:

“March 19, 1846.—Desirous of availing myself of an opportunity which Dr. Shew kindly afforded me of witnessing the hydropathic treatment of cases of labor, I accompanied him to No. — Second Street, where he had been summoned a few minutes before, to attend Mrs. S., who was then in need of his services.

“We found the patient an intelligent woman, of the nervous temperament, with her constitution much broken down—though she was but thirty-one years of age—by the results of severe previous labors, the last a miscarriage. After some of her former confinements, she had been weeks and months in recovering. In one case, when, she was treated for puerperal fever, her husband paid in one year not less than one hundred and fifty dollars—no trifling sum out of the earnings of a working man with a large family—to the apothecary alone, for leeches and medicines. The patient had always been in the habit of using strong tea and coffee; drank the mineral water of the city wells; for some months had relished nothing but the little delicacies sent in by her friends, and throughout the winter had been able to do little or nothing at home.

“In consequence of excessive fatigue, a few days before, in ‘house-hunting,’ as she called it, she had been seized on Tuesday, the 17th, at 10 A. M., at the close of the fifth month of her pregnancy, with the pains of labor—her former miscarriage having, of course, induced a predisposition to another. These pains increased in frequency and severity till they caused the greatest suffering, and prevented all sleep on Wednesday night and Thursday, up to the hour (3 P. M.) when she sent for Dr. Shew.”

Here, then, was a patient, whose previous history, impaired constitution, loss of sleep, and exhaustion from intense and almost incessant suffering, protracted now for more than two days, seemed to promise any thing but a speedy recovery, even should delivery be safely effected. It should be added that, up to the time, she was an utter stranger even to the hydropathic treatment.

“Her bowels having been moved the day before, all that was deemed necessary was to render the condition of the patient more comfortable, by resorting to sedative frictions along the spine with a towel wrung out of cold water, and to the tepid hip-bath, with sponging and rubbing the whole surface of the body. After this, less complaint was made, till soon after 6 P. M., when there was a sudden aggravation of the bearing-down pains, resulting in the delivery of a well-formed but still-born male child, of apparently five months.

“In about fifteen minutes the after-birth was detached, and taken away. Not even the usual amount of hemorrhage occurred. A bandage was applied to the abdomen, as the patient expressed a wish for it; and after resting awhile, a little panada was given her as nourishment.

“Mrs. S. continued very comfortable through the evening; no excess of the natural discharge; complained only of exhaustion, and slight difficulty of passing urine. As there was some heat of the surface—the pulse being from 90 to 100—tepid sponging was resorted to, which proved very grateful to the patient.

“Second Day (Friday), Seven, A. M.—Found the patient had obtained considerable sleep at intervals during the night; felt very comfortable, though occasionally had slight pains in the abdomen; tongue moist; pulse 81; had passed a little water during the night, but with difficulty; had a strong desire for a cup of coffee, but persuaded her to take a little panada in its place; had not much appetite; was permitted to sit up for a few minutes while her bed was made.

“Half-past Eleven, A. M.—Mrs. S. still very comfortable; found her sitting up in the rocking-chair, the very picture of convalescence. Sponging enjoined, if any feverishness should arise.

“Three, P. M.—Dr. S. sent for, as the patient had been seized a few minutes before, rather suddenly, with a sharp pain in the left side. Had been drinking a tumbler of cold lemonade. Had a natural movement of the bowels that morning, and passed a little water. The tepid sponging of the surface had been neglected. Pain fixed, severe, pretty constant, remitting only for a moment or so. No corresponding contractions of the uterine tumor observed. Some pain also complained of in the hip, with which she had, on a former occasion, been troubled. Up to that time had had no chill. Warm fomentations were applied, but with little relief.

“Half-past Four, P. M.—A chilliness felt, then shivering, prolonged, with increase of the fixed pain of the side; pulse 112, weak; patient restless, anxious, desponding; knitting of the brows, involuntary weeping. A bottle of warm water was applied to the feet, and soon after, the chills ceased.

“A large warm enema was now administered; this brought away considerable fecal matter; and fomentations were applied to the abdomen. Next, the patient was seated in the hip-bath, at a temperature of 95°, for fifteen minutes, when water was passed more freely than before, and a slight nausea experienced. The result of this was complete abatement, for the time, of the pain in the uterine region, the diminution of the frequency of the pulse to 90, and great comfort. The bandage to the abdomen having been removed, to allow of the bath, was not replaced. If need be, fomentations to be kept up.

“At 7 P. M. found the patient in a profuse perspiration; pain in the abdomen had lost its acuteness; soreness there was all now complained of—soreness in the head, ‘in the bones, and all over.’ Abdomen swollen, and tender on pressure; breathing shallow; pulse 110–12; discharge from the womb (the lochial discharge) arrested. Patient is to be kept quiet; to take no nourishment; no fire to be in the room.

“At 9¼ P. M., the perspiration still continues; complains of pain in the hip, but chiefly in the left side, as before, and shooting across the abdomen; pain now very severe, increased by coughing; breathing thoracic (shallow), and 28 in the minute; pulse 98; is thirsty; tongue moistish, with a slight milky coat. Fomentations as usual.

“Half-past Ten, P. M.—Pain increasing in the abdomen and hip; tenderness increasing; can scarce bear slight pressure on the abdomen; knees drawn up; restless, discouraged; pulse 100, though not very full or strong; skin still slightly moist.

“In this critical state of things, when nearly every symptom of that fearful disease, puerperal fever, was invading the system, and when, according to the prescribed rules of practice, the most vigorous antiphlogistic measures would be called for, a plan of treatment was adopted that was, as it seemed to me, far more likely to kill than to cure, and which I could not but protest against at the time, but which, as the result proved, was eminently calculated to turn back the tide of disease so rapidly setting in. It certainly afforded striking evidence of the resources of hydropathy, and its promptness and efficiency in relieving pain, and extinguishing inflammation.

“Mrs. S. was carefully lifted from her bed, and after being placed in her chair, was transferred to a hip-bath, containing about one pail of water fresh from the Croton hydrant near by, of the temperature of 42° Fah. A towel, wrung out of cold water, was applied to the forehead at the same time. Of course she was well covered with blankets. She had been seated there but a few minutes, when she expressed herself as feeling very comfortable indeed. The severe pain in her abdomen and thigh had left her as if by magic, and so complete was the relief, that she fell into a gentle doze, from which, awakened by nodding, she observed, ‘There, I feel so easy now, I lost myself, I believe.’

“While in the bath, her pulse was lowered several beats in the minute; the unimmersed parts of the body remained warm; the hips were to her of a refreshing coolness. After remaining thus seated in the water about twenty-five minutes—a slight addition of more cold water, by gradual pouring, having been made during this time—she was lifted back to the bed. Her pain had now entirely vanished; the natural lochial discharge was soon restored; the pulse reduced to 94; and, warm and comfortable, she had a prospect of a good night’s rest.

“Third Day (Saturday), Seven A. M.—Found patient looking comfortable and happy. No pain now in the abdomen, slight soreness only; tympanitis (swelling) gone; tongue moist, and hardly coated; pulse 79; had had no sensation of chilliness after her bath, but slept from 12½ to 4 A. M., without waking, and another doze after that; window had been a little raised all night, and no fire in the room, though it was cool. Now was able to pass water without difficulty. Was directed to take for breakfast some coarse wheaten bread, toasted, and softened with milk, and a little scraped apple, if she wished.

“Eleven, A. M.—Mrs. S. appears very comfortable. With the aid of a friend has been up and changed her clothing. Pulse 84; complains of no pain of any consequence in the abdomen.

“Half-past One, P. M.—Had been under the necessity of getting up without assistance, and fatigued herself, and thus induced a return of very severe pain in the uterine region. Dr. S. was sent for, when resort was had again to the hip-bath, filled with cold water from the hydrant, which had with such wonderful promptitude averted the danger of puerperal fever, with which she was threatened on the evening of the second day; as on that occasion, in less than five minutes, the pain and feverishness was completely quelled. She was allowed to remain in the bath half an hour, and requested to abstain from food till evening.

“Five, P. M.—Patient doing remarkably well; cheerful; free from pains in the abdomen, save now and then a very slight one; some soreness on pressure; pulse 84, compressible.

“Ten, P. M.—Had slept during evening; had taken a little nourishment. Has some difficulty in passing water, and as occasional slight pains and soreness still continues in the abdomen, the cold hip-bath, at 42° Fah., was again resorted to for about thirty minutes. During this time the pulse was lowered from 80 beats in a minute to 70; water was passed freely, and pains put to flight.

“After the bath, the patient continuing warm and comfortable, was directed, should there be any return of pains during the night, to seat herself in the hip-bath, which was left in the room.

“Fourth Day (Sunday), Half-past Seven, A. M.—Patient had slept most of the night; looks bright; feels ‘very comfortable;’ pulse 72, soft and natural; had raised herself in bed without difficulty, and washed. On account of some difficulty in passing water, the hip-bath was used for about fifteen minutes, when the urine flowed more copiously and freely than at any previous time. Left seated in the rocking-chair; sitting up occasionally; she says it has rested and refreshed her from the first.

“Appetite good; thinks even the plainest food would be relished. Breakfast to be as before; the toasted coarse bread, soaked in milk, with a little scraped apple. Directed to take no nourishment at any time, unless a decided appetite, nor then oftener than three times in a day. Is to take an enema and another hip-bath in the course of the morning.

“Six, P. M.—Had continued to gain during the day till toward evening. It most unfortunately happened that an intoxicated man, mistaking the house, strayed into the room where she was lying, with no attendant but a young girl; seating himself, without any ceremony, in the rocking-chair, with a lighted cigar in his mouth, he smoked away to his satisfaction, and then very deliberately composed himself for a nap. This strange visitor, and the fumes of the tobacco, had given poor Mrs. S. a severe headache, the first with which she had been troubled; considerable nausea, with paleness of the face, cold feet, etc. A towel wet with cold water was applied to the head, and a hip-bath ordered.

“Half-past Nine, P. M.—Was rapidly recovering from the effects of the afternoon’s unexpected visit; sat up awhile.

“Fifth Day (Monday).—At 7½ A. M., found Mrs. S. sitting up in bed sewing; pulse 75; had rested well; has a good appetite. Breakfast to be as before; may safely take a hip-bath at any time when suffering from pains and is not made very chilly by sitting in it.

“Was able this morning to rise and walk about the room unsupported. Required no assistance in getting to the bath; bowels moved naturally; sat up several hours to-day; appears bright, pleasant, and cheerful.

“Sixth Day (Tuesday).—Mrs. S. feels to-day as much better than she did yesterday, as she did yesterday better than the day before. Sat up, and was about the room nearly all day; continues the practice of daily sponging the whole surface, and the use of the hip-bath. At night, retention having ensued from over-distention of the bladder, in consequence of an untimely and protracted visit from some of patient’s friends, Dr. S. was sent for, and deemed it advisable to resort to the catheter, which she had frequently been compelled to use on former occasions, sometimes for months together.

“Seventh Day (Wednesday).—Mrs. S. appeared to be better in the morning; able to rise without assistance, to walk about, and even to sweep the room; catheter again required.

“Eighth Day (Thursday).—During the night, of her own accord, took two or three or four cool hip-baths, and found them refreshing, and of service in promoting easy evacuation of the bladder. At one time dropped asleep, and remained so an hour or more—sitting in the water. Pulse in the morning. Dressed the children and arranged the room herself to-day; and though a week had hardly elapsed since her confinement, felt strong enough in the morning to go down stairs, and to do a half day’s work in sewing, etc., from which she appeared to experience no injury. A few days after she ventured to ride down to the lower part of the city, and having since continued to improve, save an occasional return of an old difficulty—retention—is most gratefully sensible, under Heaven, to her physician and hydropathy, for a far more speedy and pleasant convalescence than she ever experienced after any of her former confinements.”

Professor Gilman, of this city (New York), in his edition of the Dublin Practice of Midwifery, gives us the following account of a method of treatment which was adopted with remarkable success in the old country:

“In an epidemic (puerperal fever), which raged at Keil in 1834, ’35, and ’36,” says Professor G., “Michælis used ice, both externally and internally, with excellent effect. The cases in which he gave it with success were marked by burning pain and heat in the bowels, thirst, painful eructations, and tenderness of the epigastrium. The brain was clear; no delirium. The ice was given by the mouth, in bits the size of the finger, every half hour or oftener; it was also applied over the abdomen in a large bullock’s bladder, extending from the epigastrium to the pelvis, in a layer half an inch thick. This application was in some cases continued for three days, the bladder being changed as soon as the ice melted. It was very grateful to the patient, and Michælis thought it had cured some cases where affusion had actually taken place into the peritoneal cavity. The use of ice was not persisted in unless it was grateful to the patient. The symptoms of amendment were a sudden and very great fall in the frequency of the pulse, a peaceful sleep, relief from the painful eructations, and diminished distention of the bowels. A profuse watery diarrhea occurring with these favorable changes, seemed to him to be critical.”

This treatment of Michælis is certainly a very bold one. Those who are well acquainted with the water-treatment will be able at once to comprehend the fact, that the applications mentioned were sufficient to cause “a sudden and very great fall in the frequency of the pulse, a peaceful sleep, relief from the painful eructations, and diminished distention of the bowels.” Nor is it incredible that a cure might thus take place, even in some cases where affusion into the peritoneal cavity had actually taken place, since the effort of nature tends always, so long as life lasts, necessarily to that end. It is well worthy of remark, that the treatment of Michælis was persisted in only so long as it was grateful to the patient. This is an important rule to remember.

Nor do I regard it necessary, absolutely, to use ice in the treatment of this or any other inflammatory affection. Water—even at the temperature of rivers at this latitude in the summer—which is usually, I believe, at about 70° Fah., may be made very effectual in the cure of inflammatory diseases. Thus, if we wrap one or more wet sheets about a patient, having him, at the same time, on a cool straw bed, and neither the bed or wet sheets having any covering whatever, we, through the natural processes of evaporation and refrigeration, abstract in a short time a great amount of animal heat. We may likewise change these applications as often as we desire, or pour water upon the sheets frequently, and thus cool the patient to any desirable extent, without the use of ice or water that is extremely cold. It should be understood, also, that general applications—applications over the whole or a large part of the body’s surface—are far more effectual in reducing the inflammation of a local part, than applications locally made can be. This fact is not generally understood.

Is Childbed Fever a Contagion?—This disease is believed by many to be at times contagious. It would, doubtless, be a difficult undertaking to prove positively that such is the fact. It is the opinion of some able writers on medicine, “that there is unquestionably an epidemic influence, or atmospheric constitution, which sometimes, in extensive districts of country, in villages, in towns, and cities, and especially in crowded lying-in hospitals, determines, by an unknown force, the attack of childbed fever, and so modifies the pathognomonic conditions as to hurry numerous victims to the grave, and this, notwithstanding the most reasonable methods of cure.”

But that the disease is really communicable from one patient to another, is not so palpable. One author—Professor Meigs—a man whose good character and long experience entitle his opinions to much weight, tells us that a great experience—and few have enjoyed greater—has not enabled him to perceive that he has been the means of disseminating this malady among lying-in women, to whom he had given professional aid while attending upon dangerous and fatal attacks of it, or after making or witnessing autopsic examinations of the bodies of the dead. On the other hand, Dr. Gooch, an author whose opinions are probably equally deserving of respect, tells us in reference to puerperal fever, that it is not uncommon for the greater number of cases to occur in the practice of one man, while the practitioners of the neighborhood, who are not more skillful or busy, meet with few or none. A practitioner opened the body of a woman who had died of puerperal fever, and continued to wear the same clothes. A lady whom he delivered a few days afterward was attacked with, and died of a similar disease; two more of his lying-in patients, in rapid succession, met with the same fate. Struck by the thought that he might have carried the contagion in his clothes, he instantly changed them, and met with no more cases of the kind.

A woman in the country, who was employed as washerwoman and nurse, washed the linen of one who had died of puerperal fever; the next lying-in patient she nursed died of the same disease; a third nursed by her met with the same fate, till the neighborhood, getting afraid of her, ceased to employ her. The disease has been known, according to Dr. Gooch, to occur in some wards of a hospital, while the others were at the same time free from it. Dr. Blundell, who is certainly very high authority, while he admits that this fever may occur spontaneously, and that its infectious nature may be plausibly disputed, affirms, that in his own family he had rather that those he esteemed the most should be delivered, unaided, in a stable—by the manger side—than that they should receive the best help in the fairest apartment, but exposed to the vapors of this pitiless disease. Gossiping friends, wet-nurses, monthly nurses, the practitioner himself—these are the channels by which, in Dr. Blundell’s estimation, the infection is principally conveyed.

Some authors contend, also, that it is only through the influence of the imagination, or by sympathy, that puerperal fever becomes more prevalent by times than ordinarily; and there can be but little doubt that these causes operate to a greater or less extent in communicating the malady. If a weak and nervous patient fears it, and especially if it is prevailing epidemically in the neighborhood in which she resides, she is much more liable to an attack than if she had no thoughts whatever of the disease. It is, moreover, under such circumstances more likely to prove fatal than when it occurs sporadically.

Fortunately, however, the question of contagion does not at all affect the treatment of this terrible malady. All agree that it is an inflammatory disease which demands, under all circumstances, at our hands, an antiphlogistic or anti-inflammatory treatment. There can be no two opinions on this point; and it is a circumstance worthy of the most particular remark, that we have in water-treatment the most abundant of therapeutic resources by which to combat inflammation of whatever name or grade—resources more potent and effective, a hundred-fold, than any other ever known to man.