I will take it for granted that they have so far counterpoised the depreciating language of my fellow-countryman and fellow-teacher as to gain me a reader here and there among the youthful class of students I am now addressing. It is only for their sake that I think it necessary to analyze, or explain, or illustrate, or corroborate any portion of the following Essay. But I know that nothing can be made too plain for beginners; and as I do not expect the practitioner, or even the more mature student, to take the trouble to follow me through an Introduction which I consider wholly unnecessary and superfluous for them, I shall not hesitate to stoop to the most elementary simplicity for the benefit of the younger student. I do this more willingly because it affords a good opportunity, as it seems to me, of exercising the untrained mind in that medical logic which does not seem to have been either taught or practised in our schools of late, to the extent that might be desired.
I will now exhibit, in a series of propositions reduced to their simplest expression, the same essential statements and conclusions as are contained in the Essay, with such commentaries and explanations as may be profitable to the inexperienced class of readers addressed.
I. It has been long believed, by many competent observers, that Puerperal Fever (so called) is sometimes carried from patient to patient by medical assistants.
II. The express object of this Essay is to prove that it is so carried.
III. In order to prove this point, it is not necessary to consult any medical theorist as to whether or not it is consistent with his preconceived notions that such a mode of transfer should exist.
IV. If the medical theorist insists on being consulted, and we see fit to indulge him, he cannot be allowed to assume that the alleged laws of contagion, deduced from observation in other diseases, shall be cited to disprove the alleged laws deduced from observation in this. Science would never make progress under such conditions.
Neither the long incubation of hydrophobia, nor the protecting power of vaccination, would ever have been admitted, if the results of observation in these affections had been rejected as contradictory to the previously ascertained laws of contagion.
V. The disease in question is not a common one; producing, on the average, about three deaths in a thousand births, according to the English Registration returns which I have examined.
VI. When an unusually large number of cases of this disease occur about the same time, it is inferred, therefore, that there exists some special cause for this increased frequency. If the disease prevails extensively over a wide region of country, it is attributed without dispute to an epidemic influence. If it prevails in a single locality, as in a hospital, and not elsewhere, this is considered proof that some local cause is there active in its production.
VII. When a large number of cases of this disease occur in rapid succession, in one individual's ordinary practice, and few or none elsewhere, these cases appearing in scattered localities, in patients of the same average condition as those who escape under the care of others, there is the same reason for connecting the cause of the disease with the person in this instance, as with the place in that last mentioned.
VIII. Many series of cases, answering to these conditions, are given in this Essay, and many others will be referred to which have occurred since it was written.
IX. The alleged results of observation may be set aside; first, because the so-called facts are in their own nature equivocal; secondly, because they stand on insufficient authority; thirdly, because they are not sufficiently numerous. But, in this case, the disease is one of striking and well-marked character; the witnesses are experts, interested in denying and disbelieving the facts; the number of consecutive cases in many instances frightful, and the number of series of cases such that I have no room for many of them except by mere reference.
X. These results of observation, being admitted, may, we will suppose, be interpreted in different methods. Thus the coincidences may be considered the effect of chance. I have had the chances calculated by a competent person, that a given practitioner, A., shall have sixteen fatal cases in a month, on the following data:
A. to average attendance upon two hundred and fifty births in a year; three deaths in one thousand births to be assumed as the average from puerperal fever; no epidemic to be at the time prevailing. It follows, from the answer given me, that if we suppose every one of the five hundred thousand annual births of England to have been recorded during the last half-century, there would not be one chance in a million million million millions that one such series should be noted. No possible fractional error in this calculation can render the chance a working probability. Applied to dozens of series of various lengths, it is obviously an absurdity. Chance, therefore, is out of the question as an explanation of the admitted coincidences.
XI. There is, therefore, some relation of cause and effect between the physician's presence and the patient's disease.