After the student has read the case in Dr. Meigs's 136th paragraph, and the following one, in which he exclaims against the idea of contagion, because the patient, delivered on the 26th of December, was attacked in twenty-four hours, and died on the third day, let him read what happened at the "Black Assizes" of 1577 and 1750. In the first case, six hundred persons sickened the same night of the exposure, and three hundred more in three days. [Elliotson's Practice, p. 298.] Of those attacked in the latter year, the exposure being on the 11th of May, Alderman Lambert died on the 13th, Under-Sheriff Cox on the 14th, and many of note before the 20th. But these are old stories. Let the student listen then to Dr.
Gerhard, whose reputation as a cautious observer he may be supposed to know. "The nurse was shaving a man, who died in a few hours after his entrance; he inhaled his breath, which had a nauseous taste, and in an hour afterwards was taken with nausea, cephalalgia, and singing of the ears. From that moment the attack began, and assumed a severe character. The assistant was supporting another patient, who died soon afterwards; he felt the pungent heat upon his skin, and was taken immediately with the symptoms of typhus."[Am. Jour. Med.
Sciences, Feb. 1837, p. 299.] It is by notes of cases, rather than notes of admiration, that we must be guided, when we study the Revised Statutes of Nature, as laid down from the curule chairs of Medicine.
Let the student read Dr. Meigs's 140th paragraph soberly, and then remember, that not only does he infer, suspect, and surmise, but he actually asserts (page 154, "there was poison in the house," because three out of five patients admitted into a ward had puerperal fever and died. Have I not as much right to draw a positive inference from "Dr. A.'s " seventy exclusive cases as he from the three cases in the ward of the Dublin Hospital? All practical medicine, and all action in common affairs, is founded on inferences. How does Dr. Meigs know that the patients he bled in puerperal fever would not have all got well if he had not bled them?
"You see a man discharge a gun at another; you see the flash, you hear the report, you see the person fall a lifeless corpse; and you infer, from all these circumstances, that there was a ball discharged from the gun, which entered his body and caused his death, because such is the usual and natural cause of such an effect. But you did not see the ball leave the gun, pass through the air, and enter the body of the slain; and your testimony to the fact of killing is, therefore, only inferential,--in other words, circumstantial. It is possible that no ball was in the gun; and we infer that there was, only because we cannot account for death on any other supposition."
[Chief Justice Gibson, in Am. Law Journal, vol. vi. p. 123.]
"The question always comes to this: Is the circumstance of intercourse with the sick followed by the appearance of the disease in a proportion of cases so much greater than any other circumstance common to any portion of the inhabitants of the place under observation, as to make it inconceivable that the succession of cases occurring in persons having that intercourse should have been the result of chance? If so, the inference is unavoidable, that that intercourse must have acted as a cause of the disease. All observations which do not bear strictly on that point are irrelevant, and, in the case of an epidemic first appearing in a town or district, a succession of two cases is sometimes sufficient to furnish evidence which, on the principle I have stated, is nearly irresistible."
Possibly an inexperienced youth may be awe-struck by the quotation from Cuvier. These words, or their equivalent, are certainly to be found in his Introduction. So are the words "top not come down"! to be found in the Bible, and they were as much meant for the ladies' head-dresses as the words of Cuvier were meant to make clinical observation wait for a permit from anybody to look with its eyes and count on its fingers. Let the inquiring youth read the whole Introduction, and he will see what they mean.
I intend no breach of courtesy, but this is a proper place to warn the student against skimming the prefaces and introductions of works for mottoes and embellishments to his thesis. He cannot learn anatomy by thrusting an exploring needle into the body. He will be very liable to misquote his author's meaning while he is picking off his outside sentences. He may make as great a blunder as that simple prince who praised the conductor of his orchestra for the piece just before the overture; the musician was too good a courtier to tell him that it was only the tuning of the instruments.
To the six propositions in the 142d paragraph, and the remarks about "specific" diseases, the answer, if any is necessary, seems very simple. An inflammation of a serous membrane may give rise to secretions which act as a poison, whether that be a "specific" poison or not, as Dr. Homer has told his young readers, and as dissectors know too well; and that poison may produce its symptoms in a few hours after the system has received it, as any may see in Druitt's "Surgery," if they care to look. Puerperal peritonitis may produce such a poison, and puerperal women may be very sensible to its influences, conveyed by contact or exhalation. Whether this is so or not, facts alone can determine, and to facts we have had recourse to settle it.
The following statement is made by Dr. Meigs in his 142d paragraph, and developed more at length, with rhetorical amplifications, in the 134th. "No human being, save a pregnant or parturient woman, is susceptible to the poison." This statement is wholly incorrect, as I am sorry to have to point out to a Teacher in Dr. Meigs's position.
