Prevention of the disease
(about puerperal Fever/ Alexander Gordon/Aberdeen/1795)
Considering the many difficulties, and the opposition which I met with in curing the Puerperal Fever, it will be readily believed, that I should be extremely solicitous to discover a preventive for the disease. And, though I was very diligent in this search, yet my endeavours were for a long time unsuccessful. For those means, which have been recommended by authors, were found altogether inadequate to the purpose. And, for this reason, I hope I shall be pardoned for considering them as the suggestions of theory, which will not stand the test of experience; my experience authorizing me to say, that those who trust to them will be greatly disappointed.
Those who propose to prevent the Puerperal Fever must have two intentions in view. The one is, to prevent the infection from being communicated; and the other is, after the infection has been communicated, to prevent its action.
My endeavours were entirely directed to this last purpose for the Puerperal Fever had prevailed for some time before I discovered that it was infectious; and after this discovery was made, I saw the danger of disclosing the fatal secret.
With respect to the most effectual means of preventing the infection from being communicated, I must speak, with great uncertainty, because in this matter I have not experience for my guide. When treating of the cause, the nature, and cure of the disease, I spoke with the most confidence, because I had experience and facts for my guide; but here those sure guides are wanting, and therefore I speak with diffidence.
Whether the infection of the Puerperal Fever is capable of being destroyed by the same means as that of other fevers, I cannot affirm with certainty, but think it very probable, and that they ought to be tried.
That fresh air and cleanliness are insufficient for the destruction of contagion, and that there is no certain antidote but fire and smoke lit been demonstrated by the ingenious Dr. Lind. This excellent author has proved, that fire and smoke are the most powerful agents for annihilating infection ; and, as he thinks, even the plague itself.
The methods which he recommends for the purification of infected chambers, and for the fumigation of infected apparel, may be seen by perusing his ingenious papers on fevers and infection, to which I refer the reader.
The same means ought to be practised for preventing the infection of the Puerperal Fever. The patient's apparel and bed-clothes ought either to be burnt or thoroughly purified; and the nurses and physicians, who have attended patients affected with the Puerperal Fever, ought carefully to wash themselves, and to get their apparel properly fumigated before it be put on again.
So much with respect to the method of preventing the infection of the Puerperal Fever from being communicated. I shall next consider the means of preventing the action of that infection, after it has been communicated; and on this head I speak with proper confidence, because I speak from experience, the surest test-of medical truth. And, is I have already mentioned, I found myself disappointed when I trusted to those means which have been recommended by some authors of considerable respectability. For, neither antiseptic nor tonic medicines, nor such as obviate sensibility, or irritability, were found effectual. Consequently, bark, wine, opium, &c. will disappoint those who put their confidence in them.
I found, likewise, that neither the greatest care, the best of management, nor the strictest attention
to regimen, were sufficient to prevent it.
After many unsuccessful trials, I began to think that those means which cured the Puerperal. Fever would a fortiori prevent it. Bleeding, therefore, occurred to me as the most probable means of preventing the Puerperal Fever; but I was unwilling to have recourse to it as a preventive, because, if it failed, I was, by that means, deprived of the only certain remedy for the cure. . And such was the prejudice against bleeding, that if I had used it as a preventive, and it had failed, I should not have been permitted to repeat the operation afterwards, at the attack of the disease, when it was indispensably necessary.
I was therefore compelled to rest contented with purging; and the purging bolus, which was so effectual in the cure, was equally efficacious as a preventive. This bolus was given the day after delivery, in the morning, and it either prevented the disease altogether, or answered this good purpose, that the cure was anticipated before the attack of the disease.
In short, all who got the medicine, either escaped the disease, or were easily cured if they did not. Indeed, all who got it escaped, except James Davidson's wife, No.52., who got the bolus the day after delivery, which purged her briskly; but she was, notwithstanding, seized with the fever on the third day about five o'clock in the afternoon. Being in the country, I did not see her till eight, when her pulse was 140, attended with the usual symptoms of pain in the abdomen, &c. The bolus was repeated, and twenty-four ounces of blood taken away, by which the disease was at once cured.