extremities, and convulsions before death; and the critical diarrhoea and reappearance of the lochia in favourable cases.* That puerperal women are liable to be affected by fevers during their prevalence has for a long time been acknowledged, and the most trustworthy writers upon this subject have not neglected to give some account of the epidemic diseases coincident with puerperal fever. The epidemics mentioned by Mr. Hey as occurring in Barnsley in 1808, and at Leeds in Nov. 1809, which continued in the latter town until Christmas 1812, were coincident with erysipelas. The epidemic that raged in the Dublin Lying-in Hospital in the years 1819-20, was attributed, to a great extent, by Dr. Labatt, to contagion from typhus fever, which then prevailed in that city. The epidemic in Birmingham in 1833-4-5-6 was cotemporary with erysipelas in the hospitals and town, according to Dr. Ingleby. Again, in Dublin, in 1828, puerperal fever made its appearance at a time when typhus fever was prevalent. From a careful analysis of all the epidemics of this disease, Dr. Fleetwood Churchillt has come to the conclusion that there are often three diseases concurrent with puerperal fever,—bowel complaints (gastro-enteritis), typhus fever, and erysipelas; and I think, from what has been above stated, we may add that it was often observed by Hippocrates to be induced, during the Third Constitution, from the contagion of the epidemic bilious remittent fever. Dr. Ormerod alludes to his belief that this epidemic type is explicable on the supposition of the existence of some atmospheric condition affecting all who cannot resist it in the same way. The next question with regard to these fevers is the condition of the atmosphere that induced them. On referring to the Table of this Constitution (p. 47), it will be seen that the seasons through which they prevailed were cold, northerly, and droughty. The scanty meteorological observations * Euv. d'Hipp. t. ii. p. 691. + Diseases peculiar to Women, Syd. Soc., p. 36. Clinical Observations on Continued Fevers, p. 27. of later authors, in connection with puerperal fever, hardly afford us any data to go by; the general conclusions are, however, that this disease occurs at all times of the year. During the epidemic of 1769, 1770, Dr. Leake* observed that about the 14th of March, 1770, a sharp frost commenced, with large falls of snow, and alternate showers of sleet and hail, the wind being at north-east. This weather, which was uncommonly severe, lasted till near the end of the month, at which time the malignant force of the childbed fever began to abate. He quoted Hippocrates where this author observes that a mild rainy winter, succeeded by northerly winds, was dangerous to pregnant women. Agreeably to this observation, Dr. Leake adds, that in the winter, when the childbed fever began, the weather was observed to be remarkably mild and moist, with a warmer temperature of the air than was natural for the season; and this was succeeded by cold, bleak winds in the spring (N and NE), which were very unfriendly both to animals and vegetables. M. Tenon,† in his observations on this epidemic, when it occurred after the year 1774, states that it commenced usually about the middle of November, and continued till the end of January: it is met also at other seasons of the year, even during spring. The epidemic of 1746 in Paris prevailed during the winter: of twenty women confined in February of that year scarcely one recovered. In England it appeared in the British Lying-in Hospital in London, lasting from June 1760, to the beginning of July 1761. to In the Dublin Lying-in Hospital, from 1st December, 1767, end of May the next year, of 360 women delivered, 16 died. In 1774 (Dublin), of 280 women delivered during March, April, and May, 13 died. In 1787 March and April, in 1788 November, were the most fatal months. * Practical Observations on Childbed Fevers, by John Leake, M.D. 1772. + Mémoires sur les Hôpitaux de Paris, p. 243, 1816. The epidemic of 1821-22, in Edinburgh, prevailed from March, when the weather was very changeable, accompanied with sudden variations of the temperature. Out of 789 patients delivered, 79 were affected and 22 died. It subsided during the dry warm months for from 16th July to 14th October, 1821 there were only six cases. After the last of these dates the cold rainy weather set in, and with it the disease returned. In the warm months of 1822 the disease again declined. (Dr. Campbell). In 1829 it occurred in Dublin to an alarming extent during January, February, and March. Such are a few facts connected with some of the more important epidemics. Dr. Churchill observes that puerperal fever prevails most during the winter or spring months, and in moist and cold weather, or with alternations of cold and warm moist weather. Dr. Eutler says that "a sickly season adds both to the danger and frequency of puerperal fever." Abortions.-That Hippocrates believed in the great influence that weather has over pregnant women no one can for a moment doubt who has read the many passages in which he alludes to this subject. "If the winter be southerly, showery, and mild, and the spring northerly, dry, and winterly, those women who expect to be confined during the spring are apt to have premature labours (or abort)."* The premature labours of this season are evidently the effect of the prevailing fevers. Modern authors have observed abortion to be epidemic at times; and Dr. Copland gives the names of those who have mentioned the fact: for instance, Fischer, Tessier, Desormeaux. Agriculturists have observed that cows are apt to slip their calves more frequently at some seasons than at others; and some authorities affirm that it is generally most frequent after the prevalence of wet weather, which is also conducive to the production of ergot in the different grasses on which they feed. In 1852 abortion among cows was very prevalent, although it was a dry season for calving. Hipp. Op. ed. Kühn, vol. i. p. 44. F It is remarkable that the smell of a cow that has aborted has a strong tendency to produce a similar effect in another pregnant animal.* During a very wet season at Cannington some few years ago, when there was a great deal of ergoted wheat in consequence, it was observed that for several months hardly any of the women went their full time, and there were numerous miscarriages. There are many opportunities of studying this subject somewhat more fully than several others; inasmuch as if the breeder of cattle were to take regular meteorological observations, many and valuable facts might be obtained which in all probability would be of infinite service to our profession. The state of the Atmosphere conducive to Fevers, &c.—Were this subject to be fully treated it would take up much more space than is consistent with the object that I have in view,— viz. merely to give a sketch of antient and modern views on the subjects brought under consideration, as an introduction to a more detailed study of meteorological phenomena in their relation to disease. I shall therefore content myself with giving a few extracts from Hippocrates, an epitome of what modern writers have added, and conclude with statistics from the bills of mortality. Opinions and observations of the antients.-In accordance with what we observe on referring to the Table of this Constitution (page 47), Hippocrates remarks in the Aphorisms, "that fevers are acute in droughts; and if these prevail throughout the year, such will be its constitution, and such will be the diseases that we ought to expect."+ Again: "If the winter have been dry and northerly, and the spring rainy and southerly, of necessity there will be acute fevers." Whilst travelling, our author mentions that he arrived at Perinthus, a town of Thrace, near about the summer solstice. The winter had been Cyclopædia of Agriculture, Div. vi. p. 547. Aph. iii. 12. dry, mild, and southerly; the spring very dry, until the setting of the Pleiades: if there was any rain, it was only in a few drops. The Etesian winds hardly blew at all. During the summer ardent fevers became epidemical (Toũ Cépeos kavσol ἐπεδήμήσαν πολλοί).* Aretæust mentions that persons are liable to ardent fevers during the spring (ἔαρος δεύτερον, φλεγμονῇ καὶ πυρετοῖσι καυσώδεσι). As the fevers under discussion are different both in severity and form to what generally come under our observation in the British Isles, I shall merely give a general view of the conditions conducive to the generation of these epidemics, for our knowledge is not sufficiently accurate to warrant us in making anything like a classification of causes, although such an attainment would be highly desirable; and with the impulse that the study of meteorology has lately received from the medical profession, it may, I think, both be hoped for and expected. Modern Observations, &c.-As I have remarked before, the weather does not always act immediately upon the system, and produce disease. Heat and moisture may certainly make a decided impression upon the body, and a continuance of this impression may induce a train of phenomena that in the end would be sufficiently marked to justify the term disease; and this state of the atmosphere may affect a great number of people in the same manner, and thus produce an epidemic. The wind, the rain, and the sun, however, act more frequently in an indirect manner. How often do rivers swell with the mountain torrents, flood a neighbouring tract of land during the winter. The stream subsides; not so, however, the adventitious lakes that it has caused: time alone is required for such a mass of water to be drained off or evaporated. During this slow process the land plants die, and form a decomposed mass at the bottom, which, when the heat of the summer sun pours upon * Ed. Kühn, vol. iii. p. 444. † Ed. Kühn, p. 37. |