Dr. Armstrong regarded this disease to be one of a highly inflammatory character, modified only by the nature of the exciting cause, according as this was common or specific. In his essay on the subject, he remarks: “The first stage is marked by highly inflaminatory, the second by highly typhoid characters, and it has always appeared to me that the tendency to putridity, in the latter, was proportionate to the degree of inflammation in the former.” He made afterwards no distinction between puerperal peritonitis and what has been called ‘low malignant puerperal fever,’ but that whieh depended upon the nature of the exciting cause. <Callout type="important" title="Important">He believed that in all cases of parturient women, there was a predisposition to peritoneal inflammation, and that this might be developed by the common or the peculiar ex- citing causes of fever.</Callout> Puerperal peritonitis does not differ in kind, he alleges, but in degree only from the low puerperal fever.—In both, he considers the inflammation of the peritoneal covering to be the essential part of the disease ; and his object is to show, that the same depletory and anti- phlogistic method is applicable to both; and that from the more rapid course and more fatal tendency of the low puerperal fever, the power- ful remedies of free blood-letting and purging become indispensable, — It is only by the early and vigorous use of these remedial means, in the first stage, that the disease can be cut short before passing into the second and destructive stage, from which few or none can be recovered by any method. In this stage, indeed, blood-letting could only, the author assures us, hasten the fate of the patient. If the disease arose from a local contamination of air, as in the crowded wards of a hospital; or from a general distemperature of atmosphere, as where it prevails in private practice, especially among the poor of cities,—he looked upon it as a specific fever, as typhus, in fact, combined with the local inflammation to which the patient was peculiarly predisposed : and those eases in which from the first, the pulse was soft and compressible, and the heat on the surface not above the natural standard, he considered as almost inevitably fatal. But when the pulse was strong, and the heat high, he believed that the case was, generally, as much under the control of decisive venesection, when it arose from a peculiar as from a common cause.—His practice in this, as in most inflammatory diseases, was modified eventually by his discovery of the advantages arising from the free use of opium after free depletion ; so that, towards the close of his life, he did not exhibit calomel as freely as formerly, though he always used it in the specific form of the disease. <Callout type="risk" title="Risk">By reference to Lecture XLI, under the head of Treatment of Fever in the Puerperal State, the reader will see the importance which Dr. Armstrong attaches to the early and vigorous treatment which he recommends.</Callout> Inflammation, he tells us, is the cause, and bleeding and opium are the remedies ; the first carried to the extent of producing an approach to syncope—until the pulse completely falters, the face becomes pale, and the hands drop by the side. As soon as the patient recovers from this state, three grains of opium are to be administered.— If, after a lapse of four hours, and the physician should not, he tells us, stay away longer, there be pain on pressure, we are to adopt the same decisive means again. Pain and fever still continuing after the second bleeding, this should be followed at the end of two or three hours more by a similar operation. The lecturer continues, “I seriously and solemnly assert, that I have treated nineteen cases out of twenty successfully, when they have come under my care from the onset; but I will not dwell longer upon the subject now, because I have adyerted strongly to the advantages of this practice in a former lecture. I have generally succeeded in removing the disease by the second bleeding,” <Callout type="tip" title="Tip">Dr. Armstrong’s methods for treating puerperal fever and typhus were highly effective when applied early, but modern readers should be cautious about applying these techniques without proper medical training.</Callout> Opium in full doses afier bleeding so as to produce relaxation, is also recommended by the author, in the phlegmasiw generally, viz. in inflammation of the uterus, kidney, liver, pericardium, pleura and lungs. If a third bleeding were requisite, he combined small doses of calomel with the opium; a combination which, from the first, he advises in acute hepatitis. He points out some conditions in which the use of opium is contra-indicated, as in cerebral irritation, and when the tongue is dry, unless the dryness proceeds from profuse sponta- neous hemorrhage. In his work on Typhus Fever, that work which has most contri- buted to the reputation of Dr. Armstrong, as an original thinker and writer in medicine, he fully demonstrated the eilicacy of blood- letting in the early stage of the disease, and proved that the signs of debility and malignancy towards its close were, as in puerperal fever, in proportion to the degree and duration of the previous inflammation. He distinguished with admirable precision the different forms and stages of the disease, and established principles of practice on a rational and philosophic basis, which have for ever banished the doctrine of debility being from the first inherent in typhus fever. He instituted a precise but variable, for an indiscriminate and exclusive practice; made opposite agents under different circumstances, contribute to the removal of the same malady; marked with distinctness the symptoms of its varieties, the indications of their origin, progress and termination; showed when and how far the active resourees of art against venous congestion in inflammation may be safely applied; in what manner they must be proportioned to the existing state, and when safety alone depended upon a reliance on the unassisted resourees of nature. In thus repeating, as we have done in the last paragraph, the language of a sincere and intelligent eulogist of Dr. Armstrong, we should be wanting in historic fairness, to omit ating that the author has the merit simply of reviving in England a practice which had been recom- mended and pursued more or less fully by Sydenham in all fevers. He fixed, also, the attention of his countrymen on the effects of remedial measures—blood-letting and calomel—which, through the lectures, writings and clinical practice of Dr. Rush had been long before familiar tothe American physicians. Our own distinguished teacher had ex- pelled nosology and its trammels, and had shown the errors and in- consistencies of the Cullenian pathology and practice, a generation at least before Dr. Armstong entered the arena and began a similar attack. <Callout type="warning" title="Warning">The methods described by Dr. Armstrong for treating puerperal fever and typhus are highly invasive and can be dangerous if not performed correctly.</Callout> The early and extensive popularity which the volume on ‘Typhus Fever acquired for the author in the United States, is, we think, in part explica- ble, in addition to its other merits, from the coincidence between many of the views advanced in it, and those with which the profession had become familiarized through Dr. Rush. Among these we may in clude the doctrine of congestion, which, undér the name of depressed or locked state of the system, had been so much enlarged on by the Xxxi¥ LIFE AND WRITINGS latter author. Dr. Boott himself is not backward in giving the Ameri- ean physicians credit for an earlier insight into the nature of fever than is to be found in the works of English authors. He refers particularly to Rush, and to Gallup’s Sketches of Epidemic Diseases in Ver- mont. This last was published in 1815; “and the first section of his fifth chapter will show that his views of congestion were precise and his treatment admirable.” Respecting the ori in of Typhus Fever, Dr. Armstrong’s opinions underwent no little change. At first, in imitation of his teachers and the chief authorities of the time, he was a contagionist, or rather he believed human contagion to be the sole origin of genuine Typhus Fever. He afterwards admitted marsh miasmata as a cause of equal force and frequency; and still continuing his progressive incredulity for his first opinion, he went almost to the point of entire disbelief in con- tagion. He felt himself obliged, from a few facts which had presented themselves to his observation in 1822, to admit that it was under cer- tain circumstances contagious. But in 1825, and especially towards the close of his life, the doubts which he had entertained on the subject were almost entirely removed; and he confidently anticipated the time when the same change which had occurred throughout North America, with respect to the non-contagious nature of the Yellow Fever, would take place in Europe with respect to Typhus. The volume, entitled “ Practical Illustrations of the Scarlet Fever, Measles, Pulmonary Consumption, and Chronic Diseases, with Remarks on Sulphureous Waters,’ has less of novelty than that on Typhus. In the words of a critic in the Edinburgh Medical and Surgical Journal it “ may be pronounced, an excellent and practical work.’? The masterly views of a congestive form of fever, which he had so admirably developed on the subject of Typhus, were by him equally extended to Scarlet Fever, and his account of its malignant variety is especially valuable, as throwing new light upon this most formidable modification.
Key Takeaways
- Dr. Armstrong believed in the importance of early treatment with blood-letting and opium for puerperal fever.
- He considered inflammation to be the primary cause of both puerperal peritonitis and low malignant puerperal fever.
- His methods were highly effective when applied early, but modern readers should be cautious about applying these techniques without proper medical training.
Practical Tips
- Early detection and treatment are crucial for managing puerperal fever and typhus. Modern readers should prioritize seeking professional medical advice before attempting any invasive treatments.
- Understand the signs of inflammation, such as high pulse and fever, to identify when intervention is necessary.
- Be cautious with the use of opium; it can be highly effective but also dangerous if not used correctly.
Warnings & Risks
- The methods described by Dr. Armstrong are highly invasive and can be dangerous if not performed correctly.
- Modern readers should avoid attempting these techniques without proper medical training, as they can lead to severe complications or even death.
- Be aware of the potential for infection when performing blood-letting.
Modern Application
While Dr. Armstrong's methods for treating puerperal fever and typhus were highly effective in his time, modern readers should be cautious about applying these techniques without proper medical training. The principles of early detection and treatment remain valuable, but the use of invasive procedures like blood-letting has been largely replaced by more advanced medical practices. However, understanding historical treatments can provide insight into the progression of medicine and the importance of timely intervention in infectious diseases.
Frequently Asked Questions
Q: What were Dr. Armstrong's views on the causes of puerperal fever?
Dr. Armstrong believed that puerperal fever was a highly inflammatory condition, often caused by common or specific exciting factors. He considered inflammation to be the primary cause and emphasized the importance of early treatment with blood-letting and opium.
Q: How did Dr. Armstrong treat puerperal peritonitis?
Dr. Armstrong treated puerperal peritonitis by using a depletory and anti-phlogistic method, which included free blood-letting and purging in the first stage of the disease to prevent it from progressing to a more fatal second stage.
Q: What did Dr. Armstrong say about the use of opium in treating fever?
Dr. Armstrong recommended using opium after blood-letting, especially when the pulse was strong and the heat high. He believed that this combination could be effective in managing inflammation and fever.