The Hunterian Oration on the Etiology of Puerperal Fever
Authors: A. L. Galabin
Journal: BMJ (1887)

Physician and Lecturer on Midwifery to Guy's Hospital.I NEED hardly remind you that the genius of Hunter was not limited to the field of surgery and general pathology, but that he devoted some of his attention also to subjects connected with obstetrics.Thus his name is immortalised in the description of the several parts of the dccidua of the gravid uterus, and especially in that term decidua serotina, whose late Latinity is apt to perplex students having minds imbued with classical models of a purer age.No one can comprehend this nomenclature without mastering the Hunterian.theory of decidual formation.In undertaking, therefore, to address you, I venture, as an obstetrician, to select an obstetrical subject, and to direct your attention to some of the problems connected with Puerperal Fevers.I do so the more readily, because many of these problems are yet unsolved, and their solution demands especially three things in which Hunter was pro-eminent-painstaking clinical observation, scientific.experi.ment, and sound reasoning.While I cannot hope to bring before you novel facts, I shall be repaid if I can obtain the aid of some members of the Hunterian So;iety in investigating these questions by Hunterian lmethods.Modern discoveries as to the connection of microscopic organisms with disease, which have thrown such a flood of light on the nature of spreading inflammations, of several infectious diseases, and on some diseases not hitherto considered infectious, have not failed consider- ably to modify opinions as to the nature of puerperal fever.No other rational theory has, indeed, ever been proposed to account for the existence of an infectious or contagious disease, which may spread indefinitely from one individual to another, but is limited by tume in the individual, except the theory that it is dependent upon parasitic organisms.A merely chemical ferment may indeed suffice, although present in very minute quantity, to kill an individual A rs(cond may even be inoculated from the first, and suffer in minor de- gree, as when the hand is wounded in dissecting an animal dead from snake-bite.But all experiment shows that such a chemical ferment, if free from organisms, is incapable of causing a disease spreading Ifrom one animal to another progressively.Tle Darwinian theory of p.ngenesis, indeed, asserts that the cells of the body give off germs of a minuteness far beyond the reach of any present or any future microscope; and that it is owing to the pre- bt nce of such germs, derived not only from the parent, but from fur- ther ancestors, in the ovum and the spermatozoa, that the progeny grows to resemble its parents, and even reproduces traits of its long- past ancestors.However incredible such a theory may appear at first sight, it will hardly be possible, in any easier and simpler way, to ac- count for the extraordinary powers of ovum and spermatozoon.If we accept such a theory, we may suppose that cells having, for some reason unknown, taken on a morbid action, may throw off germs which reproduce such morbid action not only in other cells of the same animal, but in those of another animal, if in any way they get acc-ss to its tissues.WVe can hardly dispute the existence of some such spermatic inflience of one cell over another in malignant growths -a, for instance, when we find that the glands of the rectum or the uterLas are reproduced in a secondary deposit in the liver or the lun -.Ir is conceivable, then, that an infectious disease might exist, de- pIewlent on such a spermatic influence of cells through their own fgonis, and net on any parasitic organisms.Bat, on this theory, it appears iupossible to imagine any explanation, either for the tendency Ut the animal to recover from the disease after a certain time, or for the immunity, more or less complete, which is generally conferred by one attack against future attacks of the same disease.The disease oughlt to be ever spreading into a wider circle and increasing, as is the case in the advance of cancer.