deadly results of autopsies, the inoculation by fluids from the living patient, the murderous poison of hospitals-does there not result a conclusion that laughs all sophistry to scorn, and renders all argument an insult?

I have had occasion to mention some instances in which there was an apparent relation between puerperal fever and erysipelas. The length to which this paper has extended does not allow me to enter into the consideration of this most important subject. I will only say that the evidence appears to me altogether satisfactory that some most fatal series of puerperal fever have been produced by an infection. originating in the matter or effluvia of erysipelas. In evidence of some connection between the two diseases, I need not go back to the older authors, as Pouteau or Gordon, but will content myself with giving the following references, with their dates; from which it will be seen that the testimony has been constantly coming before the profession for the last few years:

"London Cyclopædia of Practical Medicine," article Puerperal Fever, 1833.

Mr. Ceeley's Account of the Puerperal Fever at Aylesbury, "Lancet," 1835.

Dr. Ramsbotham's Lecture, "London Medical Gazette," 1835.

Mr. Yates Ackerly's Letter in the same journal, 1838. Mr. Ingleby on Epidemic Puerperal Fever, "Edinburgh Medical and Surgical Journal," 1838.

Mr. Paley's Letter, "London Medical Gazette," 1839. Remarks at the Medical and Chirurgical Society, "Lancet," 1840.

Dr. Rigby's "System of Midwifery," 1841.

"Nunneley on Erysipelas," a work which contains a large number of references on the subject, 1841.

"British and Foreign Quarterly Review," 1842.

Dr. S. Jackson, of Northumberland, as already quoted from the Summary of the College of Physicians, 1842.

And, lastly, a startling series of cases by Mr. Storrs, of Doncaster, to be found in the "American Journal of the Medical Sciences" for January, 1843.

The relation of puerperal fever with other continued

Hey

fevers would seem to be remote and rarely obvious. refers to two cases of synochus occurring in the Royal Infirmary of Edinburgh, in women who had attended upon puerperal patients. Dr. Collins refers to several instances in which puerperal fever has appeared to originate from a continued proximity to patients suffering with typhus."

Such occurrences as those just mentioned, though most important to be remembered and guarded against, hardly attract our notice in the midst of the gloomy facts by which they are surrounded. Of these facts, at the risk of fatiguing repetitions, I have summoned a sufficient number, as I believe, to convince the most incredulous that every attempt to disguise the truth which underlies them all is useless.

It is true that some of the historians of the disease, especially Hulme, Hull, and Leake, in England; Tonnellé, Dugès, and Baudelocque, in France, profess not to have found puerperal fever contagious. At the most they give us mere negative facts, worthless against an extent of evidence which now overlaps the widest range of doubt, and doubles upon itself in the redundancy of superfluous demonstration. Examined in detail, this and much of the show of testimony brought up to stare the daylight of conviction out of countenance, proves to be in a great measure unmeaning and inapplicable, as might be easily shown were it necessary. Nor do I feel the necessity of enforcing the conclusion which arises spontaneously from the facts which have been enumerated by formally citing the opinions of those grave authorities who have for the last half-century been sounding the unwelcome truth it has cost so many lives to establish.

"It is to the British practitioner," says Dr. Rigby, "that we are indebted for strongly insisting upon this important and dangerous character of puerperal fever."

The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton," Haighton," Good, Waller," Blundell,

35

38 Treatise on Midwifery, p. 228.

38

84 British and Foreign Med. Rev. for January, 1842.
35 Encyc. Britannica, xiii, 467, art., Medicine."

36 Outlines of Midwifery, p. 109.

38 Study of Medicine, ii, 195.

66

89 Medical and Physical Journal, July,

$7 Oral Lectures, etc.

1830.

45

a

Gooch, Ramsbotham, Douglas," Lee, Ingleby, Locock, Abercrombie," Alison," Travers," Rigby, and Watson many of whose writings I have already referred to, may have some influence with those who prefer the weight of authorities to the simple deductions of their own reason from the facts laid before them. A few Continental writers have adopted similar conclusions." It gives me pleasure to remember that, while the doctrine has been unceremoniously discredited in one of the leading journals," and made very light of by teachers in two of the principal medical schools of this country, Dr. Channing has for many years inculcated, and enforced by examples, the danger to be apprehended and the precautions to be taken in the disease under consideration.

48

I have no wish to express any harsh feeling with regard to the painful subject which has come before us. If there are any so far excited by the story of these dreadful events that they ask for some word of indignant remonstrance to show that science does not turn the hearts of its followers into ice or stone, let me remind them that such words have been uttered by those who speak with an authority I could not claim. It is as a lesson rather than as a reproach that I call up the memory of these irreparable errors and wrongs. No tongue can tell the heart-breaking calamity they have caused; they have closed the eyes just opened upon a new world of love and happiness; they have bowed the strength of manhood into the dust; they have cast the helplessness of infancy into the stranger's arms, or bequeathed it, with less cruelty, the death of its dying parent. There is no tone deep enough for regret, and no voice loud enough for warning. The woman about to become a mother, or with her new-born infant upon her bosom, should be the object of trembling care and sympathy wherever she bears her tender burden or stretches her aching limbs. The very 40 Dublin Hospital Reports for 1822.

41 Library of Practical Medicine, i, 373.

42 Researches on Diseases of the Stomach, etc., p. 181.

43 Library of Practical Medicine, i, 96.

Further Researches on Constitutional Irritation, p. 128.

45 London Medical Gazette, February, 1842.

48 See British and Foreign Medical Review, vol. iii, p. 525, and vol. iv, P. 517. Also Ed. Med. and Surg. Journal for July, 1824, and American Journal of Med. Sciences for January, 1841.

47 Phil. Med. Journal, vol. xii, p. 364.

48 Dr. Blundell and Dr. Rigby in the works already cited.

outcast of the streets has pity upon her sister in degradation when the seal of promised maternity is impressed upon her. The remorseless vengeance of the law, brought down upon its victim by a machinery as sure as destiny, is arrested in its fall at a word which reveals her transient claim for mercy. The solemn prayer of the liturgy singles out her sorrows from the multiplied trials of life, to plead for her in the hour of peril. God forbid that any member of the profession to which she trusts her life, doubly precious at that eventful period, should hazard it negligently, unadvisedly, or selfishly!

There may be some among those whom I address who are disposed to ask the question, What course are we to follow in relation to this matter? The facts are before them, and the answer must be left to their own judgment and conscience. If any should care to know my own conclusions, they are the following; and in taking the liberty to state them very freely and broadly, I would ask the inquirer to examine them as freely in the light of the evidence which has been laid before him.

1. A physician holding himself in readiness to attend cases of midwifery should never take any active part in the postmortem examination of cases of puerperal fever.

2. If a physician is present at such autopsies, he should use thorough ablution, change every article of dress, and allow twenty-four hours or more to elapse before attending to any case of midwifery. It may be well to extend the same caution to cases of simple peritonitis.

3. Similar precautions should be taken after the autopsy or surgical treatment of cases of erysipelas, if the physician is obliged to unite such offices with his obstetrical duties, which is in the highest degree inexpedient.

4. On the occurrence of a single case of puerperal fever in his practice, the physician is bound to consider the next female he attends in labor, unless some weeks at least have elapsed, as in danger of being infected by him, and it is his duty to take every precaution to diminish her risk of disease and death.

5. If within a short period two cases of puerperal fever happen close to each other, in the practice of the same

physician, the disease not existing or prevailing in the neighborhood, he would do wisely to relinquish his obstetrical practice for at least one month, and endeavor to free himself by every available means from any noxious influence he may carry about with him.

6. The occurrence of three or more closely connected cases, in the practice of one individual, no others existing in the neighborhood, and no other sufficient cause being alleged for the coincidence, is primâ facie evidence that he is the vehicle of contagion.

7. It is the duty of the physician to take every precaution that the disease shall not be introduced by nurses or other assistants, by making proper inquiries concerning them, and giving timely warning of every suspected source of danger.

8. Whatever indulgence may be granted to those who have heretofore been the ignorant causes of so much misery, the time has come when the existence of a private pestilence in the sphere of a single physician should be looked upon, not as a misfortune, but a crime; and in the knowledge of such occurrences the duties of the practitioner to his profession should give way to his paramount obligations to society.

ADDITIONAL REFERENCES AND CASES.

Fifth Annual Report of the Registrar-General of England, 1843. Appendix. Letter from William Farr, Esq.-Several new series of cases are given in the letter of Mr. Storrs, contained in the appendix to this report. Mr. Storrs suggests precautions similar to those I have laid down, and these precautions are strongly enforced by Mr. Farr, who is, therefore, obnoxious to the same criticisms as myself. Hall and Dexter, in Am. Journal of Med. Sc. for January, 1844.— Cases of puerperal fever seeming to originate in erysipelas.

Elkington, of Birmingham, in Provincial Med. Journal, cited in Am. Journ. Med. Sc. for April, 1844.—Six cases in less than a fortnight, seeming to originate in a case of erysipelas.

West's Reports, in Brit. and For. Med. Review for October, 1845, and January, 1847.-Affection of the arm, resembling malignant pustule, after removing the placenta of a patient who died from puerperal fever. Reference to cases at Wurzburg, as proving contagion, and to Keiller's cases in the Monthly Journal for February, 1846, as showing connection of puerperal fever and erysipelas.

Kneeland.-Contagiousness of Puerperal Fever. Am. Jour. Med. .Sc., January, 1846. Also, Connection between Puerperal Fever and Epidemic Erysipelas. Ibid., April, 1846.