room。Thesameeveningheattendedawomaninlaborwithoutpreviouslychanginghisclothes；thispatientdied。Thenextmorninghedeliveredawomanwiththeforceps；shediedalso，andofmanyotherswhowereseizedwiththediseasewithinafewweeks，threesharedthesamefateinsuccession。
InJune，1823，heassistedsomeofhispupilsattheautopsyofacaseofpuerperalfever。Hewasunabletowashhishandswithpropercare，forwantofthenecessaryaccommodations。Ongettinghomehefoundthattwopatientsrequiredhisassistance。Hewentwithoutfurtherablution，orchanginghisclothes；boththesepatientsdiedwithpuerperalfever。ThissameDr。CampbellisoneofDr。
Churchill’sauthoritiesagainstcontagion。
Mr。Robertonsaysthatinoneinstancewithinhisknowledgeapractitionerpassedthecatheterforapatientwithpuerperalfeverlateintheevening；thesamenightheattendedaladywhohadthesymptomsofthediseaseonthesecondday。Inanotherinstanceasurgeonwascalledwhileintheactofinspectingthebodyofawomanwhohaddiedofthisfever，toattendalabor；withinforty-eighthoursthispatientwasseizedwiththefever。’
Onthe16thofMarch，1831，amedicalpractitionerexaminedthebodyofawomanwhohaddiedafewdaysafterdelivery，frompuerperalperitonitis。Ontheeveningofthe17thhedeliveredapatient，whowasseizedwithpuerperalfeveronthe19th，anddiedonthe24th。
Betweenthisperiodandthe6thofApril，thesamepractitionerattendedtwootherpatients，bothofwhomwereattackedwiththesamediseaseanddied。
Intheautumnof1829aphysicianwaspresentattheexaminationofacaseofpuerperalfever，dissectedouttheorgans，andassistedinsewingupthebody。Hehadscarcelyreachedhomewhenhewassummonedtoattendayoungladyinlabor。Insixteenhoursshewasattackedwiththesymptomsofpuerperalfever，andnarrowlyescapedwithherlife。
InDecember，1830，amidwife，whohadattendedtwofatalcasesofpuerperalfeverattheBritishLying-inHospital，examinedapatientwhohadjustbeenadmitted，toascertainiflaborhadcommenced。
Thispatientremainedtwodaysintheexpectationthatlaborwouldcomeon，whenshereturnedhomeandwasthensuddenlytakeninlaboranddeliveredbeforeshecouldsetoutforthehospital。Shewentonfavorablyfortwodays，andwasthentakenwithpuerperalfeveranddiedinthirty-sixhours。
“Ayoungpractitioner，contrarytoadvice，examinedthebodyofapatientwhohaddiedfrompuerperalfever；therewasnoepidemicatthetime；thecaseappearedtobepurelysporadic。Hedeliveredthreeotherwomenshortlyafterwards；theyalldiedwithpuerperalfever，thesymptomsofwhichbrokeoutverysoonafterlabor。Thepatientsofhiscolleaguedidwell，exceptone，whereheassistedtoremovesomecoagulafromtheuterus；shewasattackedinthesamemannerasthosewhomhehadattended，anddiedalso。“Thewriterinthe“BritishandForeignMedicalReview，“fromwhomIquotethisstatement，——andwhoisnootherthanDr。Rigby，adds，“Wetrustthatthisfactalonewillforeversilencesuchdoubts，andstampthewell-
meritedepithetof’criminal，’asabovequoted，uponsuchattempts。“
[Brit。andFor。MedicalReviewforJan。1842，p。112。]
>FromthecasesgivenbyMr。Ingleby，Iselectthefollowing。Twogentlemen，afterhavingbeenengagedinconductingthepost-mortemexaminationofacaseofpuerperalfever，wentinthesamedress，eachrespectively，toacaseofmidwifery。“Theonepatientwasseizedwiththerigoraboutthirtyhoursafterwards。Theotherpatientwasseizedwitharigorthethirdmorningafterdelivery。
Onerecovered，onedied。“[Edin。Med。andSurg。Journal，April，1838。]
Oneofthesesamegentlemenattendedanotherwomaninthesameclothestwodaysaftertheautopsyreferredto。“Therigordidnottakeplaceuntiltheeveningofthefifthdayfromthefirstvisit。
Resultfatal。“Thesecasesbelongedtoaseriesofseven，thefirstofwhichwasthoughttohaveoriginatedinacaseoferysipelas。
“Severalcasesofamildcharacterfollowedtheforegoingseven，andtheirnaturebeingnowmostunequivocal，myfrienddeclinedvisitingallmidwiferycasesforatime，andtherewasnorecurrenceofthedisease。“Thesecasesoccurredin1833。Fiveofthemprovedfatal。
Mr。Inglebygivesanotherseriesofseveneaseswhichoccurredtoapractitionerin1836，thefirstofwhichwasalsoattributedtohishavingopenedseveralerysipelatousabscessesashorttimepreviously。
IneednotrefertothecaselatelyreadbeforethisSociety，inwhichaphysicianwent，soonafterperforminganautopsyofacaseofpuerperalfever，toawomaninlabor，whowasseizedwiththesamediseaseandperished。Theforfeitofthaterrorhasbeenalreadypaid。
AtameetingoftheMedicalandChirurgicalSocietybeforereferredto，Dr。Merrimanrelatedaninstanceoccurringinhisownpractice，whichexcitesareasonablesuspicionthattwolivesweresacrificedtoastilllessdangerousexperiment。Hewasattheexaminationofacaseofpuerperalfeverattwoo’clockintheafternoon。Hetookcarenottotouchthebody。Atnineo’clockthesameeveningheattendedawomaninlabor；shewassonearlydeliveredthathehadscarcelyanythingtodo。Thenextmorningshehadsevererigors，andinforty-eighthoursshewasacorpse。Herinfanthaderysipelasanddiedintwodays。[Lancet，May2，1840。]
Inconnectionwiththefactswhichhavebeenstated，itseemspropertoalludetothedangerousandoftenfataleffectswhichhavefollowedfromwoundsreceivedinthepost-mortemexaminationofpatientswhohavediedofpuerperalfever。Thefactthatsuchwoundsareattendedwithpeculiarriskhasbeenlongnoticed。IfindthatChaussierwasinthehabitofcautioninghisstudentsagainstthedangertowhichtheywereexposedinthesedissections。[Stein，L’Artd’Accoucher，1794；Dict。desSciencesMedicales，art。“Puerperal。“]
TheheadpharmacienoftheHotelDieu，inhisanalysisofthefluideffusedinpuerperalperitonitis，saysthatpractitionersareconvincedofitsdeleteriousqualities，andthatitisverydangeroustoapplyittothedenudedskin。[JournaldePharmacie，January，1836。]SirBenjaminBrodiespeaksofitasbeingwellknownthattheinoculationoflymphorpusfromtheperitoneumofapuerperalpatientisoftenattendedwithdangerousandevenfatalsymptoms。
Threecasesinconfirmationofthisstatement，twoofthemfatal，havebeenreportedtothisSocietywithinafewmonths。
Ofaboutfiftycasesofinjuriesofthiskind，ofvariousdegreesofseverity，whichIhavecollectedfromdifferentsources，atleasttwelvewereinstancesofinfectionfrompuerperalperitonitis。Someoftheothersaresostatedastorenderitprobablethattheymayhavebeenofthesamenature。Fiveothercaseswereofperitonealinflammation；threeinmales。Threewerewhatwascalledenteritis，inoneinstancecomplicatedwitherysipelas；butitiswellknownthatthistermhasbeenoftenusedtosignifyinflammationoftheperitoneumcoveringtheintestines。Ontheotherhand，nocaseoftyphusortyphoidfeverismentionedasgivingrisetodangerousconsequences，withtheexceptionofthesingleinstanceofanundertakermentionedbyMr。Travers，whoseemstohavebeenpoisonedbyafluidwhichexudedfromthebody。Theotheraccidentswereproducedbydissection，orsomeothermodeofcontactwithbodiesofpatientswhohaddiedofvariousaffections。Theyalsodifferedmuchinseverity，thecasesofpuerperaloriginbeingamongthemostformidableandfatal。Nowamoment’sreflectionwillshowthatthenumberofcasesofseriousconsequencesensuingfromthedissectionofthebodiesofthosewhohadperishedofpuerperalfeverissovastlydisproportionedtotherelativelysmallnumberofautopsiesmadeinthiscomplaintascomparedwithtyphusorpneumoniafromwhichlastdiseasenotonecaseofpoisoninghappened，andstillmorefromalldiseasesputtogether，thattheconclusionisirresistiblethatamostfearfulmorbidpoisonisoftengeneratedinthecourseofthisdisease。Whetherornotitissuigeneris，confinedtothisdisease，orproducedinsomeothers，as，forinstance，erysipelas，Ineed，notstoptoinquire。
InconnectionwiththismaybetakenthefollowingstatementofDr。
Rigby。“Thatthedischargesfromapatientunderpuerperalfeverareinthehighestdegreecontagiouswehaveabundantevidenceinthehistoryoflying-inhospitals。Thepuerperalabscessesarealsocontagious，andmaybecommunicatedtohealthylying-inwomenbywashingwiththesamesponge；thisfacthasbeenrepeatedlyprovedintheViennaHospital；buttheyareequallycommunicabletowomennotpregnant；onmorethanoneoccasionthewomenengagedinwashingthesoiledbed-linenoftheGeneralLying-inHospitalhavebeenattackedwithabscessinthefingersorhands，attendedwithrapidlyspreadinginflammationofthecellulartissue。“
Nowaddtoallthistheundisputedfact，thatwithinthewallsoflying-inhospitalsthereisoftengeneratedamiasm，palpableasthechlorineusedtodestroyit，tenacioussoasinsomecasesalmosttodefyextirpation，deadlyinsomeinstitutionsastheplague；whichhaskilledwomeninaprivatehospitalofLondonsofastthattheywereburiedtwoinonecoffintoconcealitshorrors；whichenabledTonnelletorecordtwohundredandtwenty-twoautopsiesattheMaterniteofParis；whichhasledDr。Leetoexpresshisdeliberateconvictionthatthelossoflifeoccasionedbytheseinstitutionscompletelydefeatstheobjectsoftheirfounders；andoutofthistrainofcumulativeevidence，themultipliedgroupsofcasesclusteringaboutindividuals，thedeadlyresultsofautopsies，theinoculationbyfluidsfromthelivingpatient，themurderouspoisonofhospitals，-doestherenotresultaconclusionthatlaughsallsophistrytoscorn，andrendersallargumentaninsult？
Ihavehadoccasiontomentionsomeinstancesinwhichtherewasanapparentrelationbetweenpuerperalfeveranderysipelas。Thelengthtowhichthispaperhasextendeddoesnotallowmetoenterintotheconsiderationofthismostimportantsubject。Iwillonlysay，thattheevidenceappearstomealtogethersatisfactorythatsomemostfatalseriesofpuerperalfeverhavebeenproducedbyaninfectionoriginatinginthematteroreffluviaoferysipelas。Inevidenceofsomeconnectionbetweenthetwodiseases，Ineednotgobacktotheolderauthors，asPouteauorGordon，butwillcontentmyselfwithgivingthefollowingreferences，withtheirdates；fromwhichitwillbeseenthatthetestimonyhasbeenconstantlycomingbeforetheprofessionforthelastfewyears。
“LondonCyclopaediaofPracticalMedicine，“articlePuerperalFever，1833。
Mr。Ceeley’sAccountofthePuerperalFeveratAylesbury。“Lancet，“
1835。
Dr。Ramsbotham’sLecture。“LondonMedicalGazette，“1835。
Mr。YatesAckerly’sLetterinthesameJournal，1838。
Mr。InglebyonEpidemicPuerperalFever。“EdinburghMedicalandSurgicalJournal，“1838。
Mr。Paley’sLetter。“LondonMedicalGazette，“1839。
RemarksattheMedicalandChirurgicalSociety。“Lancet，“1840。
Dr。Rigby’s“SystemofMidwifery。“1841。
“NunneleyonErysipelas，“——aworkwhichcontainsalargenumberofreferencesonthesubject。1841。
“BritishandForeignQuarterlyReview，“1842。
Dr。S。JacksonofNorthumberland，asalreadyquotedfromtheSummaryoftheCollegeofPhysicians，1842。
Andlastly，astartlingseriesofcasesbyMr。StorrsofDoncaster，tobe，foundinthe“AmericanJournaloftheMedicalSciences“forJanuary，1843。
Therelationofpuerperalfeverwithothercontinuedfeverswouldseemtoberemoteandrarelyobvious。HeyreferstotwocasesofsynochusoccurringintheRoyalInfirmaryofEdinburgh，inwomenwhohadattendeduponpuerperalpatients。Dr。Collinsreferstoseveralinstancesinwhichpuerperalfeverhasappearedtooriginatefromacontinuedproximitytopatientssufferingwithtyphus。
Suchoccurrencesasthosejustmentioned，thoughmostimportanttoberememberedandguardedagainst，hardlyattractournoticeinthemidstofthegloomyfactsbywhichtheyaresurrounded。Ofthesefacts，attheriskoffatiguingrepetitions，Ihavesummonedasufficientnumber，asIbelieve，toconvincethemostincredulousthateveryattempttodisguisethetruthwhichunderliesthemallisuseless。
Itistruethatsomeofthehistoriansofthedisease，especiallyHulme，Hull，andLeake，inEngland；Tonnelle，Duges，andBaudelocque，inFrance，professnottohavefoundpuerperalfevercontagious。Atthemosttheygiveusmerenegativefacts，worthlessagainstanextentofevidencewhichnowoverlapsthewidestrangeofdoubt，anddoublesuponitselfintheredundancyofsuperfluousdemonstration。
Examinedindetail，thisandmuchoftheshowoftestimonybroughtuptostarethedaylightofconvictionoutofcountenance，provestobeinagreatmeasureunmeaningandinapplicable，asmightbeeasilyshownwereitnecessary。NordoIfeelthenecessityofenforcingtheconclusionwhicharisesspontaneouslyfromthefactswhichhavebeenenumerated，byformallycitingtheopinionsofthosegraveauthoritieswhohaveforthelasthalf-centurybeensoundingtheunwelcometruthithascostsomanylivestoestablish。