“ItistotheBritishpractitioner，“saysDr。Rigby，“thatweareindebtedforstronglyinsistinguponthisimportantanddangerouscharacterofpuerperalfever。“
ThenamesofGordon，JohnClarke，Denman，Burns，Young，Hamilton，Haighton，Good，Waller；Blundell，Gooch，Ramsbotham，Douglas，Lee，Ingleby，Locock，Abercrombie，Alison；Travers，Rigby，andWatson，manyofwhosewritingsIhavealreadyreferredto，mayhavesomeinfluencewiththosewhoprefertheweightofauthoritiestothesimpledeductionsoftheirownreasonfromthefactslaidbeforethem。AfewContinentalwritershaveadoptedsimilarconclusions。Itgivesmepleasuretoremember，thatwhilethedoctrinehasbeenunceremoniouslydiscreditedinoneoftheleadingJournals，andmadeverylightofbyteachersintwooftheprincipalMedicalSchools，ofthiscountry，Dr。Channinghasformanyyearsinculcated，andenforcedbyexamples，thedangertobeapprehendedandtheprecautionstobetakeninthediseaseunderconsideration。
Ihavenowishtoexpressanyharshfeelingwithregardtothepainfulsubjectwhichhascomebeforeus。Ifthereareanysofarexcitedbythestoryofthesedreadfuleventsthattheyaskforsomewordofindignantremonstrancetoshowthatsciencedoesnotturntheheartsofitsfollowersintoiceorstone，letmeremindthemthatsuchwordshavebeenutteredbythosewhospeakwithanauthorityI
couldnotclaim。ItisasalessonratherthanasareproachthatI
callupthememoryoftheseirreparableerrorsandwrongs。Notonguecantelltheheart-breakingcalamitytheyhavecaused；theyhaveclosedtheeyesjustopeneduponanewworldofloveandhappiness；
theyhavebowedthestrengthofmanhoodintothedust；theyhavecastthehelplessnessofinfancyintothestranger’sarms，orbequeathedit，withlesscruelty，thedeathofitsdyingparent。Thereisnotonedeepenoughforregret，andnovoiceloudenoughforwarning。
Thewomanabouttobecomeamother，orwithhernew-borninfantuponherbosom，shouldbetheobjectoftremblingcareandsympathywherevershebearshertenderburden，orstretchesherachinglimbs。
Theveryoutcastofthestreetshaspityuponhersisterindegradation，whenthesealofpromisedmaternityisimpresseduponher。Theremorselessvengeanceofthelaw，broughtdownuponitsvictimbyamachineryassureasdestiny，isarrestedinitsfallatawordwhichrevealshertransientclaimformercy。Thesolemnprayeroftheliturgysinglesouthersorrowsfromthemultipliedtrialsoflife，topleadforherinthehourofperil。Godforbidthatanymemberoftheprofessiontowhichshetrustsherlife，doublypreciousatthateventfulperiod，shouldhazarditnegligently，unadvisedly，orselfishly！
TheremaybesomeamongthosewhomIaddresswhoaredisposedtoaskthequestion，Whatcoursearewetofollowinrelationtothismatter？Thefactsarebeforethem，andtheanswermustbelefttotheirownjudgmentandconscience。Ifanyshouldcaretoknowmyownconclusions，theyarethefollowing；andintakingthelibertytostatethemveryfreelyandbroadly，Iwouldasktheinquirertoexaminethemasfreelyinthelightoftheevidencewhichhasbeenlaidbeforehim。
1。Aphysicianholdinghimselfinreadinesstoattendcasesofmidwiferyshouldnevertakeanyactivepartinthepost-mortemexaminationofcasesofpuerperalfever。
2。Ifaphysicianispresentatsuchautopsies，heshouldusethoroughablution，changeeveryarticleofdress，andallowtwenty-
fourhoursormoretoelapsebeforeattendingtoanycaseofmidwifery。Itmaybewelltoextendthesamecautiontocasesofsimpleperitonitis。
3。Similarprecautionsshouldbetakenaftertheautopsyorsurgicaltreatmentofcasesoferysipelas，ifthephysicianisobligedtounitesuchofficeswithhisobstetricalduties，whichisinthehighestdegreeinexpedient。
4。Ontheoccurrenceofasinglecaseofpuerperalfeverinhispractice，thephysicianisboundtoconsiderthenextfemaleheattendsinlabor，unlesssomeweeksatleasthaveelapsed，asindangerofbeinginfectedbyhim，anditishisdutytotakeeveryprecautiontodiminishherriskofdiseaseanddeath。
5。Ifwithinashortperiodtwocasesofpuerperalfeverhappenclosetoeachother，inthepracticeofthesamephysician，thediseasenotexistingorprevailingintheneighborhood，hewoulddowiselytorelinquishhisobstetricalpracticeforatleastonemonth，andendeavortofreehimselfbyeveryavailablemeansfromanynoxiousinfluencehemaycarryaboutwithhim。
6。Theoccurrenceofthreeormorecloselyconnectedcases，inthepracticeofoneindividual，noothersexistingintheneighborhood，andnoothersufficientcausebeingallegedforthecoincidence，isprimafacieevidencethatheisthevehicleofcontagion。
7。Itisthedutyofthephysiciantotakeeveryprecautionthatthediseaseshallnotbeintroducedbynursesorotherassistants，bymakingproperinquiriesconcerningthem，andgivingtimelywarningofeverysuspectedsourceofdanger。
8。Whateverindulgencemaybegrantedtothosewhohaveheretoforebeentheignorantcausesofsomuchmisery，thetimehascomewhentheexistenceofaprivatepestilenceinthesphereofasinglephysicianshouldbelookedupon，notasamisfortune，butacrime；
andintheknowledgeofsuchoccurrencesthedutiesofthepractitionertohisprofessionshouldgivewaytohisparamountobligationstosociety。
ADDITIONALREFERENCESANDCASES。
FifthAnnualReportoftheRegistrar-GeneralofEngland，1843。Appendix。LetterfromWilliamFarr，Esq——SeveralnewseriesofcasesaregivenintheLetterofMr。Stows，containedintheAppendixtothisReport。Mr。StowssuggestsprecautionssimilartothoseIhavelaiddown，andtheseprecautionsarestronglyenforcedbyMr。Farr，whois，therefore，obnoxioustothesamecriticismsasmyself。
HallandDexter，inAm。JournalofMed。Sc。forJanuary，1844-
Casesofpuerperalfeverseemingtooriginateinerysipelas。
Elkington，ofBirmingham，inProvincialMed。Journal，citedinAm。
Journ。Med。Se。forApril，1844——Sixcasesinlessthanafortnight，seemingtooriginateinacaseoferysipelas。
West’sReports，inBrit。andFor。Med。ReviewforOctober，1845，andJanuary，1847——Affectionofthearm，resemblingmalignantpustule，afterremovingtheplacentaofapatientwhodiedfrompuerperalfever。ReferencetocasesatWurzburg，asprovingcontagion，andtoKeiller’scasesintheMonthlyJournalforFebruary，1846，asshowingconnectionofpuerperalfeveranderysipelas。
Kneeland——ContagiousnessofPuerperalFever。Am。Jour。Med。
Se。，January，1846。Also，ConnectionbetweenPuerperalFeverandEpidemicErysipelas。Ibid。，April，1846。
RobertStorrs——ContagiousEffectsofPuerperalFeverontheMaleSubject；oronPersonsnotChild-bearing。FromProvincialMed。andSurg。Journal。Am。Jour。Med。Sc。，January，184，6。Numerouscases。SeealsoDr。Reid’scaseinsameJournalforApril，1846。
Routh’spaperinProc。ofRoyalMed。Chir。Soc。，Am。Jour。Med。
Sc。，April，1849，alsoinB。andF。Med。Chir。Review，April，1850。
Hill，ofLeuchars——ASeriesofCasesillustratingtheContagiousNatureofErysipelasandofPuerperalFever，andtheirIntimatePathologicalConnection。FromMonthlyJournalofMed。Sc。Am。
Jour。Med。Se。，July，1850。
SkodaontheCausesofPuerperalFever。Peritonitisinrabbits，frominoculationwithdifferentmorbidsecretions。Am。Jour。Med。
Se。，October，1850。
Arneth。PaperreadbeforetheNationalAcademyofMedicine。Annalesd’Hygiene，TomeLXV。2ePartie。MeansofDisinfectionproposedbyM。“Semmeliveis“Semmelweiss。Lotionsofchlorideoflimeanduseofnail-brushbeforeadmissiontolying-inwards。Allegedsuddenandgreatdecreaseofmortalityfrompuerperalfever。Causeofdiseaseattributedtoinoculationwithcadavericmatters。SeealsoRouth’spaper，mentionedabove。
Moir。RemarksatameetingoftheEdinburghMedico-ChirurgicalSociety。ReferstocasesofDr。Kellie，ofLeith。Sixteeninsuccession，allfatal。Alsotoseveralinstancesofindividualpupilshavinghadasuccessionofcasesinvariousquartersofthetown，whileothers，practisingasextensivelyinthesamelocalities，hadnone。Alsotoseveralspecialcasesnotmentionedelsewhere。
Am。Jour。Med。Se。forOctober，1851。FromNewMonthlyJournalofMed。Science。
Simpson——ObservationsataMeetingoftheEdinburghObstetricalSociety。An“eminentgentleman，“accordingtoDr。Meigs，whose“nameisaswellknowninAmericaasinhisnativeland。“
Obstetrics。Phil。1852，pp。368，375。Thestudentisreferredtothispaperforavaluableresumeofmanyofthefacts，andthenecessaryinferences，relatingtothissubject。Alsoforanotherseriesofcases，Mr。Sidey’s，fiveorsixinrapidsuccession。
Dr。SimpsonattendedthedissectionoftwoofDr。Sidey’scases，andfreelyhandledthediseasedparts。Hisnextfourchild-bedpatientswereaffectedwithpuerperalfever，anditwasthefirsttimehehadseenitinpractice。AsDr。SimpsonisagentlemanDr。Meigs，asabove，andas“agentleman’shandsareclean“Dr。Meigs’SixthLetter，itfollowsthatagentlemanwithcleanhandsmaycarrythedisease。Am。Jour。Med。Sc。，October，1851。
Peddle——ThefiveorsixcasesofDr。Sidey，followedbythefourofDr。Simpson，didnotendtheseries。ApractitionerinLeithhavingexaminedinDr。Simpson’shouse，aportionoftheuterusobtainedfromoneofthepatients，hadimmediatelyafterwardsthreefatalcasesofpuerperalfever。Dr。Veddiereferredtotwodistinctseriesofconsecutivecasesinhisownpractice。Hehadsincetakenprecautions，andnotmetwithanysuchcases。Am。Jour。Med。Sc。，October，1851。
Copland。Considersitprovedthatpuerperalfevermaybepropagatedbythehandsandtheclothes，oreither，ofathirdperson，thebed-
clothesorbody-clothesofapatient。Mentionsanewseriesofcases，oneofwhichhesaw，withthepractitionerwhohadattendedthem。Shewasthesixthhehadhadwithinafewdays。Alldied。
Dr。Coplandinsistedthatcontagionhadcausedthesecases；advisedprecautionarymeasures，andthepractitionerhadnoothercasesforaconsiderabletime。Considersitcriminal，aftertheevidenceadduced，——whichhecouldhavequadrupled，——andtheweightofauthoritybroughtforward，forapractitionertobethemediumoftransmittingcontagionanddeathtohispatients。Dr。Coplandlaysdownrulessimilartothosesuggestedbymyself，andisthereforeentitledtothesameepithetforsodoing。MedicalDictionary，NewYork，1852。Article，PuerperalStatesandDiseases。
Ifthereisanyappetiteforfactssocravingastobeyetunappeased，——Lesotho，necdumsatiata，——morecanbeobtained。
Dr。Hodgeremarksthat“thefrequencyandimportanceofthissingularcircumstancethatthediseaseisoccasionallymoreprevalentwithonepractitionerthananotherhasbeenexceedinglyoverrated。“Morethanthirtystringsofcases，morethantwohundredandfiftysufferersfrompuerperalfever，morethanonehundredandthirtydeathsappearastheresultsofasparingestimateofsuchamongthefactsIhavegleanedascouldbenumericallyvalued。Thesefactsconstitute，wemaytakeitforgranted，butasmallfractionofthosethathaveactuallyoccurred。Thenumberofthemmightbegreater，but“’tisenough，’twillserve，“inMercutio’smodestphrase，sofarasfrequencyisconcerned。Forajustestimateoftheimportanceofthesingularcircumstance，itmightbepropertoconsultthelanguidsurvivors，thewidowedhusbands，andthemotherlesschildren，aswellas“theunfortunateaccoucheur。“
III
CURRENTSANDCOUNTER-CURRENTSINMEDICALSCIENCE
AnAddressdeliveredbeforetheMassachusettsMedicalSociety，attheAnnualMeeting，May30，1860。
“Facultatemagisquamviolentia。
HIPPOCRATES。
OurAnnualMeetingneverfailstoteachusatleastonelesson。TheartwhoseprovinceitistohealandtosavecannotprotectitsownranksfromtheinroadsofdiseaseandthewasteoftheDestroyer。
SeventeenofourassociateshavebeentakenfromussinceourlastAnniversary。Mostofthemfollowedtheircallinginthevillagesortownsthatlieamongthehillsoralongtheinlandstreams。Onlythosewhohavelivedthekindly，mutuallydependentlifeofthecountry，cantellhownearthephysicianwhoisthemainrelianceinsicknessofallthefamiliesthroughoutathinlysettledregioncomestotheheartsofthepeopleamongwhomhelabors，howtheyvaluehimwhileliving，howtheycherishhismemorywhendead。Forthesefriendsofourswhohavegonebefore，thereisnownomoretoil；theystartfromtheirslumbersnomoreatthecryofpain；theysallyforthnomoreintothestorms；theyridenolongeroverthelonelyroadsthatknewthemsowell；theirwheelsarerustingontheiraxlesorrollingwithotherburdens；theirwatchfuleyesareclosedtoallthesorrowstheylivedtosoothe。Notoneofthesewasfamousinthegreatworld；somewerealmostunknownbeyondtheirownimmediatecircle。Buttheyhaveleftbehindthemthatlovingremembrancewhichisbetterthanfame，andiftheirepitaphsarechiselledbrieflyinstone，theyarewrittenatfulllengthonlivingtabletsinathousandhomestowhichtheycarriedtheirever-welcomeaidandsympathy。