PUERPERAL FEVER 237 



I am not sure that this paper will escape another remark 

 which it might be wished were founded in justice. It may 

 be said that the facts are too generally known and acknowl- 

 edged to require any formal argument or exposition, that 

 there is nothing new in the positions advanced, and no need 

 of laying additional statements before the profession. But on 

 turning to two works, one almost universally, and the other 

 extensively, appealed to as authority in this country, I see 

 ample reason to overlook this objection. In the last edition 

 of Dewees's Treatise on the "Diseases of Females" it is 

 expressly said, " In this country, under no circumstance that 

 puerperal fever has appeared hitherto, does it afford the 

 slightest ground for the belief that it is contagious." In the 

 " Philadelphia Practice of Midwifery " not one word can 

 be found in the chapter devoted to this disease which would 

 lead the reader to suspect that the idea of contagion had 

 ever been entertained. It seems proper, therefore, to remind 

 those who are in the habit of referring to the works for 

 guidance that there may possibly be some sources of danger 

 they have slighted or omitted, quite as important as a trifl- 

 ing irregularity of diet, or a confined state of the bowels, 

 and that whatever confidence a physician may have in his 

 own mode of treatment, his services are of questionable 

 value whenever he carries the bane as well as the antidote 

 about his person. 



The practical point to be illustrated is the following : The 

 disease known as puerperal fever is so far contagious as to 

 be frequently carried from patient to patient by physicians 

 and nurses. 



Let me begin by throwing out certain incidental questions, 

 which, without being absolutely essential, would render the 

 subject more complicated, and by making such concessions 

 and assumptions as may be fairly supposed to be without the 

 pale of discussion. 



i. It is granted that all the forms of what is called puer- 

 peral fever may not be, and probably are not, equally contag- 

 ious or infectious. I do not enter into the distinctions which 

 have been drawn by authors, because the facts do not appear 

 to me sufficient to establish any absolute line of demarcation 

 between such forms as may be propagated by contagion and 



