250 O. W. HOLMES 





fever. No post-mortem examinations were held in any of 

 these puerperal cases." 



Some additional statements in this letter are deserving, 

 of insertion: 



" A physician attended a woman in the immediate neigh- 

 borhood of the cases numbered 2, 3, and 4. This patient 

 was confined the morning of March ist, and died on the 

 night of March 7th. It is doubtful whether this should 

 be considered a case of puerperal fever. She had suffered 

 from canker, indigestion, and diarrhoea for a year previous 

 to her delivery. Her complaints were much aggravated 

 for two or three months previous to delivery; she had 

 become greatly emaciated, and weakened to such an 

 extent that it had not been expected that she would long 

 survive her confinement, if indeed she reached that period. 

 Her labor was easy enough ; she flowed a good deal, 

 seemed exceedingly prostrated, had ringing in her ears, 

 and other symptoms of exhaustion; the pulse was quick 

 and small. On the second and third day there was some 

 tenderness and tumefaction of the abdomen, which increased 

 somewhat on the fourth and fifth. He had cases in mid- 

 wifery before and after this, which presented nothing 

 peculiar. 



It is also mentioned in the same letter that another 

 physician had a case during the last summer and another 

 last fall, both of which recovered. 



Another gentleman reports a case last December, a second 

 case five weeks, and another three weeks, since. All these 

 recovered. A case also occurred very recently in the prac- 

 tice of a physician in the village where the eighth patient 

 of Dr. C. resides, which proved fatal. " This patient had 

 some patches of erysipelas on the legs and arms. The same 

 physician has delivered three cases since, which have all done 

 well. There have been no other cases in this town or its 

 vicinity recently. There have been some few cases of ery- 

 sipelas." It deserves notice that the partner of Dr. C, who 

 attended the autopsy of the man above mentioned and took an 

 active part in it, who also suffered very slightly from a 

 prick under the thumb-nail received during the examin- 

 ation, had twelve cases of midwifery between March 26th 





