252 O. W. HOLMES 



two to three miles apart, and nearly that distance from 

 my residence. There were no other cases in their im- 

 mediate vicinity which came to my knowledge. The gen- 

 eral health of all the women was pretty good, and all the 

 labors as good as common, except the first. This woman, 

 in consequence of my not arriving in season, and the 

 child being half-born at some time before I arrived, was 

 very much exposed to the cold at the time of confinement, 

 and afterwards, being confined in a very open, cold room. 

 Of the six cases, you perceive only one recovered. 



" In the winter of 1817 two of my patients had puerperal 

 fever, one very badly, the other not so badly. Both re- 

 covered. One other had swelled leg or phlegmasia dolens, 

 and one or two others did not recover as well as usual. 



" In the summer of 1835 another disastrous period oc- 

 curred in my practice. July ist I attended a lady in labor, 

 who was afterwards quite ill and feverish; but at the time 

 I did not consider her case a decided puerperal fever. On 

 the 8th I attended one who did well. On the I2th, one 

 who was seriously sick. This was also an equivocal case, 

 apparently arising from constipation and irritation of the 

 rectum. These women were ten miles apart and five from 

 my residence. On ic;th and 20th two who did well. On 

 25th I attended another. This was a severe labor, and 

 followed by unequivocal puerperal fever, or peritonitis. 

 She recovered. August 2d and 3d, in about twenty-four 

 hours, I attended four persons. Two of them did very well ; 

 one was attacked with some of the common symptoms, 

 which, however, subsided in a day or two, and the other 

 had decided puerperal fever, but recovered. This woman 

 resided five miles from me. Up to this time I wore 

 the same coat. All my other clothes had frequently been 

 changed. On 6th, I attended two women, one of whom 

 was not sick at all; but the other, Mrs. L., was afterwards 

 taken ill. On loth, I attended a lady, who did very well. 

 I had previously changed all my clothes, and had no gar- 

 ment on which had been in a puerperal room. On I2th, 

 I was called to Mrs. S., in labor. While she was ill, I left 

 her to visit Mrs. L., one of the ladies who was confined 

 on 6th. Mrs. L. had been more unwell than usual, but I 





