256 O. W. HOLMES 



the virulent atmosphere of an impure lying-in hospital, or 

 poisoned in her chamber by the unsuspected breath of con- 

 tagion. From all causes together not more than four deaths 

 in a thousand births and miscarriages happened in England 

 and Wales during the period embraced by the first Report 

 of the Registrar-General. 16 In the second Report the mor- 

 tality was shown to be about five in one thousand. 17 In the 

 Dublin Lying-in Hospital, during the seven years of Dr. 

 Collins's mastership, there was one case of puerperal fever 

 to 178 deliveries, or less than six to the thousand, and one 

 death from this disease in 278 cases, or between three and 

 four to the thousand." Yet during this period the disease 

 was endemic in the hospital, and might have gone on to 

 rival the horrors of the pestilence of the Maternite, had 

 not the poison been destroyed by a thorough purification. 



In private practice, leaving out of view the cases that are 

 to be ascribed to the self-acting system of propagation, it 

 would seem that the disease must be far from common. Mr. 

 White, of Manchester, says: "Out of the whole number of 

 lying-in patients whom I have delivered (and I may safely 

 call it a great one), I have never lost one, nor to the best of 

 my recollection has one been greatly endangered, by the 

 puerperal, miliary, low nervous, putrid malignant, or milk 

 fever." 1 ' Dr. Joseph Clarke informed Dr. Collins that in 

 the course of forty-five years' most extensive practice he 

 lost but four patients from this disease. 20 One of the most 

 eminent practitioners of Glasgow who has been engaged in 

 very extensive practice for upwards of a quarter of a cen- 

 tury testifies that he never saw more than twelve cases of 

 real puerperal fever. 21 



I have myself been told by two gentlemen practicing in 

 this city, and having for many years a large midwifery busi- 

 ness, that they had neither of them lost a patient from this 

 disease, and by one of them that he had only seen it in 

 consultation with other physicians. In five hundred cases 

 of midwifery, of which Dr. Storer has given an abstract 

 in the first number of this journal, there was only one in- 

 stance of fatal puerperal peritonitis. 



18 First Report, p. 105. 17 Second Report, p. 73. 



18 Collins's Treatise on Midwifery, p. 228, etc. 19 Op. cit., p. 115. 



20 Op. cit., p. 228. ^Lancet, May 4, 1833. 





