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O. W. HOLMES 



physician, the disease not existing or prevailing in the 

 neighborhood, he would do wisely to relinquish his obstetrical 

 practice for at least one month, and endeavor to free him- 

 self by every available means from any noxious influence he 

 may carry about with him. 



6. The occurrence of three or more closely connected cases, 

 in the practice of one individual, no others existing in the 

 neighborhood, and no other sufficient cause being alleged for 

 the coincidence, is prima facie evidence that he is the vehicle 

 of contagion. 



7. It is the duty of the physician to take every precaution 

 that the disease shall not be introduced by nurses or other 

 assistants, by making proper inquiries concerning them, and 

 giving timely warning of every suspected source of danger. 



8. Whatever indulgence may be granted to those who have 

 heretofore been the ignorant causes of so much misery, the 

 time has come when the existence of a private pestilence in 

 the sphere of a single physician should be looked upon, not 

 as a misfortune, but a crime; and in the knowledge of such 

 occurrences the duties of the practitioner to his profession 

 should give way to his paramount obligations to society. 



ADDITIONAL REFERENCES AND CASES. 



Fifth Annual Report of the Registrar-General of England, 1843. 

 Appendix. Letter from William Fair, Esq. Several new series of 

 cases are given in the letter of Mr. Storrs, contained in the appendix 

 to this report. Mr. Storrs suggests precautions similar to those I 

 have laid down, and these precautions are strongly enforced by Mr. 

 Farr, who is, therefore, obnoxious to the same criticisms as myself. 



Hall and Dexter, in Am. Journal of Med. Sc. for January, 1844. 

 Cases of puerperal fever seeming to originate in erysipelas. 



Elkington, of Birmingham, in Provincial Med. Journal, cited in 

 Am. Journ. Med. Sc. for April, 1844. Six cases in less than a fort- 

 night, seeming to originate in a case of erysipelas. 



West's Reports, in Brit, and For. Med. Review for October, 1845, 

 and January, 1847. Affection of the arm, resembling malignant 

 pustule, after removing the placenta of a patient who died from 

 puerperal fever. Reference to cases at Wurzburg, as proving con- 

 tagion, and to Keiller's cases in the Monthly Journal for February, 

 1846, as showing connection of puerperal fever and erysipelas. 



Kneeland. Contagiousness of Puerperal Fever. Am. Jour. Med. 

 Sc., January, 1846. Also, Connection between Puerperal Fever and 

 Epidemic Erysipelas. Ibid., April, 1846. 



