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ne of demarcation between such forms as may be propagated by contagion and those which are never so propagated。 This general result I shall only support by the authority of Dr。 Ramsbotham； who gives； as the result of his experience； that the same symptoms belong to what he calls the infectious and the sporadic forms of the disease； and the opinion of Armstrong in his original Essay。 If others can show any such distinction； I leave it to them to do it。 But there are cases enough that show the prevalence of the disease among the patients of a single practitioner when it was in no degree epidemic； in the proper sense of the term。 I may refer to those of Mr。 Roberton and of Dr。 Peirson； hereafter to be cited； as examples。
2。 I shall not enter into any dispute about the particular mode of infection； whether it be by the atmosphere the physician carries about him into the sick…chamber； or by the direct application of the virus to the absorbing surfaces with which his hand comes in contact。 Many facts and opinions are in favor of each of these modes of transmission。 But it is obvious that in the majority of cases it must be impossible to decide by which of these channels the disease is conveyed； from the nature of the intercourse between the physician and the patient。
3。 It is not pretended that the contagion of puerperal fever must always be followed by the disease。 It is true of all contagious diseases； that they frequently spare those who appear to be fully submitted to their influence。 Even the vaccine virus； fresh from the subject； fails every day to produce its legitimate effect； though every precaution is taken to insure its action。 This is still more remarkably the case with scarlet fever and some other diseases。
4。 It is granted that the disease may be produced and variously modified by many causes besides contagion； and more especially by epidemic and endemic influences。 But this is not peculiar to the disease in question。 There is no doubt that small…pox is propagated to a great extent by contagion； yet it goes through the same periods of periodical increase and diminution which have been remarked in puerperal fever。 If the question is asked how we are to reconcile the great variations in the mortality of puerperal fever in different seasons and places with the supposition of contagion； I will answer it by another question from Mr。 Farr's letter to the Registrar… General。 He makes the statement that 〃five die weekly of small…pox in the metropolis when the disease is not epidemic；〃and adds； 〃The problem for solution is； Why do the five deaths become 10； 15； 20； 31； 58； 88； weekly； and then progressively fall through the same measured steps？〃
5。 I take it for granted； that if it can be shown that great numbers of lives have been and are sacrificed to ignorance or blindness on this point； no other error of which physicians or nurses may be occasionally suspected will be alleged in palliation of this； but that whenever and wherever they can be shown to carry disease and death instead of health and safety； the common instincts of humanity will silence every attempt to explain away their responsibility。
The treatise of Dr。 Gordon of Aberdeen was published in the year 1795； being among the earlier special works upon the disease。 Apart of his testimony has been occasionally copied into other works； but his expressions are so clear； his experience is given with such manly distinctness and disinterested honesty； that it may be quoted as a model which might have been often followed with advantage。
〃This disease seized such women only as were visited； or delivered by a practitioner； or taken care of by a nurse； who had previously attended patients affected with the disease。〃
〃I had evident proofs of its infectious nature； and that the infection was as readily communicated as that of the small…pox or measles； and operated more speedily than any other infection with which I am acquainted。〃
〃I had evident proofs that every person who had been with a patient in the puerperal fever became charged with an atmosphere of infection； which was communicated to every pregnant woman who happened to come within its sphere。 This is not an assertion； but a fact； admitting of demonstration； as may be seen by a perusal of the foregoing table；〃referring to a table of seventy…seven cases； in many of which the channel of propagation was evident。
He adds； 〃It is a disagreeable declaration for me to mention； that I myself was the means of carrying the infection to a great number of women。〃 He then enumerates a number of instances in which the disease was conveyed by midwives and others to the neighboring villages； and declares that 〃these facts fully prove that the cause of the puerperal fever； of which I treat； was a specific contagion； or infection； altogether unconnected with a noxious constitution of the atmosphere。〃
But his most terrible evidence is given in these words： 〃I ARRIVED AT THAT CERTAINTY IN THE MATTER； THAT I COULD VENTURE TO FORETELL WHAT WOMEN WOULD BE AFFECTED WITH THE DISEASE； UPON HEARING BY WHAT MIDWIFE THEY WERE TO BE DELIVERED； OR BY WHAT NURSE THEY WERE TO BE ATTENDED； DURING THEIR LYING…IN： AND ALMOST IN EVERY INSTANCE； MY PREDICTION WAS VERIFIED。〃
Even previously to Gordon； Mr。 White of Manchester had said； 〃I am acquainted with two gentlemen in another town； where the whole business of midwifery is divided betwixt them； and it is very remarkable that one of them loses several patients every year of the puerperal fever； and the other never so much as meets with the disorder；〃a difference which he seems to attribute to their various modes of treatment。 ＇On the Management of Lying…in Women； p。 120。＇
Dr。 Armstrong has given a number of instances in his Essay on Puerperal Fever； of the prevalence of the disease among the patients of a single practitioner。 At Sunderland； 〃in all； forty…three cases occurred from the 1st of January to the 1st of October； when the disease ceased； and of this number forty were witnessed by Mr。 Gregson and his assistant； Mr。 Gregory； the remainder having been separately seen by three accoucheurs。〃 There is appended to the London edition of this Essay； a letter from Mr。 Gregson； in which that gentleman says； in reference to the great number of cases occurring in his practice； 〃The cause of this I cannot pretend fully to explain； but I should be wanting in common liberality if I were to make any hesitation in asserting； that the disease which appeared in my practice was highly contagious； and communicable from one puerperal woman to another。〃 〃It is customary among the lower and middle ranks of people to make frequent personal visits to puerperal women resident in the same neighborhood； and I have ample evidence for affirming that the infection of the disease was often carried about in that manner； and； however painful to my feelings； I must in candor declare； that it is very probable the contagion was conveyed； in some instances； by myself； though I took every possible care to prevent such a thing from happening； the moment that I ascertained that the distemper was infectious。〃 Dr。 Armstrong goes on to mention six other instances within his knowledge；