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2。 If a physician is present at such autopsies； he should use thorough ablution； change every article of dress； and allow twenty… four hours or more to elapse before attending to any case of midwifery。 It may be well to extend the same caution to cases of simple peritonitis。
3。 Similar precautions should be taken after the autopsy or surgical treatment of cases of erysipelas； if the physician is obliged to unite such offices with his obstetrical duties； which is in the highest degree inexpedient。
4。 On the occurrence of a single case of puerperal fever in his practice； the physician is bound to consider the next female he attends in labor； unless some weeks at least have elapsed； as in danger of being infected by him； and it is his duty to take every precaution to diminish her risk of disease and death。
5。 If within a short period two cases of puerperal fever happen close to each other； in the practice of the same 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 himself 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 Farr； Esq。 Several new series of cases are given in the Letter of Mr。 Stows； contained in the Appendix to this Report。 Mr。 Stows 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。 Se。 for April； 1844。Six cases in less than a fortnight； 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 contagion； 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。 Se。； January； 1846。 Also； Connection between Puerperal Fever and Epidemic Erysipelas。 Ibid。； April； 1846。
Robert Storrs。 Contagious Effects of Puerperal Fever on the Male Subject； or on Persons not Child…bearing。 （From Provincial Med。 and Surg。 Journal。） Am。 Jour。 Med。 Sc。； January； 184；6。 Numerous cases。 See also Dr。 Reid's case in same Journal for April； 1846。
Routh's paper in Proc。 of Royal Med。 Chir。 Soc。； Am。 Jour。 Med。 Sc。； April； 1849； also in B。 and F。 Med。 Chir。 Review； April； 1850。
Hill； of Leuchars。 A Series of Cases illustrating the Contagious Nature of Erysipelas and of Puerperal Fever； and their Intimate Pathological Connection。 （From Monthly Journal of Med。 Sc。） Am。 Jour。 Med。 Se。； July； 1850。
Skoda on the Causes of Puerperal Fever。 （Peritonitis in rabbits； from inoculation with different morbid secretions。） Am。 Jour。 Med。 Se。； October； 1850。
Arneth。 Paper read before the National Academy of Medicine。 Annales d'Hygiene； Tome LXV。 2e Partie。 （Means of Disinfection proposed by M。 〃Semmeliveis〃 （Semmelweiss。） Lotions of chloride of lime and use of nail…brush before admission to lying…in wards。 Alleged sudden and great decrease of mortality from puerperal fever。 Cause of disease attributed to inoculation with cadaveric matters。） See also Routh's paper； mentioned above。
Moir。 Remarks at a meeting of the Edinburgh Medico…Chirurgical Society。 Refers to cases of Dr。 Kellie； of Leith。 Sixteen in succession； all fatal。 Also to several instances of individual pupils having had a succession of cases in various quarters of the town； while others； practising as extensively in the same localities； had none。 Also to several special cases not mentioned elsewhere。 Am。 Jour。 Med。 Se。 for October； 1851。 （From New Monthly Journal of Med。 Science。）
Simpson。 Observations at a Meeting of the Edinburgh Obstetrical Society。 （An 〃eminent gentleman；〃 according to Dr。 Meigs； whose 〃name is as well known in America as in （his） native land。〃 Obstetrics。 Phil。 1852； pp。 368； 375。） The student is referred to this paper for a valuable resume of many of the facts； and the necessary inferences； relating to this subject。 Also for another series of cases； Mr。 Sidey's； five or six in rapid succession。 Dr。 Simpson attended the dissection of two of Dr。 Sidey's cases； and freely handled the diseased parts。 His next four child…bed patients were affected with puerperal fever； and it was the first time he had seen it in practice。 As Dr。 Simpson is a gentleman （Dr。 Meigs； as above）； and as 〃a gentleman's hands are clean 〃 （Dr。 Meigs' Sixth Letter）； it follows that a gentleman with clean hands may carry the disease。 Am。 Jour。 Med。 Sc。； October； 1851。
Peddle。 The five or six cases of Dr。 Sidey； followed by the four of Dr。 Simpson； did not end the series。 A practitioner in Leith having examined in Dr。 Simpson's house； a portion of the uterus obtained from one of the patients； had immediately afterwards three fatal cases of puerperal fever。 Dr。 Veddie referred to two distinct series of consecutive cases in his own practice。 He had since taken precautions； and not met with any such cases。 Am。 Jour。 Med。 Sc。； October； 1851。
Copland。 Considers it proved that puerperal fever maybe propagated by the hands and the clothes； or either； of a third person； the bed… clothes or body…clothes of a patient。 Mentions a new series of cases； one of which he saw； with the practitioner who had attended them。 She was the sixth he had had within a few days。 All died。 Dr。 Copland insisted that contagion had caused these cases； advised precautionary measures； and the practitioner had no other cases for a considerable time。 Considers it criminal； after the evidence adduced；which he could have quadrupled；and the weight of authority brought forward； for a practitioner to be the medium of transmitting contagion and death to his patients。 Dr。 Copland lays down rules similar to those suggested by myself； and is therefore entitled to the same epithet for so doing。 Medical Dictionary； New York； 1852。 Article； Puerperal States and Diseases。
If there is any appetite for facts so craving as to be yet unappeased；Lesotho； necdum satiata；more can be obtained。 Dr。 Hodge remarks that 〃the frequency and importance of this singular circumstance （that the disease is occasionally more prevalent with one practitioner than another） has been exceedingly overrated。〃 More than thirty strings of cases； more than two hundred and fifty sufferers from puerperal fever； more than one hundred and thirty deaths appear as the results of a sparing estimate of such among the facts I have gleaned as could be numerically valued。 These facts constitute； we may take it for granted； but a small fraction of those that have actually occurred。 The number of them might be greater； but 〃't is enough； 't will serve；〃 in Mercutio's modest phrase； so