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 smallpox is propagated to a great extent by contagion, yet it goes through the same records 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 smallpox 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.  A part 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 smallpox 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.”