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 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 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.  Sc., January, 1846.  Also, Connection between Puerperal Fever Epidemic Erysipelas.  Ibid., April, 1846.