The foregoing catalogue might with ease be greatly amplified, were time and space allowed me here; but, even as it is, it may serve to show the Student that the cause, for there is a cause, may be in activity in many different and distant quarters, and in many consecutive years. At least, the inspection of the table ought to convince him that childbed fever is no rarely occurring disorder, therefore, is well worthy of his earnest contemplation.

The most singular known property of the cause of childbed fever is that it operates upon woman pregnant or lying-in, and upon them only; and that, while its reign causes terror and desolation among that class of persons, it never in the least degree influences the health or threatens the security of the virgin, the child, the youth, the man, or the married but non-pregnant woman. One may well feel amazed at such a proposition, seeing that pregnant and lying-in women, as to their generical nature, susceptibility, and forces, are like all other

women, and in a general sense participate in man's nature. How interesting then the inquiry as to what it is within the animal economy of the gravid woman, that can be acted upon by the epidemic-cause to pervert and develop the phenomena of the childbed fever only in that class of persons. And here, it seems to me, he may begin to perceive some ground to stand upon. What is it, then, within the animal economy of the pregnant or lying-in woman, that can be acted upon deleteriously by the poisoning force of the epidemic-cause, whereas all other members of the human race are not obnoxious to the power of that cause?

For my own part, I confess that when I contemplate the living being man, I am compelled to attribute to his nervous element, or nervous substance or mass, all his impressionable quality, as well as all his perceptive and motor force-not motion; for I can not but consider that he lives by his nervous mass, and through it alone; and that whatever, within him, participates in the condition of vitality, does so because, and solely because it participates in the nervous substance, nervous element or mass; and that nothing within him lives, save because of its nervous element. If the blood-disk lives, if the maculæ germinativæ are alive, if an ovarian ovule lives, if the nucleus of a cell is endowed with plastic and alterative forces, it is, in all these cases, because the disk, the maculæ or the nucleus are endowed with nervous mass, in the condition of what Oken calls pointsubstance. And now, having made this averment, it seems unnecessary to say that I consider the derm, muscle, mucous and serous tissue, the vascular, absorbent, and indeed all the tissues, whether of a general or a special anatomy, to be endowed with life-force, only in virtue of the nervous mass within them, without whose presence and combination in them no vital power or organization could possibly exist in them.

This is the ground upon which, I say, the Student can stand, and on which he shall be sure at last to find a firm and solid footing.

Seeing that neither meteorology, nor eudiometry, nor any power in chemistry, can ever furnish him with a rationale of epidemiccausation, let him, for the sake of argument, admit that the atmosphere may be rendered unwholesome or inquinate by telluric poisons mixed with its lower strata; then it is easy to conceive that these poisons, like opium and the narcotics; like arsenic and mercury; like diffusible stimulants, as ether, chloroform, and other such, may imperceptibly modify the crasis and healthy force of the nervous mass, to that degree as to extend the ravages of the Black death, of English sweat, Syrian plague, or Asiatic cholera, or Influenza, among thou

sands or millions of our race; or prevail, as epizootic causes, over flocks and herds, and the beasts of the field, or fishes in rivers and in the ocean. It is easy also for the mind to discover that such an epidemiccause, though it bring within its range men and boys, unmarried women and children, as well as pregnant and lying-in women, shall not be able to effect such considerable morbid changes in the nervous mass as to make any of these classes become victims to it, save pregnant and lying-in women alone; and these, only because their peculiar condition serves, as exciting cause, to bring out into full manifestation the power of the true proximate or epidemic-cause. Epidemic-causes or poisons, such as this, must necessarily be esteemed to be very weak as to their influence on human health; else, we should certainly observe changes in the health of other persons besides the pregnant and lying-in. Still, even such feeble poisons may be able to impress on the body a tendency to become diseased-and such tendencies once established, it is necessary to look no farther than to pregnancy and labor for the exciting and operative causes of the malady. A curious remark is to be found in Dr. Collins, p. 386, which shows that the modifications of the air that precede the eruption of epidemic childbed fever in hospitals are gradual. "Dr. Joseph Clarke states it was generally observed that, previous to puerperal fever becoming epidemic in the hospital, the patients recovered more slowly; or, to use the language of the nurses, it was much more difficult to get them out of bed than usual. This, from experience, I have no doubt is the case; and, when observed, should arouse the medical attendant to adopt, without delay, every means he considers in the least calculated to prevent its occurrence."

I am quite sure that all those practitioners who have lived during the prevalence of the epidemic, even without meeting with the cases in their own practice, must have made the same observation as to the slowness and difficulty of recovery in the majority of lying-in women during the reign of an epidemic childbed fever; and hence we may rightly infer that the cause has acted on these very persons that Dr. Clarke describes, and the like of which have been seen by almost all obstetricians, but so feebly, as only to render them unfit to "get out of bed” as soon after the confinement as is to be usually expected. For my part, I cannot doubt that, during the reign of epidemic cholera in Philadelphia, when we lost some seven hundred citizens out of 420,000 souls, there were more than 100,000 persons suffering more or less from the operation of the cause; whereas, in fact, not many thousands of them felt or perceived anything positively amiss in regard to their health. Those only in whom some occasional cause

came to start the train of morbid symptoms, could give evidence of the power of the proximate causation.

In like manner, I conceive that, in a fatal epidemic childbed fever in Hôtel Dieu or Dublin Hospital, the cause could not but embrace within its epidemic-sphere all the nurses and attendants in the house; but, wanting the occasional causes, none sicken save the pregnant and lying-in inmates of the houses, the districts, or states, comprised in the catalogue. I conceive that these remarks are just, and that they show how it may happen that an epidemical constitution of the air may incline many women in childbed to fall sick with peritonitis, or metritis, or phlebitis, although the cause is of such feeble power as to be wholly incapable of making any persons except these very women fall sick.

Many medical men, and along with them a major part of the unthinking, unreasoning public, looking in vain for rationales of the cause of childbed fever, endeavor to satisfy their hankering after knowledge on that point, by adopting the notion that the cause of epidemic childbed fever is a contagion.

The Student will naturally be desirous to learn, if childbed fever be really a contagious disease, what the principle of that contagion is; and I apprehend that here, as in the instance of the epidemic malady, he shall have to rest content with the sound of the word contagion, a word which, being interpreted, means communicable from person to person, or by individual to individual. This is the whole meaning of the word; for, as to how, and the what, no man hath yet obtained the least definite notion, since no man hath known or can know what a miasm or a contagion is. Miasm and contagion are words, nothing more; they represent no precise material idea of the mind.

The notion of a contagion of childbed fever, communicated from individual to individual, either immediately or mediately through a third person, has arisen upon the observation of what are asserted to be facts. It has often happened, for example, that a woman in a lyingin ward, dying with the disease, has been speedily followed to the grave by other women occupying the same apartment; and it has at once been assumed that the second and third victims had taken the contagion from the first victim, and that, without inquiring how it happened that the first patient acquired the disorder, or whether it was probable that the others might take it in the same way. Again, a physician is observed to meet with many cases in his own practice, while his brethren in the same town or district meet with none such at all: or, a monthly nurse, going from one sick woman to another woman who speedily falls sick with a like disorder, gives rise to an

impression that she or that the physician should be looked to as the conveyers of the poison or contagion. Such occurrences are not rare in the history of medical men and nurses; so that a physician or a nurse, in this predicament, has been called a walking pestilence.

There is a striking example of this tendency, of what I cannot but consider weak minded people to jump at conclusions without looking to see where they leap, in the celebrated case of the Manchester Epidemic, the history of which is given by Dr. Roberton. In regard to that epidemic, I do suppose, that at least half of the people who have heard of it, believe that the outbreak of the childbed fever there consisted in the thirty cases that happened to fall out in the practice of that unfortunate midwife that Dr. Roberton tells us of-and if it were true, that these were the only cases, one might be tempted to suspect that a contagious fever had something to do with the matter. Almost all the contagionists who seize on this epidemic as the positive proof of their correctness, have ignored the more important facts, that the disease prevailed in all classes, without exception of rank or station, and that hundreds died with it, and that even Dr. Roberton himself declares, that in many of them there could be no ground to suppose that a contagion had anything to do with the victims.

Deeply impressed as I am with the importance of this question, and quite aware that argument and proof are often alike incompetent to change the stubborn fixed opinions of men, I cannot, however, refrain from setting forth the reasons that compel me to dissent from the doctrine of contagion in childbed fever. I shall, therefore, speak my real opinions, notwithstanding I know they will be combated, and in many instances promptly rejected, and even with disdain. I feel the question to be a most important one, inasmuch as, if we are to accept the notion of a contagious origin, we ought also to meet the conse quences of that dogma. Certainly, that man must be an unfeeling and wicked wretch, who, believing in the contagion of childbed fever, should yet continue to exercise his ministry at the risk of carrying death and desolation into whatever family he should be called on to act the part of the obstetrician. For, if one case is communicable, another must also be communicable; and such a believer is bound in honor and honesty to desist from, or suspend his ministry elsewhere, as soon as he happens to be called to any case. Let him not change his dress, and purify his person, and then go like a poisoner, carrying with him wherever he goes, a peripatetic doom. Nobody has told him it is his dress that poisons-the malady is contagious from person to person, and not from dress to dress. Let him stop then at once, nor visit another patient until a long and perfect quarantine shall have