Answer。“OfcourseIshouldrequireaverylargeextrapremium，ifIwouldtaketakeriskatall。“
　　ButIdonotchoosetoaddtheexpressionsofindignationwhichtheexaminationofthefactsbeforehimcalledout。Iwassatisfiedfromtheeffecttheyproducedonhim，thatifallthehideouscataloguesofcasesnowaccumulatedwerefullybroughttotheknowledgeofthepublic，nothing，sincethedaysofBurkeandHare，hasraisedsuchacryofhorroraswouldbeshriekedintheearsoftheProfession。
　　Dr。Meigshaselsewhereinvoked“Providence“asthealternativeofaccident，toaccountforthe“coincidences。““Obstetrics，“Phil。
　　1852，p。631。Ifso，Providenceeitheractsthroughtheagencyofsecondarycauses，asinotherdiseases，ornot。Ifthroughsuchcauses，letusfindoutwhattheyare，aswetrytodoinothercases。Itmaybetruethatoffences，ordiseases，willcome，but“woeuntohimthroughwhomtheycome，“ifwecatchhiminthevoluntaryorcarelessactofbringingthem！ButifProvidencedoesnotactthroughsecondarycausesinthisparticularsphereofetiology，thenwhydoesDr。Meigstakesuchpainstoreasonsoextensivelyaboutthelawsofcontagion，which，onthatsupposition，havenomoretodowiththiscasethanwiththeplaguewhichdestroyedthepeopleafterDavidhadnumberedthem？Aboveall，whatbecomesofthetheologicalaspectofthequestion，whenheassertsthatapractitionerwas“onlyunluckyinmeetingwiththeepidemiccases？“Op。cit。p。633。WedonotdenythattheGodofbattlesdecidesthefateofnations；butweliketohavethebiggestsquadronsonourside，andweareparticularthatoursoldiersshouldnotonlysaytheirprayers，butalsokeeptheirpowderdry。WedonotdenytheagencyofProvidenceinthedisasteratNorwalk，butweturnofftheengineer，andchargetheCompanyfivethousanddollarsapieceforeverylifethatissacrificed。
　　Whyagrandjuryshouldnotbringinabillagainstaphysicianwhoswitchesoffascoreofwomenoneaftertheotheralonghisprivatetrack，whenheknowsthatthereisablackgulfattheendofit，downwhichtheyaretoplunge，whilethegreathighwayisclear，ismorethanIcananswer。ItisnotbylayingtheopendrawtoProvidencethatheistoescapethechargeofmanslaughter。
　　Tofinishwithalltheselessermattersofquestion，Iamunabletoseewhyafemalemustnecessarilybeunattendedinherconfinement，becauseshedeclinestheservicesofaparticularpractitioner。Inalltheseriesofcasesmentioned，thedeath-carryingattendantwassurroundedbyothersnottrackedbydiseaseanditsconsequences。
　　Which，Iwouldask，isworse，——tocallinanother，evenarivalpractitioner，ortosubmitanunsuspectingfemaletoariskwhichanInsuranceCompanywouldhavenothingtodowith？
　　Idonotexpectevertoreturntothissubject。Thereisapointofmentalsaturation，beyondwhichargumentcannotbeforcedwithoutbreedingimpatient，ifnotharsh，feelingstowardsthosewhorefusetobeconvinced。IfIhavesofarmanifestedneither，itiswelltostophere，andleavetheresttothoseyoungerfriendswhomayhavemorestomachforthedregsofastaleargument。
　　TheextentofmyprefatoryremarksmayleadsometothinkthatI
　　attachtoomuchimportancetomyownEssay。OthersmaywonderthatI
　　shouldexpendsomanywordsuponthetwoproductionsreferredto，theLetterandtheLecture。IdoconsidermyEssayofmuchimportancesolongasthedoctrineitmaintainsistreatedasaquestion，andsolongasanyimportantpartofthedefenceofthatdoctrineisthoughttorestonitsevidenceorarguments。Icannottreatasinsignificantanyopinionsbearingonlife，andinterestsdearerthanlife，proclaimedyearlytohundredsofyoungmen，whowillcarrythemtotheirlegitimateresultsinpractice。
　　TheteachingsofthetwoProfessorsinthegreatschoolsofPhiladelphiaaresuretobelistenedto，notonlybytheirimmediatepupils，butbytheProfessionatlarge。Iamtoomuchinearnestforeitherhumilityorvanity，butIdoentreatthosewhoholdthekeysoflifeanddeathtolistentomealsoforthisonce。Iasknopersonalfavor；butIbegtobeheardinbehalfofthewomenwhoselivesareatstake，untilsomestrongervoiceshallpleadforthem。
　　ItrustthatIhavemadetheissueperfectlydistinctandintelligible。Andletitberememberedthatthisisnosubjecttobesmoothedoverbynicelyadjustedphrasesofhalf-assentandhalf-
　　censuredividedbetweentheparties。Thebalancemustbestruckboldlyandtheresultdeclaredplainly。IfIhavebeenhasty，presumptuous，ill-informed，illogical；ifmyarrayoffactsmeansnothing；ifthereisnoreasonforanycautionintheviewofthesefacts；letmebetoldsoonsuchauthoritythatImustbelieveit，andIwillbesilenthenceforth，recognizingthatmymindisinastateofdisorganization。IfthedoctrineIhavemaintainedisamournfultruth；iftodisbelieveit，andtopractiseonthisdisbelief，andtoteachotherssotodisbelieveandpractise，istocarrydesolation，andtocharterotherstocarryit，intoconfidingfamilies，letitbeproclaimedasplainlywhatistobethoughtoftheteachingsofthosewhosneerattheallegeddangers，andscouttheveryideaofprecaution。Letitberememberedthatpersonsarenothinginthismatter；betterthattwentypamphleteersshouldbesilenced，orasmanyprofessorsunseated，thanthatonemother’slifeshouldbetaken。Thereisnoquarrelherebetweenmen，butthereisdeadlyincompatibilityandexterminatingwarfarebetweendoctrines。
　　Coincidences，meaningnothing，thoughamanhaveamonopolyofthediseaseforweeksormonths；orcauseandeffect，thecausebeinginsomewayconnectedwiththeperson；thisisthequestion。IfIamwrong，letmebeputdownbysucharebukeasnorashdeclaimerhasreceivedsincetherehasbeenapublicopinioninthemedicalprofessionofAmerica；ifIamright，letdoctrineswhichleadtoprofessionalhomicidebenolongertaughtfromthechairsofthosetwogreatInstitutions。Indifferencewillnotdohere；ourJournalistsandCommitteeshavenorighttotakeuptheirpageswithminuteanatomyandtediouslydetailedcases，whileitisaquestionwhetherornotthe“blackdeath“ofchild-bedistobescatteredbroadcastbytheagencyofthemother’sfriendandadviser。Letthemenwhomouldopinionslooktoit；ifthereisanyvoluntaryblindness，anyinterestedoversight，anyculpablenegligence，even，insuchamatter，andthefactsshallreachthepublicear；thepestilence-carrierofthelying-inchambermustlooktoGodforpardon，formanwillneverforgivehim。
　　THECONTAGIOUSNESSOFPUERPERALFEVER。
　　Incollecting，enforcing，andaddingtotheevidenceaccumulateduponthismostserioussubject，Iwouldnotbeunderstoodtoimplythatthereexistsadoubtinthemindofanywell-informedmemberofthemedicalprofessionastothefactthatpuerperalfeverissometimescommunicatedfromonepersontoanother，bothdirectlyandindirectly。InthepresentstateofourknowledgeuponthispointI
　　shouldconsidersuchdoubtsmerelyasaproofthatthesceptichadeithernotexaminedtheevidence，or，havingexaminedit，refusedtoacceptitsplainandunavoidableconsequences。Ishouldbesorrytothink，withDr。Rigby，thatitwasacaseof“obliquevision；“I
　　shouldbeunwillingtoforcehometheargumentumadhominemofDr。
　　Blundell，butIwouldnotconsenttomakeaquestionofamomentousfactwhichisnolongertobeconsideredasasubjectfortrivialdiscussions，buttobeacteduponwithsilentpromptitude。Itsignifiesnothingthatwiseandexperiencedpractitionershavesometimesdoubtedtherealityofthedangerinquestion；nomanhastherighttodoubtitanylonger。Nonegativefacts，noopposingopinions，betheywhattheymay，orwhosetheymay，canformanyanswertotheseriesofcasesnowwithinthereachofallwhochoosetoexploretherecordsofmedicalscience。
　　Iftherearesomewhoconceivethatanyimportantendwouldbeansweredbyrecordingsuchopinions，orbycollectingthehistoryofallthecasestheycouldfindinwhichnoevidenceoftheinfluenceofcontagionexisted，Ibelievetheyareinerror。Supposeafewwritersofauthoritycanbefoundtoprofessadisbeliefincontagion，——andtheyareveryfewcomparedwiththosewhothinkdifferently，——isitquiteclearthattheyformedtheiropinionsonaviewofallthefacts，orisitnotapparentthattheyreliedmostlyontheirownsolitaryexperience？Stillfurther，ofthosewhosenamesarequoted，isitnottruethatscarcelyasingleonecouldbyanypossibilityhaveknownthehalforthetenthofthefactsbearingonthesubjectwhichhavereachedsuchafrightfulamountwithinthelastfewyears？Again，astotheutilityofnegativefacts，aswemaybrieflycallthem，——instances，namely，inwhichexposurehasnotbeenfollowedbydisease，——although，likeothertruths，theymaybeworthknowing，Idonotseethattheyareliketoshedanyimportantlightuponthesubjectbeforeus。Everysuchinstancerequiresagooddealofcircumstantialexplanationbeforeitcanbeaccepted。
　　Itisnotenoughthatapractitionershouldhavehadasinglecaseofpuerperalfevernotfollowedbyothers。Itmustbeknownwhetherheattendedotherswhilethiscasewasinprogress，whetherhewentdirectlyfromonechambertoothers，whetherhetookany，andwhatprecautions。Itisimportanttoknowthatseveralwomenwereexposedtoinfectionderivedfromthepatient，sothatallowancemaybemadeforwantofpredisposition。Nowifofnegativefactssosiftedtherecouldbeaccumulatedahundredforeveryoneplaininstanceofcommunicationhererecorded，Itrustitneednotbesaidthatweareboundtoguardandwatchoverthehundredthtenantofourfold，thoughtheninetyandninemaybesureofescapingthewolfatitsentrance。Ifanyoneisdisposed，then，totakeahundredinstancesoflivesendangeredorsacrificedoutofthoseIhavementioned，andmakeitreasonablyclearthatwithinasimilartimeandcompasstenthousandescapedthesameexposure，Ishallthankhimforhisindustry，butImustbepermittedtoholdtomyownpracticalconclusions，andbeghimtoadoptoratleasttoexaminethemalso。
　　Childrenthatwalkincalicobeforeopenfiresarenotalwaysburnedtodeath；theinstancestothecontrarymaybeworthrecording；butbynomeansiftheyaretobeusedasargumentsagainstwoollenfrocksandhighfenders。
　　Iamnotsurethatthispaperwillescapeanotherremarkwhichitmightbewishedwerefoundedinjustice。Itmaybesaidthatthefactsaretoogenerallyknownandacknowledgedtorequireanyformalargumentorexposition，thatthereisnothingnewinthepositionsadvanced，andnoneedoflayingadditionalstatementsbeforetheProfession。Butonturningtotwoworks，onealmostuniversally，andtheotherextensivelyappealedtoasauthorityinthiscountry，Iseeamplereasontooverlookthisobjection。InthelasteditionofDewees’sTreatiseonthe“DiseasesofFemales，“itisexpresslysaid，“Inthiscountry，undernocircumstancethatpuerperalfeverhasappearedhitherto，doesitaffordtheslightestgroundforthebeliefthatitiscontagious。“Inthe“PhiladelphiaPracticeofMidwifery“
　　notonewordcanbefoundinthechapterdevotedtothisdiseasewhichwouldleadthereadertosuspectthattheideaofcontagionhadeverbeenentertained。Itseemsproper，therefore，toremindthosewhoareinthehabitofreferringtotheseworksforguidance，thattheremaypossiblybesomesourcesofdangertheyhaveslightedoromitted，quiteasimportantasatriflingirregularityofdiet，oraconfinedstateofthebowels，andthatwhateverconfidenceaphysicianmayhaveinhisownmodeoftreatment，hisservicesareofquestionablevaluewheneverhecarriesthebaneaswellastheantidoteabouthisperson。
　　Thepracticalpointtobeillustratedisthefollowing：
　　ThediseaseknownasPuerperalFeverissofarcontagiousastobefrequentlycarriedfrompatienttopatientbyphysiciansandnurses。
　　Letmebeginbythrowingoutcertainincidentalquestions，which，withoutbeingabsolutelyessential，wouldrenderthesubjectmorecomplicated，andbymakingsuchconcessionsandassumptionsasmaybefairlysupposedtobewithoutthepaleofdiscussion。
　　1。Itisgrantedthatalltheformsofwhatiscalledpuerperalfevermaynotbe，andprobablyarenot，equallycontagiousorinfectious。Idonotenterintothedistinctionswhichhavebeendrawnbyauthors，becausethefactsdonotappeartomesufficienttoestablishanyabsolutelineofdemarcationbetweensuchformsasmaybepropagatedbycontagionandthosewhichareneversopropagated。
　　ThisgeneralresultIshallonlysupportbytheauthorityofDr。
　　Ramsbotham，whogives，astheresultofhisexperience，thatthesamesymptomsbelongtowhathecallstheinfectiousandthesporadicformsofthedisease，andtheopinionofArmstronginhisoriginalEssay。Ifotherscanshowanysuchdistinction，Ileaveittothemtodoit。Buttherearecasesenoughthatshowtheprevalenceofthediseaseamongthepatientsofasinglepractitionerwhenitwasinnodegreeepidemic，inthepropersenseoftheterm。ImayrefertothoseofMr。RobertonandofDr。Peirson，hereaftertobecited，asexamples。
　　2。Ishallnotenterintoanydisputeabouttheparticularmodeofinfection，whetheritbebytheatmospherethephysiciancarriesabouthimintothesick-chamber，orbythedirectapplicationofthevirustotheabsorbingsurfaceswithwhichhishandcomesincontact。
　　Manyfactsandopinionsareinfavorofeachofthesemodesoftransmission。Butitisobviousthatinthemajorityofcasesitmustbeimpossibletodecidebywhichofthesechannelsthediseaseisconveyed，fromthenatureoftheintercoursebetweenthephysicianandthepatient。