Many facts
and opinions are in favor of each of these modes of transmission. But it
is obvious that in the majority of cases it must be impossible to decide
by which of these channels the disease is conveyed, from the nature of
the intercourse between the physician and the patient.
3. It is not pretended that the contagion of puerperal fever must always
be followed by the disease. It is true of all contagious diseases, that
they frequently spare those who appear to be fully submitted to their
influence. Even the vaccine virus, fresh from the subject, fails every
day to produce its legitimate effect, though every precaution is taken to
insure its action. This is still more remarkably the case with scarlet
fever and some other diseases.
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 small-pox is propagated to a great extent by
contagion, yet it goes through the same periods 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.
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