2. The organisms that may cause Puerperal Infection are many, but the most important one, both in point of frequency and as regards the severity of the infection produced, is the streptococcus pyogenes. Next in importance is the Bacillus Soli Cormaunis, while among the other organism that may occur are, staphylococcts pyogenes aureus and albus, gonococcus, pneumococcus, kdbbs- loeffler bacillus and possibly certain anaerobic organisms.
The streptococcus is the organism most frequently concerned in cases of true septicaemia, that is it the one most often found in the blood.
3. Infection arises in., and spreads from, a raw surface somewhere in the genital tract, resulting from partprition. The organisms are usually derived from without and are conveyed to the genital tract, at the time of delivery by the midwife or doctor in attendance, or at a later date by vaginal douching, dirty clothing etc. In some instances however it is possible that the organisms are present in the genital tract before delivery, and that they give rise to infection when a suitable soil is prepared for them.
4. The symptoms vary according to the type and severity of the case. A rigor, rise of temperature and quickening of the pulse almost invariably accompany the onset of the disease. In the slighter forms of infection the lochial discharges become abundant and very foul and considerable masses of retained placenta are present in the uterus. In the severer forms the lochia are scanty and have not as a rule a foul smell, endometritis is usually well marked but no decidual products are retained within the uterus. Prostration is profound and the generali condition very bad. Not infrequently there is true septicaemia, organisms being actually present in the blood.
5. Of the complications, endometritis is the commonest, pelvic cellulitis and a certain degree of pelvic peritonitis are often found, while in the fatal cases death is almost always due to general peritonitis. Pyosalpinx and ovarian abscess may be found in a certain number of cases. Pyaemia is a very serious complication, while phlegmasia alba dolens and abscess of the uterine wall are amongst the rarer complications.
6. Puerperal Infection is to a very large extent a prevent Vale condition. Prophylactic measures are therefore of great importance. Care as to the general condition of the parturient woman is important, but particular attention should be paid by the accoucheur to asepsis in conducting the labour. When infection has occurred prompt and active interference by means of the curette followed by antiseptic swabbing is advisable. Anttstreptococcus serum given in large doses is often very beneficial and is to be recommended in all cases where there is not definite evidence that another organism is the cause of the infection. Anti Bacillus Coli serum may do good in cases caused by that organism. In the after treatment the most important factor is the diet, good nourishing food should be given in large amounts.
Hysterectomy should not be regarded with favour, bit all complications should be dealt with promptly and by operation if necessary.