The severity of the disease depends not only on the virulence and dose of the infecting agent but also on the power of re sistance of the patient. Ill-health, especially kidney disease, diabetes, loss of blood and exhaustion, lower resistance generally. The local resistance of the tissues of the generative tract is lowered by bruising and injury.
Treatment is first of all preventive; the most urgent measures are to adopt the same antiseptic and aseptic precautions in labour as for a major surgical operation; and further by antenatal care to maintain the vitality at its best, avoiding all foreseeable compli cations in labour, and generally to secure natural delivery without interference. Complete emptying of and free drainage from, the womb are likewise essential, and these also must be carried out under the strictest antiseptic and aseptic conditions.
Curative treatment of puerperal sepsis depends on good nursing and attention to every detail of the patient's comfort. Fresh air and sunshine increase the powers of resistance, and artificial meth ods of increasing tissue-resistance by antitoxic sera and vaccines are also adopted. Antiseptic injections intravenously are tried but
are not very successful. Local treatment of the infected uterus has the danger of spreading the infection and is now restricted to such simple measures as the injection of glycerine to promote a free flow of lymph. Pelvic abscesses and other complications must be looked for and treated surgically. Recognition of the fact that puerperal fever must be a preventable condition in the large majority of cases has led to the formation of a strong de partmental committee of the British Ministry of Health to enquire into the conditions of its occurrence and devise means for its better prevention and treatment. There is reason to believe that the condition is more common in certain districts (e.g., the low lying Thames valley) than in others but the establishment of this as a fact together with its explanation, if true, await eluci dation. (J. S. FA.)