PUERPERAL FEVER is the most fatal disease to which women in childbed are liable. It has been described under various other names than that which is now assigned to it— as childbed fever, peritoneal fever, etc. A careful investigation of the records of more than two centuries shows that the disease prevails epidemically, and that it is more virulent in lying-in hospitals than in private practice. The essential nature of the disease is a subject that has the expression of many different opinions. The views it is (1) inflammation of the uterus, (2) inflammation of the omentum and intestines, (,)peritonitis, either alone or connected lcith erysipelas, (4) fever of the special nature, (5) disease of a putrid character, or (6) a disease of a complicated nature, have all been advocated by physicians of high reputntion; and prof. Scanzoni, one of the highest German authorities in the department of midwifery, maintains that the disease originates in an altered con dition of the blood, and consists mainly in the presence of pus in that fluid. This variety of views is doubtless, in a great measure. due to the varied characteristics of different epidemics. When a disease is epidemic, it is always difficult to ascertain whether it is contgious; but in the case of puerperal fever, there is an overwhelm ing amount of evidence, not only that the virus can be carried by the practitioner from one parturient woman to another, but from various other morbid sources; the peculiar condition of childbirth, and possibly certain atmospheric conditions, rendering the mother peculiarly susceptible of such contagion. Numerous series of fatal cases have been traced back to the medical man or nurse having immediately before been in attendance on a case of erysipelas, of sloughing sores, of gangrene, or of typhus fever. It is the opinion of Rokitansky and others that the morbid matter acquired by the dis section of subjects not dying from this disease, may excite the disease, in a patient shortly afterward delivered by the dissector; and there is no doubt that any one who assists at the post-mortem examination of a puerperal patient, becomes, as it were, a focus of intense contagion. Considering, the extreme severity and undoubted contagious this disease, the practitioners and nurses who come in contact with it should (wash their hands either with a weak solution of chlorine (which has been found of great service in destroying the contagion in the great lying-in hospital at Vienna), or in a solution of chloride of lime, as well as with soap and water. Moreover, persons much
engaged in midwifery would do well not to take any part in post-mortem examinations, especially when the death resulted from this disease; and when of necessity they are present, they should wear a special dress for the occasion, and precaution as to ablution.
Puerperal fever occurs in such•varied forms that numerous divisions or species of it have been suggested. The late Dr. Gooch, one of the highest authorities on this sub ject, divided puerperal fever into (1) the inflammatory and (2) the typhoid; while Dr. Robert Lee and Dr. Ferguson (two of the chief authorities) make four divisions.
Inflammatory puerperal fever is most commonly due to peritonitis, but may depend upon inflammation of the uterus, the ovaries, and uterine appendages, the uterine veins, etc. The ordinary symptoms, in the most common form (namely, when there is per itonitis), are rigors, followed by heat of skin, thirst, flushed face, quickened pulse, and hurried respiration. The abnormal heat of the skin soon subsides, and is followed by nausea, vomiting, pain in the region of the womb, commencing at one spot. and extend ing over the abdomen. This pain inerenses as the inflammation extends, till the patient presents the symptoms described in the article PERITONITIS. The pulse is uniformly high; the tongue coated; the urinary secretion diminished, and often passed with diffi culty; while the intellectual faculties are rarely affected. Five or six days arc the average duration of this disease, which may prove fatal on the first day, or may extend to 10 or 11 days. In some epidemics (as, for example, in Paris, in 1746; in Edinburgh, in 1773; and in Vienna, in 1795), none recovered. Dr. Ferguson states, that "to save two out of three may be termed good practice in an epidemic season." The treatment i so closely resembles that which is required in ordinary acute peritonitis (q.v.), that it is unnecessary to enter into any details regarding it.
Typhoid or malignant puerperal fever may commence in various ways, hut is always accompanied with fever of a low typhoid character, and with the symptoms which usually are associated with such fever. Treatment is of little or no avail,and the patient usually sinks at the end of a few days, or even hours.