" It seems, then, to result from a study of tfiese facts that, as Doleris says, the inflammation of the lymphatics is the first factor; that the in flammatory process then spreads to the blood-vessels by way of the thoracic duct oftener than by other peripheral channels, by reason of the obstacle offered by the ganglia, and that finally, it may appear at distant points, owing to the connection of the serous net-work with the capillaries." Whether it be desired to make septicaemia and ichoremia different varieties of puerperal infection, matters not; the capital, essential point is the hematic lesion. and this is constant, although not always identical, and hence differences in the views held by a number of authorities.
While Hersent, Vogel, Laurent de Fresnel, claim that there is slight diminution in the fibrin and in the albumin, with increase in the water and decrease in the globules, Gautier insists on the almost constant de formity of these globules. The blood, further, contains an excess of urea and of carbonic dioxide, and even of glucose and of free hydrogen. The albumin is diminished, and often lactic acid is present. Fouassier grants the diminution of the red globules and the increase in the white. Finally, Colz and Feltz, Spillmann and Heiberg, Pasteur and Doleris, note in the blood a considerable quantity of microbes. Doleris goes even further and tries, with Pasteur, to class these microbes.
" Are we dealing with true, lightning-like septicaemia? Then the blood, heavy, semi-coagulated, in appearance like badly cooked gooseberry jelly, sometimes blackish, presents an extreme alteration of the corpuscles. They are deprived largely of their hemoglobulin, which is much below the normal. Ther4 is no special increase in leucocytes. The microbe does not appear in the blood till late in the disease, sometimes only after death. It is made up of elongated elements, thin, cylindrical, moving in the tissues and penetrating into the lymphatics, and to the peritoneum.
" These are the septic bacteria.
" In order that this form may appear, the septic bacterium of Pasteur, the microbe in rods, must find an appropriate medium. There must exist anoxentia, lack of oxygen, since these bacteria cannot develop in oxygen. There must exist a generative focus outside the blood, and this is supplied by the lymphatic system.. But in order that the lesion may assume the suppurative form, there must be added to the bacterium a special microbe, the mocrococcus in double points.
" Are we dealing with attenuated septicaemia? The alteration in the blood there takes place More slowly, and it occurs, according to Doleris, from the presence of a special organism, which may be fairly called specific. It is the micrococcus in chaplets. It passes from the lymphatics into the blood continuously, without determining any lesion other than a more or less profound change in the corpuscles. Under the influence of the coccus the corpuscles become decolorizod, crenated, segmented, and the hematin almost entirely disappears.
" The nature of the organism, then, differs in the two instances.
"When the lymphatic lesion coexists and developes progressively,culture of the micrococcus of the blond gives rise almost constantly to long chaplets, sometimes to cylindrical bacteria.
"When the blood lesion exists alone, culture only gives rise to micro cocci in colonies, in irregular groups or in couples, which never arrive at the advanced stage of chaplets, possibly owing to their sojourn in the blood.
" When the hematic lesion is accompanied by phlebitis, infarctus, the almost constant form is the single point in couples. Culture reproduces it in enormous quantities, to such a degree, indeed, that it loozs as though we had made an artificial pus." 3. Secondary pass now rapidly in review the alterations found in, different organs in the body, we find the following modifications: In peritonitis, the peritoneum is greatly injected, and the abdominal organs are bound together by false membranes to form depressions in which accumulates thick serum or pus, usually in considerable amount. In the pleura the same inflammatory signs are found, and either effusion in or adhesion of the pericardium. The endocardium is injected, with ecchyinoses, ulcerations, vegetations, and there are even changes in the tissue of the heart itself.
In the lungs are found congestion, oedema, embolic infarcti, abscess, lobar and lobular pneumonia, sometimes gangrene.
In the brain, alterations to a greater or less degree of the meninges, suppuration, exudation.
In the joints, collections of fluid varying from serous to purulent.
The spleen is enlarged, soft, the color of chocolate, and is filled with abscesses. The liver contains abscesses, every stage of acute yellow atrophy, fatty degeneration more or less accentuated. The kidneys offer degenerative changes, sometimes limited to the cortex, extending even to the destruction of the epithelium of the canaliculi, or of the canaliculi themselves, emboli, abscesses, etc. The pancreas, parotids, mammie, the thyroid, may be affected and riddled with abscesses the result of emboli.
The ganglia, the cellular tissue, the muscles, may be the seat of greater or less suppuration. The intestinal canal, the bladder, the rectum may be inflamed, ulcerated or not. Finally, the skin may be the seat of erup tions, pustules, gangrene, etc. In a word, we may meet every possible lesion, these varying according to the different forms of the disease.
Finally, together with phlebitis and lymphangitis, Simpson has de scribed an arteritis and arterial obstructions which are the consequences. (Fig. 189.) In case the inflammatory form predominates, it is in the uterus and its annexa, and in the peritoneum, that the most accentuated lesions are found.
In case the purulent form is in the foreground, phlebitis, with metas tatic abscesses, is the marked lesion.
In case septicxmia, pure or attenuated, is present, lymphangitis is the chief vascular lesion, associated with lesions of one or another organ, without any special characterisation of the disease. • According, in a word, to the degree of infection and the resisting power of the individual, the effects of infection will tell to a greater or less degree on the economy; and while in one case only metritis or peritonitis will be found, in another almost all the organs will be to a greater or less degree affected, and the morbid process may, so to speak, be followed step by step.