THE PATHOGENY OF PUERPERAL FEVER.
under the term pathology of the puerperium, we might include all the morbid manifestations which may occur during, and disturb the course of the physiological puerperal state, a detailed study of these manifestations would carry us far beyond the limits of this work, and require volumes. We will limit ourselves, therefore, to a sketch of -what was formerly called puerperal fever, but what tends more and more daily, to be known as puerperal septicaemia. Although, however, we think that puerperal fever, as an essential morbid entity, should be rejected, we believe that Luys and Siredey have gone too far in wishing to banish it altogether. Among the diseases which may affect the puerperal woman, there are some which are purely inflammatory, and there are others, un fortunately the vast majority, which depend on a true poisoning, which are due, in other words, to the absorption by the puerpera of septic germs, products of decomposition, the name matters not, and those we may range under the term puerperal fever, puerperal septicaemia. Such are the accidents to which the older writers gave the name puerperal fever, and to entirely reject this term is to enter the road which leads directly to the localization of puerperal affections. Certainly all women affected with puerperal fever do not present the same lesions. At times we have a phlebitis, and again a lymphangitis, or a peritonitis, or even a pleurisy, as the principal lesion, but each of these is simply a peculiar manifestation of a general state, and it is this general state which consti tuted for the ancient writers puerperal fever, and which is to-day known under the name pf puerperal septicaemia. In a word, there is infection of the patient. One or the other term, hence, is with us interchangeable.
Puerperal fever, puerperal septicemia, may be endemic or epidemic. Even as the symptoms of the affection may vary infinitely, however, so too may the epidemics in their severity. Since the first epidemic at the Hotel-Dieu, recorded by Matiriceau and Lamotte, 1664, scarcely a year has passed without our being able to refer to an epidemic at one or another place in the different parts of the world.
While all authorities agree in regard to the application of the term puerperal fever, the theories of its origin have been innumerable, and even to-day there are questions concerning it which it remains for the future to decide.
The earliest theory was based on the idea of retention of the lochia, and decomposition of remnants of the placenta. This theory originated with Hippocrates, and was defended by Galen, Avicenne (1000), Rhodion (1532), Mercatus (1570), Victor Trinewtellus (1597), Roderic de Castro (1603), Michaelis (1615), Boerhaave (1629), Sennert (1631), Sydenham (1682), Stahl (1690), Hater (1711), Mauriceau (1712), Burton (1751), Smellie (1752), Astruc, Johnston (1769), Tissot (1795), and many others. The lochia being checked by inflammation, or by spasm of the vessels, septic materials were retained in the blood. The uterus and other organs became diseased, and there finally resulted putrid fever.
To this theory succeeded that of the metastasis of the milk, which was first promulgated by Mercurialis and Willis, in 1662, and was advocated, in particular, by Puzos, (1743), and later by Lieutaud (1750), Sauvages (1640), Levret (1766), Van Swieten, Deleurye (1777), Baldinger, Leroy, Plenck, Henkel, Boer, Fischer, Hecker, Wenzel, E. Martin, Broussais, etc.
At the beginning of this century, Autenreith formulated his physiological theory, which is purely a combination of the preceding. During preg nancy excretions flow specially towards the uterus, but after labor they are eliminated by the sweat glands, the lochia and the milk. If these peripheral functions are interfered with, the course of these excretions is turned towards the head, the thorax, and above all the abdomen. This theory was accepted and sustained by Schmidtmflller, Carus, Joerg, d'Outrepont, etc.