Then arose the gastro-bilious theory of Trincavellus, which was advo cated in particular in England by Manning, Cooper, Denman, and others.
The fifth theory is the phlogistic; according to which inflammation is the cause of puerperal fever. According to the site of the inflammatory process, we may have three varieties: 1. A metritis, the opinion of Plater, 1602, Denman, Tissot, Naege16, and others, and this metritis may be associated with a phlebitis or a lym phangitis.
2. An enteritis and a peritonitis.
3. Peritonitis, pure, the view held by Johnston, Hunter, Siebold, Capuron, Baudelocque, and others.
Then followed the erysipelatous theory, which was advocated in par ticular by Eisenmann, and accepted by Delaroche, Bayrhoffer, Gordon, Ingleby, Lee, many American and English authorities. This theory con siders puerperal fever an internal erysipelas.
• The discussion on puerperal fever at the Academie de Medicine, in 1858, resulted in a division of authorities into two categories, the localists and the essentialists.
Tho localists, represented by Boullaud, Cruveilhier, Cazeaux, Jacque mier, Velpeau, Piorry, Beau, claimed that the local lesion constituted the • disease, and they eventually all, with the exception of Beau, finished, under the influence of Trousseau, by claiming that puerperal fever had its origin in lesions of the genital tract, which were complicated by gene ral secondary lesions, the outcome of purulent infection.
The essentialists, under the leadership of Paul Dubois and Depaul, claimed that " puerperal fever was due to a primitive external influence, at first acting on the blood and then attacking the organism at points of predisposition, such as the genital system, the peritoneum, but essentially leading to general poisoning by morbid reaction on the blood, and the organs in general. The contagious nature of the disease was granted in full by them." (Doleris.) The idea, hence, of a miasm, of a poison, of a transmissible virus, was thus definitively established, and was later advocated by Ilervieux. This idea had already been broached by Whyte, in 1770, who, from the fact that puerperal affections showed themselves in particular in maternity hospi tals, claimed that septic matters either developed spontaneously in the or ganism or were introduced through the atmosphere tainted by putrid ele ments. Walsh, in 1788, reported the case of a puerpera poisoned by putrid fever; Douglas described an epidemic or contagious form; Cru veilhier accepted the doctrine of hospital miasm, and the poisoning of the puerpera through the uterine wound, and he was followed by Eisenmann and Helm, who declared that the uterine wound might be contaminated by miasmatic influences acting directly, or else penetrating into the circu lation by the respiratory tract, and finding in the irritated and the wounded uterus a point of receptivity. Finally, Kiwisch, Litzmann,
Scanzoni, Bamberger, Veit, claimed that the poison acted directly on the blood, and this is the theory of Dubois and of Depaul.
Scanzoni and Ferguson endeavored to detect the nature of the blood change, and found, successively, hyperinosis, pyemia, dissolution of the blood. In 1847 to 1861, Semmelweiss promulgated the following theory: Puerperal fever must always be considered as a fever due to the absorp tion of a decomposed animal organic matter, and this absorption may re sult from (the product of decomposition coming from the individual itself), or from (the product of decomposition coming from without). Consequently, not only the cadavers of every age, and of every sex, when they are in a state of decomposition, but also the sick of every age, and of every sex, whose disease is accompanied by decomposition of organic animal matter, and furthermore every animal organic tissue, which presents a certain degree of decomposition, every one of these may be the starting-point of puerperal fever.
Puerperal fever is not, therefore, a peculiar and exclusive disease of the puerpera. An identical affection, even as has been proved by Trous seau, Sch6e, Helm, Buhl, Simpson, Tarnier, may be met with in virgins, in the new-born, in wounded of either sex. The point of origin of the dis ease is found as well in the uterine wound, and in slight superficial wounds of the genital organs, as in lesions of the peri-uterine cellular tissue, or in the vagina. The primitive local disease becomes general through the carrying of the morbid process to the cellular tissue, thus gaining in ex tent, or else it is transported by the lymph or the blood to all the other organs; or else foreign bodies are carried by the circulation, deposited in different organs, and there become the source of the disease. The causes of isolated cases, that is to say, of those developing aside from all epidemic influences, are: 1. Lesions and wounds of the genital organs. 2. Reten tion followed by alteration of portions of the placenta or of the membranes. 3. Primitive inflammations of the vagina and of the womb, such as those caused by gonorrhoea. 4. Finally, infection of wounds of the genital organs by cadaveric emanations, purulent or gangrenous secretions, etc.