Schroeder, who is a resolute advocate of the theory of Semmelweiss, thus expresses himself: " In order to understand distinctly the manner after which infection occurs in the puerpera, it must be compared with one of the frequent varieties of infection which occurs in other parts of the body.
When, at an autopsy, infectious materials from the cadaver come in contact with a slight abrasion on the finger, we witness, according to the amount absorbed, and especially according to the individual predisposi tion, different phenomena. Either the point of contact alone is affected, so that there results suppuration of long duration; or else the inflamma tion extends to neighboring parts, and there result inflammatory affections of the lymphatic vessels of the arm, and an abscess in the subcutaneous cel lular tissue, as well as in that between the muscles. The entire system is not otherwise affected than it is in case of other local inflammatory affections—that is to say, the individual has only a moderate fever. Similarly, in a puerpera, as the result of infection of an abrasion on the vulva, there may arise an ulceration which heals quickly, or else an in flammation, which, following the course of the lymphatic vessels and the cellular tissue, may extend much further and eventuate in a suppurative lymphangitis and an exudation around the uterus and the vagina. The entire organism is not much more affected than in case of other local in flammatory diseases, and the fever is identical with that which accompa nies such affections. If, however, the infection Of the finger by the cadaveric poison is more intense, then, at the end of twenty-four or of thirty-six hours, we see serious general phenomena develop. These are characterized above all by elevation of temperature entirely out of pro portion to the local affection, a fever which imperils to a high degree the functions of the entire organism. Death may occur with lightning-like rapidity, and .aside from slight alterations in blood, we may find no changes visible to the naked eye. The individual has suc cumbed to eeptieceniia.
In other instances we find acute degeneration of the large abdominal glands and of certain portions of the voluntary muscles, or else pleuro pneumonia, peritonitis, arthritis. The individual has succumbed to ichoremia.
In other instances, finally, there are thrombi in the veins near the wound. These thrombi are decomposed, and small portions are carried by the vessels and deposited usually in the lungs, and then give rise to infarctions and to abscesses. The individual has succumbed to pyemia.
In an exactly similar way, when infection occurs in the puerpera, are the local affections thrown into the background. At the end of thirty six hours, the temperature rises to a high degree, with or without a chill, and the same fever affects her as we have seen may affect the individual suffering from cadaveric poison. The parallel need be carried no further, since the same phenomena occur here step by step, even as we have just described them.
Further still, even in case of simple wounds, the entire system may be touched, and this is what is called traumatic fever. But although the ordinary traumatic fever is evidently the result of decomposition of the inflammatory products within the tissues, products which are carried in the circulation, and which consequently give rise to what may be termed a fever from absorption; and although this fever scarcely presents what may be termed specific characters, by which it may be distinguished from that due to infection, the essential characteristic of non-infected wounds is precisely their local nature, that is to say, the inflammatory process does not extend beyond the tissues which limit it; it remains circumscribed, and the fever, even though it presents differences in intensity according to the individual, never exceeds the degree which it usually attains in local inflammatory affections. If, on the other hand, the wounded sur face is infected, either by auto-infection or by hetero-infection, the in flammatory process may still remain local, since the infectious materials are isolated from the remainder of the organism, owing to the transforma tion of the wound into an abscess incapable of resorption; but if this salu tary abscess, so to speak, does not form, or not in time, the inflammation may spread to the neighboring tissues. If it extends superficially along the skin or the mucous membrane, it manifests itself as an erysipelas. In other instances it penetrates more deeply, by following the connective tissue, and we may have an abscess. The entire organism may, in these cases, present nearly identical phenomena to those which accompany local inflammatory processes, but very frequently the temperature rises higher, the pulse becomes much more frequent than one would expect in case of a purely local affair, and this is proof that the excretions from the infected site have reached the blood. Again, when the fever is moderate, we may always doubt if the entire organism is not affected by septicaemia, or ichorremia, as the result of the nutritive inflammatory troubles which are present in all the organs.