"Puerperal women are wounded women, and in addition they have been subjected to hemorrhage, shock, weakness following on prolonged labor, and their blood and tissues generally have been peculiarly modified. Here then are a certain number of predisposing causes. Further still, the nature of the wound, its situation, the presence of materials in a state of disintegration or of decomposition, the retention of decidual or placental debris, the presence of external wounds, on the vulva, in the vagina, in a position peculiarly favorable for the entrance of germs even before do livery. Such, among others, are additional predisposing causes. We would not thus imply that always, and in every situation, infection pro ceeds from lomil lesions of the wound, for this would be to ignore the simplest undoubted pathological principles; but, unquestionably, the cases of infection from the uterus, are the most frequently observed. It is only exceptionally that infection occurs by other routes. The infection is not always of the same nature. Its varieties depend on many condi tions, the principal of which are: The degree of resistance of the subject, the care which is taken, therapeutically, to increase the resistance of the subject, and, above all, the nature of the morbid germ. As Pasteur has said, guided by the light of his experiments, the disease is complex, even as are the causes which give it life.
" The one grand fact resulting from all these experiments is the presence and the action of inferior organisms. In accord with all other workers in this line of research, I can affirm that the morbid germ of the disease, ever present in the diseased puerpera, is always absent from the healthy puerpera. This germ is a living organism, susceptible of reproduction under well-established conditions, and capable of reproducing nearly identical lesions. The morbid germs differ according to the different forms of the disease, and, more exactly, according to the lesions presented by the patient." As early as 1863, Chalvet and R6veil, Lemaire, 1867, de Ranee, 1868 1869, Quinquaud, 1872, Perrin, 1876-1877, had proved that the air in hospital wards, in particular lying-in and surgical wards, contained an infinite number of vibrios, bacteria, and micrococci of all sorts, and Pasteur and Bernheim have proved that certain of these germs are anaerobic, and others aerobic, and it is well established that, where decomposition is most abundant, where the germs find the greatest amount of material for development, there they will exist in greatest numbers, and that, as has been conclusively proved by Pasteur, the aerobic micobes prepare the soil for the anaerobic.
" Now," says Doleris, " we know what an excellent culture medium the blood is for certain germs, with what facility it decomposes under their influence, and acquires those septic properties on which the greater num ber of data in regard to septicaemia are founded. There is one point which appears to me fully established, and this is that if we do not always meet with microbes in the circulation, it is not always so where there has occurred rupture of a vessel, and consecutive apoplexy into the surround ing tissue, or into an organ. The germs then develop with extraordinary
. rapidity. It is likely that the active motion of the blood in the vessels during life is the true cause opposed to the development of germs, when they are in moderate quantities, and when they do not possess certain adhesive properties so well-described by Koch, which allows them to group together, to unite the corpuscles, and to obliterate certain capil laries where they may develop at will.
It is allowable to think that each drop of blood, of pus, of milk, of urine, of any fluid, in short, coming from the uterus, a wound, a secre tion, etc., may become a veritable nest of vibrios. These conditions are present to the highest degree in surgical wards.
On the other hand, it has been amply proved that the wounds of the genitals following on labor—and we repeat those wounds are inevitable almost during delivery—are the more exposed to the entrance of germs the more they are external. They each furnish plastic fluid, blood, lymph, morphological elements in which the organisms may develop, and they will develop the more rapidly the greater the alkalinity of the fluids. Now alkalinity is the rule during the few days following delivery, and if douches are sufficient to destroy the few germs which may have gained access by the vulva, the same is not true if the douches are not thorough or only practised at long intervals. The germs then may gain access to the uterus, and there multiply at their ease. Indeed, the anaerobic germs, finding themselves then not exposed to the air, are among condi tions most favorable for development. At the same time, the other or ganisms, which result from putrefaction, and which can live as well in as out of the air, may also develop in the vagino-uterine passage. Whence the multiplicity of the germs which are found in this canal. But all are not of the same importance, nor do they portend the same danger. Many exist normally in the utero-vaginal secretions, aside from pregnancy and labor. It results, indeed, from the experiments of Hausmann. Miller, Hottenier, that the Tertno, the common bacteria, the doubly-pointed micrococcus, which Pasteur considers the cause of •putrefaction, is almost always found there. The same holds true, however, of this organism as of the others—it is the number which constitutes the danger. Of course the quality has some effect, but we may more readily get rid of very harmful microbes in small quantity than of less harmful in great quan tity. Now it is exceptional that the lochia even of healthy women do not contain microbes, but they are of different varieties: 1. One is almost constant, the pyogenic, which Pasteur believes to be a form peculiar to pus. It is composed of two points well distinct, but united to form couples. It appears in particular about the third or fourth day, and is distinguished by the fact that it is composed of protean granulations, is flat and is automatic in movement. It is displaced in versely to the curreht of fluid. (Fig. 183.) This is the diploccocus of many writers, who reserve the term monococcus for the isolated living grains. Others call it the micrococcus.