PUERPERAL FEVER (from Lat. puerpera, parturient woman, from puce, child -I- parere, to bear), PcEneEnAt. SEPSIS, CIIII.DRED FEVER. A fever appearing in puerperal women within a week after labor—usually from the third to the fifth day—attended with septic infection of the blood and acute inflammation of one or more of the reproductive organs or the loose cellular tissues connected with them, and often charac terized by severe and widespread complications. This fever was long considered specific, and under the names childbed fever, lying-in fever, etc., was a fatal and frequent complication of the puerperium. particularly in lying-in hospitals. It is now known that the disease is due to infection from some microOrganism introduced into the genital tract by contact with unclean hands, instruments, dressings, clothing, or bed ding. The credit of pointing out the true origin of this disease is due to Dr. Oliver Wendell Holmes, who in 1843 promulgated the doctrine of extragenital infection. In 1847 Scnunelreis pro claimed the same teachings in Europe. Since modern antiseptic midwifery has caused the hands, instruments, and the materials used in the lying-in room to be sterilized, puerperal fever has become a comparatively rare occurrence, while a better knowledge of its pathology and prompt treatment of its earliest symptoms make it a much less fatal and severe sequel of labor.
The complications that may arise in puerperal fever are both grave and numerous. Pericarditis. pleurisy. endocarditis, pneumoniq, and inflam mation of the joints may occur, and the liver. kidneys, bladder, or spleen may be secondarily infected. The disease is usually ushered in with violent and prolonged chills, followed by an irregular fever, uneasiness, nausea. extreme gen
eral depression, with a rapid. feeble pulse, and shallow respiration. The' expression is anxious, the tongue heavily coated, and the urine scanty and albuminous. Severe eases run a rapid course and often terminate fatally within a week.
The prevention of puerperal infection by the exercise of rigid cleanliness in every labor ease, and particularly when instrumental interference is demanded, is now one of the most important duties of the obstetrician. (See ANTISEPTICS,) When, however. infection has taken place. on the appearance of the initial syMptoms the genital tract should be irrigated at frequent intervals with from three to four quarts of some warm antiseptic solution. Mercuric chloride. creolin, carbolic acid, or plain normal salt solutions are those usually employed for this purpose. if this measure does not prove efficient in abating the fever in a short. time, it is necessary to explore the uterine cavity and remove by means of the wire curette the decomposing material which is almost. certain to he found there. Frequent douching with one of the solutions named above is continued until convalescence sets in. The general treatment is stimulating and supportive. An abundance of easily digestible liquid food, such as milk, beef tea, broths, and animal juices, must be' given. Alcoholic stimulants may have to be given in large amounts with strychnine and other cardiac tonics. Fever is reduced preferably by cold sponging, and abdominal pain and swelling relieved by the application of the hot-water coil or hot-turpentine stupe. Com plications must be met as they arise.