54. On the Primary cause of Puerperal Fever

1848 American Journal of the Medical Sciences  
pulpy mass, which could wilh difficulty ho removed from its position. The dura mater around wan nearly one-quarter of an inch in thickness, and somi-carlilaginous, and adhered so closely to tho bone, ns to render its delachmont impossible A considerable portion of tho orbital plates of tho frontal bono, more particularly on tho left side, and also parts of tho ethmoid and sphenoid bones, were destroyed. Tho optic nerves appoared healthy; the pituitary body was much softened.-Prov. Med. and
more » ... Prov. Med. and Snrg. Journ., Nov. 17lh, 1847. MIDWIFERY. 54. On the Primary cause of Puerperal Fever, lly Da. Scanzoni, of Prague.-Dr. S. commences by stating that the wound produced on the internal surface of tho uterus by tho detachment of tho placenta during parturition, is universally re¬ garded as tho peculiarcauso of puorperal fever. He considerslhis view too exclu¬ sive, and in opposition to it mentions two or three cases whoto tho symptoms of puerperal fover had shown themselves boforo labour had commenced, and con¬ tinued after it to a fatal termination, and thero was no hemorrhage, nor putrefaction of tho placenta to indicate that that organ had been detached before the proper period of labour. Dr. S. then beliovos that "tho seed of tho disease is sown be¬ fore the commencement of labour;" accordingly ho seeks for tho germ of tho dis¬ ease in tho blood, and, as tho peculiar condition of tho blood of a puerperal is formed from that of a pregnant lemalo, he conceives that tho special predisposing causes of puerperal fover exist in the composition of the blood. In proof of this, tho author mentions that in those cases which camo under his own observation, where that composition of the blood, which is peculiar to pregnant women, was totally prevented from taking place, or was modified by tho presence of somo other dyscrasia, the patients were never attacked with puorperal fever, although exposed, in an eminent degreo. to that combination of circumstances which is supposed to induco it; and, on the other hand, when, during pregnancy, females are attacked wilh any disease depending on hyperiuosis of the blood, such pa¬ tients are very liable to suffer from puerperal inflammations, accompanied by copious fibrinous exudations. Tho author refers to the writings of Helm, Kiwisch, Rokitansky, and Engel, showing that the blood of puerporal females is in a Btato of hyperiuosis, i. c. containing an excess of fibrine. The author saw that strong healthy women, in whom this stato of hyperiuosis of tho blood natural to preg¬ nancy had attained its full development, suffered, during a severe opidemie, under that form of puorperal diseaso which gave indications of an excess of fibrino in the blood, viz. endometritis or peritonitis, accompanied wilh copious fibrinous ex¬ udation, such as is met with in pleuritic and pneumonia. Physiologists are us yet unable to oxplain how this augmentation of fibrino is produced. Fibrinous doposits are frequently found in or upon tho placentas of mature children, but very rarely has tho same alteration been found in tho caso of premature fceluses. These deposits are mostly confined to tho two last months of pregnancy, and thoir existence may, according to our author, bo accounted for by the active interchange of material which, toward tho end of pregnancy, lakes place between the maternal and the foetal blood; tho former abounds in fibrino, and if the consumption of this olemenl on the part of the child bo diminished, whilst the supply afforded by tho mother remain tho same, fibrinous deposits must tako place, and these probably on tho inner surface of tho uterus: this is a fact our author has been unablo to ascertain, ns tho inspection of the bodies of women dying during pregnancy are exceedingly rare. The fibrinous deposits in tho pla¬ centa, howover, according to Dr. S., prove that the fretus does notconsumo all tho fibrino supplied to it, and they lend probability to the idea, that in consequence of tho continually increasing supply of fibrino in tho circulation of tho mother, and the comparatively small consumption of that element on the part of tho child, an abnormal accumulation of fibrino must bo the result, constituting hyperiuosis in tho mother. This fibrinous diathesis, in pregnant females, may pass into secondary dropsy or purulent doposit; secondary dropsy follows from tho anemia gradually dovol-
doi:10.1097/00000441-184801000-00079 fatcat:tegyeh3m45clpa67rmlm64ofuq