120 The Philippine Journal of Science 1920 
In other words, is so-called autoinfection during puerperium 
possible? 
Kaltenbach, in 1888, admits the possibility of autoinfection in 
the following sentence of his communication to the German 
Gynecological Society : 
It is possible that pathogenic organisms may harbor in the genital tract 
during pregnancy without giving rise to any symptoms and only exert their 
influence during labor or the puerperium when the wounds following delivery 
will afford opportunity for their growth and absorption. Of course, in the 
strict sense of the words, this is not autoinfection, but merely a variety of 
external infection, the only difference from the usual form of contact in- 
fection being the length of time that the offending microorganisms have 
been in the genital tract. Thus, admitting that the vagina may contain 
pathogenic organisms, it is admissible that they may lead to infection 
without any further introduction of organisms from without. 
The possibility of autoinfection, therefore, must stand or fall 
by the demonstration of pathogenic organisms within the 
genital tract of pregnant, parturient, or puerperal women who 
have not been examined previously. 
The streptococcus group, because of their well known im- 
portance in puerperal infection, have interested many in the 
study of vaginal bacteriology during the later weeks of preg- 
nancy. Doderlein in his study of one hundred ninety-five cases 
distinguished two varieties of vaginal secretion; namely, normal 
and pathological. In the normal vaginal secretion he found 
a facultative anaérobic bacillus in frequent association with a 
type of blastomycetes which he believed to be Saccharomyces 
albicans. This bacillus which bears his name was found to be 
nonpathogenic. He accordingly concluded that the normal se- 
cretion presents no possibility for autoinfection, because of 
being bactericidal to pus-producing organisms. On the other 
hand, he found pathogenic streptococci in 10 per cent of the 
pathological vaginal secretions. This pathological secretion 
may afford then an opportunity for autoinfection, because of 
the possibility of the presence of a streptococcus which was 
pathogenic in more than half of his cases. Joeten, in 1912, re- 
ported one hundred antepartum cultures with streptococci in 
sixty-seven ; fourteen of these were hemolytic, but evidence of the 
pathogenicity of these bacteria was wanting. Walton and Me- 
dalia (1912) found streptococci present in the vagina of pregnant 
women in from 10 to 40 per cent. They worked on the hemo- 
lytic and nonhemolytic form without, however, differentiating 
them further. In the one hundred three cases which they studied, 
antepartum and postpartum, the only two cases with morbid 
