is) 



PUKNTE NACIONAL 



PUERPERAL FKVER 



indoor* ladders take the place of staircase* every- 

 where. A somewhat pyramidal aspect U given to 

 the whole building l>y each successive story reced- 

 ing a few feet frmn tin- lim> of that llow ii. Eiich 

 family of the tril>e hit-, a separate apai t ment, ami 

 there are also large rooms for general council 

 chamben and for tribal dances. In New Mexico 

 there are nineteen such villages, with over 8000 

 occupante, who are -kilml agriculturists, employ- 

 ing irrigation ditch extensively, and rear horsed, 

 cattle, and tihecp. Spinning and weaving and the 

 manufacture of pottery aim) are carried on. The 

 Moquis of Arizona are a related tribe, numliering 

 some 1800, in seven villages Imilt on the summit of 

 isolated hills. The Pueblos are under lioman 

 Catholic mi -ionaries, and are making steady pro- 

 gress in civilisation and education, although on 

 their Christianity they have grafted many of their 

 old pagan beliefs and customs, to which they 

 obstinately cling. They were first visited by the 

 Spaniards about 1530, at which period their habits 

 and their habitations were very much the same as 

 to-day. It is evident, however, from the wide area 

 over which the ruins of old pueblos and remains of 

 ancient pottery have been found, that they were 

 at one time very much more numerous than they 

 are now. 



Pnente Xarlonnl, a town of Colombia, in 

 Sant&nder department, on the Kio Suarcz. Coal 

 and iron are mined, and there are some trilling 

 manufactures. Pop. 1*2,000. 



Puerperal Fever. In ite most general sense 

 this term may be applied to any acute febrile 

 disease affecting women during the puerperal or 

 lying in state. In this sense it might be taken to 

 include the febrile states induced by the poisons of 

 scarlatina, typhus, and other zymotic*. Hut, while 

 the zymotic jmisons induce manifestations in the 

 puerperal woman in some respects widely differing 

 from the results of their action in the non-puerperal 

 -late, their features are quite distinct and recog- 

 >ii-able. and the special characteristics of their 

 action depend on the peculiar condition of the 

 subject for the time being, and not on any differ- 

 ence in the specific character of the poisons. The 

 term puerperal fever is now in ite narrower sense 

 le-irictcd to that special acute febrile disease 

 resulting from the septic infection of the puerperal 

 woman, and may lx- considered to be synonymous 

 with the term puerperal septicaemia. 



It is a frequent and much dreaded disorder, and 

 accounts for a very large number of the deaths 

 arising from child -liearing. Its dread character 

 and symptoms were recognised by Hippocrates anil 

 by him regarded as due to the suppression of the 

 loehia or discharge after childbirth* view which 

 held ground for nearly 2000 year- for in 1680 

 Svdenham taught practically the same opinion, 

 i-'rom this time until IS47 various views as 

 ' its cause and nature prevailed. But in this 

 \ear the true nature of the cause was recog- 

 nised by Semmclwciss of Vienna, who noticed 

 that in a clinic in the maternity which hi- con 

 ducted, and which was attended solely by midwi\e~. 

 puerperal fever scarcely ever occurred, while in 

 another attended by student*, many of whom came 

 straight from the dissecting-room, its ravages were 

 appalling. From this he argued, after careful 

 analysis of his oWrvations, that the student* 

 brought into the maternity a poison that induced 

 in the women they attended and examined the 

 disease, which was conspicuous by its absence in 

 the- ward attended by the midwives only. Abund- 

 ant evidence has accumulated since to show that 

 his views were correct, and it has been shown that 

 of all the cause* of this malady the poison termed 

 ~ -'ric (Le. derived from the deconii>osing dead 



body) U one of the most active and fatal. Modern 

 research has shown us that the activity of this and 

 other septic (Hiisons is dm- to the inlluenre of microbic 

 organisms or 'germs,' and we are well aware that 

 a great variety of such germ-bMling substai 

 exi-t, each capable of inducing the symptoms and 

 condition which we recogni.se under the name of 

 puerperal septicirmia. Tim--, while the result* are 

 to all intents the same, the causes may vary con- 

 siderably in their ultimate nature, and may be 

 derived from a variety of sources ; for example, the 

 cadaveric poison already referred to, the pu- from 

 a septic abscess, sewage gas, !vc. It would seem 

 that the septic poison may lie introduced into the 

 system in two dillerent ways, and this distinction 

 has an important clinical and practical Ix-aring. 



(1) The so-called Heterogenetic mode includes 

 those cases in which the ]mison is applied to the 

 tissues of the patient directly, as from the hands of 

 the' accoucheur. The microlie then enters the 

 liMics and produces ite effects by developing in and 

 influencing the vitality of the tissues themselves. 



(2) The so-called Autogenetic mode. In this case 

 a piece of the retained placenta, blood -clot, or 

 slough remains in the genital tract. Putrefactive 

 changes set in as the result of microbic infection, 

 and the products of the putrefaction enter the 

 s\st.cm and exert their morbid influence* upon it. 

 In this class of cases the patient as it were manu- 

 factures the immediate poison in her own liody 

 (hence the term). But it will l>e evident that in 

 both the ultimate cause is the presence of microbic 

 organisms. The symptoms may occur in from two 

 to fourteen days after labour. ' They begin with a 

 rigor or 'chill,'' followed by a rapid rise of pulse 

 ami temperature. Thereafter pain in the alidomcn 

 usually sets in and the loehia In-come fetid or 

 suppressed. The local manifestation of the disease 

 consisting of inflammatory changes varies in kind, 

 degree, and site. Almost all the organs may lie 

 involved, more especially the uterus, peritoneum, 

 kidney, liver, &c. In some cases the influence of 

 the poison is so overpowering and rapid that death 

 ensues before any gross change in the tissues occurs, 

 but usually there is abundant evidence of the 

 extent of the anatomical changes. 



Once the disease is fairly established the prognosis 

 is grave in a high degree. The chances of recovery 

 where the treatment is appropriate and \igoron- 

 are very much greater in the MtQfgNMtta variety 

 than in the other. The scat of the mischief can lie 

 attacked, and the decomposing mat tereilhei entire! \ 

 removed, or the putrefactive process stopped by the 

 use of ellicient antiseptics. Where the sepsis has 

 been introduced directly (heterogenetic form) the 

 possibility of direct interference is almost nil, and 

 the matter resolves itself into a contest lietwccn 

 the vitality of the victim and the activity of the 

 poison, in which the former often succumbs. 



The preventive treatment (fropltjfleucu) of this 

 scourge is, however, one of the triumphs of modem 

 medicine. Up to 1870 the special home of puerperal 

 septicaemia was the lying-in hospital, when- the 

 atmosphere and furniture were saturated with the 

 septic material derived from the emanations and 

 excreta of previous patients. Such insiiiutions 

 were seldom long free from outbreaks of this 

 scourge, and from time to time epidemics arose with 

 a virulence and effect that made the total mortality 

 appalling. But from IS70 and onwards the in 

 creasing knowledge of the influence of germ poison 

 in disease-production and the power of antiseptics 

 in keeping this inlluenre in check Ix-gaii to tell, 

 with the result that such outbreaks are now entirely 

 unknown and the mortality is practically reduced 

 to //. No better illustration of this advance can 

 IM- found than the exiM-rience in the Hoyal Mater- 

 nity Hospital of Edinburgh. In 1879 the new 



