PUERPERAL FEVER 689 



Dudgeon 1 believes the B. coli is frequently a secondary agent 

 and not the primary infection. He finds that the M. pyogenes, 

 var. albus, is very commonly present from the first, and may exert 

 a protective action by determining the occurrence of phagocytosis. 



PSILOSIS OR SPRUE. Bahr regards this disease as being caused 

 by a yeast-like form, an Oidium or Monilia. Ashford isolated a 

 Monilia (M. psilosis) which he regards as specific, and Michel 

 has tried a vaccine composed of it with promising results. 



PUERPERAL FEVER. This condition may be either a localised 

 infection with intoxication (saprsemia), or a localised infection 

 with general infection (puerperal septicaemia) ; in both the 

 primary seat of infection may be perinaeal or vaginal lacerations, 

 or the contents of the uterus or the placental site. The infecting 

 organisms may be 8. pyogenes, pure (20 per cent.), or with other 

 organisms (30 per cent.), occasionally the 8. pneumonia?, B. 

 coli, M. pyogenes, var. albus, M. pyogenes, var. aureus, M. gonor- 

 rhcew, B. Welchii, and diphtheroid bacilli. These are rarely 

 alone, but generally occur with one or other of the organisms 

 named. The B. diphtheria? may exceptionally be met with. 



PURPURA. Haemorrhagic septicaemia may be caused by a 

 number of capsulated bacilli allied to the B. pneumonice of Fried - 

 lander 2 (see pp. 313, 490), as well as by streptococci and pyogenic 

 cocci. Paratyphoid infection may be accompanied with purpura. 



PYORRHCEA ALVEOLARIS (Bigg's disease). Goadby 3 found 

 the following organisms to be probably causative in this disease : 

 M. citreus granulatus, M. pyogenes, var. aureus, streptococci, M. 

 catarrhalis, and diphtheroid bacilli, and has used vaccine treat- 

 ment with success. Eyre and Payne 4 found similar organisms. 

 Drew and Griffin 5 find present in pyorrhrea Entamcebd gingivalis 

 (p. 586), spirochaetes and treponemata, pyogenic cocci and other 

 bacteria. They consider that mechanical injury starts the 

 condition ; the tissues then become invaded by spirochaetes, 

 which cause destruction of tissue and the formation of pockets. 

 When once the pockets are formed bacterial invasion occurs. 

 The amosbae when established in the pockets appear to aid in the 



1 Bacteriology of Peritonitis (Constable, 1905). 



2 See Howard, Journ. Exp. Med., vol. iv, 1899, p. 149 (Bibliog.). 



3 Proc. Roy. Soc. Med., February, 1910 (Odontological Section). 

 * Ibid., December, 1909. 



5 Journ. Roy. Microscop. Soc., 1917, pt. 2 (April), p. 185. 

 M.B. 44 



