PUERPERAL INi'ECTION 341 



3. Acute Puerperal Septiccemia. 



Definition. — A septicsemia of an acute type, following par- 

 turition, its symtoms from the very outset predominating over 

 any other. This septicaemia is of great importance from an 

 obstetrical and hygienic point of view. The local disturbances 

 in these cases are very limited, so that but few alterations of an 

 insignificant nature are detected on post mortem and on 

 microscopical examination of the uterus and vagina. Putre- 

 faction is not necessarily present. This septicaemia occa- 

 sionally is met with after puerperal phlegmon and septic 

 metritis. 



Etiology. — Little is known of the infectious material caus- 

 ing acute puerperal septicsemia in the cow. In all probability 

 streptococci play a great role in this disease. 



Acute puerperal septicsenlia occasionally follows difficult 

 labor with injury to the parturient passage, and may be seen 

 when birth takes place normally without manual interference. 



The source of entrance for the infection are wounds ; often 

 these are only simple epithelial defects, as they occur in every 

 normal birth. 



The infection may also take place by intermediaries; for 

 instance, the arm and hand of the obstetrician, instruments, 

 ropes, also straw and stable paraphernalia. 



I know cases of acute puerperal septicsemia, where 

 no exploration had been made, which died, and where the 

 infection only could have been transmitted by straw which 

 had been used as bedding for a cow dead with puerperal 

 septicsemia a few days previously. There are also cases known 

 where cows died a few days after giving birth without any 

 apparent cause, but slight assistance having been rendered 

 them during parturition. Post mortem also failed to reveal 

 any lesions which might throw light upon the cause of death. 

 These mysterious cases only discontinued to appear after 

 attention had been drawn to the transmission of the virulent 

 agent, prevented after that by vigorous antiseptic measures. 



Symptoms. — The disease sets in suddenly on the second 



