PUERPERAL FEVER. 169. 
Another cause of this infection may be sloughing and putrefaction of uterine 
tissue which has been injured, as it might be by instruments employed in 
delivery. . : 
Did the post-partum discharge not have free escape, putrefaction and all its 
attendant evils might follow. 
There yet might occur other changes in the genital canal, connecting organs 
or adjacent parts, and the end be putrefaction, absorption, and puerperal fever. 
In this class the place or foci of infection is always in the generative organs, 
and commonly the uterus; and its occurrence must be easy in the presence 
of putrefaction, for the vitality is lowered, the nervous system deranged and 
depressed by prolonged labor, and the resistance of the system to noxious 
matters is thereby greatly reduced. 
As stated, in septic infection poisonous germs are introduced into the blood, 
where they multiply rapidly, develop an alkaloidal poison, and are conveyed to. 
the uterus and other abdominal structures. 
Doubtless the generative organs are their avenue of admission, and from 
them they are taken up by the blood, for when this is properly protected, infec- 
tion and true puerperal fever does not occur. 
These germs may ingraft themselves and redevelop on any abraded surface 
of the genital tract. But such rarely exists outside of the uterus, except when 
instruments have been used and parts wounded. On the other hand, the con- 
ditions within that organ at the time of whelping are most favorable for them; 
for a puppy born and its after-birth no longer adherent, there is abundant oppor- 
tunity for attachment and absorption of germs at the point at which it had been 
fastened. 
Now assuming that one or all of a litter have been born, that the mother 
was examined during whelping, and the hand used was tainted with only an 
infinitesimal quantity of the septic germs; so far reaching are they and so great 
is their virulence, it would scarcely be possible for her to escape infection. 
This danger would be even greater were she suffering from or threatened. 
with putrid infection, for matter undergoing putrefaction is a perfect hotbed 
for germ development. And this fact suggests that although most cases of 
puerperal fever are the result of septic infection or of putrid infection, and of 
one form only, there must be cases of mixed infection, or, in other words, cases. 
in which the two forms are combined. 
The appreciable symptoms produced by putrid infection and septic infection 
are nearly identical in cases in which the infection is intense and well advanced, 
but in their invasions and during the earlier stages there is marked variation. 
Considering first a severe case, the following signs are exhibited. A chill 
occurs and fever is speedily manifested. The pulse is quickened and continues 
up, as well as gains in rapidity. It is also weak, soon loses volume, and becomes. 
“thin and thread-like.” 
