1948 DISEASES OF THE GENERATIVE SYSTEM 



we have found streptococci and other organisms. These people 

 are well acquainted with puerperal fever, which they call ' el 

 jarat/ or sometimes ' humma nafas,' or when slight they term it 

 milk fever, or ' humma laban,' and which they consider to be 

 transmitted from one case to another. 



The civilized peoples of Khartoum and Omdurman, more especially 

 the Greeks, Syrians, and better-class natives, suffer from febris puer- 

 peralis and fehris in puerperio, but no statistics are available to 

 show the incidence of the disease. 



As regards Zanzibar, the deaths from puerperal fever are given 

 as eight out of a total mortality of 1,022, of which 572 are female 

 deaths at all ages. 



In none of the above statistics is it possible to compare the 

 puerperal deaths with the number of births, as these were not 

 accurately known. 



In the West Indies and in Central and South America the fever 

 is not uncommon, and Brooke, writing in 1908, with his experience of 

 the West Indies and Singapore, says: — 



' The mortality and morbidity from puerperal sepsis and the infantile death- 

 rate among native communities are enormous.' 



He blames the village midwife or handywoman, who, he says, 

 is a prejudicial, ignorant, and dirty person, and summarizes his 

 remarks by stating: — 



We see that, for the native woman under her native skies, want and poverty 

 may play havoc with the child that is to be, but there is often a physical 

 environmen t of ignorance and sepsis during labour which demands the attention 

 of pubUc opinion.* 



Our experience in various tropical and subtropical regions 

 supports these statements made by Brooke. 



Etiology. — Early in the seventeenth century there appeared the 

 idea of a double origin for the fever- — viz., the autcgenetic and the 

 heterogenetic — and also that the disease was microbic in origin 

 (Kircher, 1671). 



In 1788 Denman observed that the disease was carried from cases 

 of puerperal fever to healthy lying-in women by doctors and mid- 

 wives, which view was strongly supported by the work of Alexander 

 Gordon in Aberdeen in 1795, and by Oliver Wendell Holmes in 

 America in 1843, the last-named observer asserting that not 

 merely could it be conveyed in this manner, but that it could come 

 in a similar way from a case of erysipelas or from a post-mortem, 

 and that it was necessary for the physician to disinfect his hands 

 and to change his clothes after leaving a case of puerperal fever. 

 This work was ably supported and put upon a sound basis by Sem- 

 melweiss, whose brilliant researches are too wel Iknown to require 

 recapitulation. 



With these investigations the heterogenetic origin of the disease 

 was firmly estabhshed, and it now remained for the bacteriologists 

 to show the nature of the infective material which, when carried 

 from the sick to the healthy, produced the disease. 



