ETIOLOGY 



1949 



In 1871 von Recklinghausen found micrococci in the bodies of 

 persons dying from puerperal fever. The next important step was 

 the discovery by Pasteur in 1878-79 of his ' microbe en chapelet ' 

 in the blood of puerperal fever patients. 



As this organism belonged to the genus named streptococcus by 

 Billroth, in 1874, Arloing gave it the name Streptococcus puerperalis,- 

 in 1884, apparently believing that it was distinct from the organism 

 named S. erysipelatos Fehleisen, 1883, which is more popularly 

 known as S. pyogenes Rosenbach, 1884. Later Furneaux-Jordan 

 and Mackay have revived 5. puerperalis, but Arloing's name has 

 priority and stands for a synonym of S. erysipelatos. 



A new phase of the bacteriological history was opened in 1893 by 

 Veillon finding an obligatory anaerobic micrococcus in such diseases 

 as Ludwig's angina, suppuration of Bartholin's glands, phlegmonous 

 perinephritis, etc. This organism, which he called Micrococcus 

 fcetidus Veillon, 1893, though usually a diplococcus, can exist in 

 short chains, and therefore may well be a streptococcus. Halle, in 

 1898, found it in the secretions of the normal vagina as well as in 

 pus from Bartholin's glands and in the exudate of retained placentae. 

 It was next observed by Jeannin in 1907 to be present in numerous 

 cases of putrid puerperal infection, and is thought by Veillon's 

 pupils to be the same organism as the anaerobic streptococcus found 

 in vaginal secretion in 1897 by Menge and Kroenig, whose work had 

 been questioned by Koblank but supported by Nat vig, Schottmiiller, 

 and Hamm. 



In 1907 Gioelli reported the presence of a coccus, thought to be a 

 staphylococcus, which he found in a peri-uterine abscess and named 

 Coccus anaerohius Gioelli, 1907, while in 1908 he dealt with the 

 question of the bacteriology of puerperal infections. As this coccus 

 produces foetid gas it may well be the same as Veillon's organism. 



In 1910 Schottmiiller increased our knowledge as to the strepto- 

 cocci in puerperal fever by finding a new obligatory anaerobe, which 

 he called Streptococcus putridus, and which he found not merely in 

 puerperal fever, but also in otitis media, meningitis, cysto-pyelitis, 

 abscess of the lung, gangrene of the lung, and empyema, and he 

 followed this up in 1911 by two papers upon the aetiology of fehris 

 puerperalis and fehris in puerperio. 



In fifty cases of fehris puerperalis he found the following organisms 

 to be present thirty-three times — i.e., in 66 per cent., and in all 

 severe and fatal cases: — 



S. erysipelatos Fehleisen, 1883, in fifteen cases in the uterine discharges and 

 in two of these also in the peripheral blood. 5. putridiis Schottmiiller, 1910, 

 in fifteen cases in the uterus, including five blood infections. S. erysipelatos 

 with S. putridus three times in the uterine discharge, with both together in 

 the blood once and separately in the other two cases. 



He also met with Streptococcus mitior seu viridans, an aerobic 

 organism first described by himself in. 1903, in the uterus and blood 

 of one case. 



He considers that there are two distinct methods of infection: the 



