MTIOLOGY— METHODS OF INFECTION 1951 



4. S. mitior Schottmiiller, 1903. 



5. 5. puerperalis Furneaux-Jordan and Mackay, 1912. 



6. S. salivarius Andrewes and Horder, 1906. 



7. 5. hovinus Broadhurst, 1915 (synonym, 5. hovis Chalmers and 

 Atiyah, 1916). 



8. S. versatilis Broadhurst, 1915. 



Other Organisms. — Streptococci are, however, by no means the only organ- 

 isms found in puerperal fever, as the following have also been recorded: 

 Aurococcus aureus (Rosenbach, 1884), Albococcus tetragenus (Gafiky, 1884); 

 Dipiococcus pneumonicB (Weichselbaum, 1887); Dipiococcus gonorrhcecB (Bumm, 

 1885); Bacillus colt (Escherich, 1886); but Bacillus typhosus (Zopf, 1885) 

 (Eberth's bacillus) only rests under suspicion, while B. pseudodiphtheriticus 

 has also been reported. 



Among the anaerobic organisms other than streptococci the following have 

 been met with in puerperal infections : Bacillus emphysematoscB (Frankel, 1 893) ; 

 Bacillus tetani (Fliigge, 1886); and a vibrio described by Curtis in 19 13, and 

 probably by Kroenig in 1895, which, though deserving of a definite appellation, 

 is still unnamed. 



Abortion. — A very interesting point is the question whether the same organ- 

 isms are found post abortum as post partum. This was investigated by Schott- 

 miiller in 191 1, more particularly in criminal abortions, with the result that 

 he found the following organisms arranged in order of frequency to be present: 

 S. putridus, a Staphylococcus, B. coli, and B. emphysematoscB, while S. erysipe- 

 latos was relatively rarely met with. 



Febris in Puerperio. — Another point of interest is the organisms causing 

 febris in puerperio — i.e., the slight fever known by Willis' name of lacteal or 

 milk fever, which is frequently met with post partum. This has also been 

 investigated by Schottmiiller and Heymann, who found the following germs to 

 be present: 5. putridus, a Staphylococcus, B. coli, B. erysipelatos, B. vagincs, and 

 B. emphysematoseT', arranged in order of frequency. 



Thus it would appear that the same organisms occur in the mild and in the 

 severe infections, a fact which places on a sound basis Willis' observation that 

 the mild lacteal may become the severe putrid fever. 



■■ Methods of Infection. — ^Adverting to the methods of infection of 

 the parturient woman, we note that Geddes in his ' Statistics of 

 Puerperal Fevers/ published in 1912, says that he believes 99 per 

 cent, of the cases are due to those conducting the labour. A state- 

 ment of this nature makes it imperative to possess some knowledge as 

 to the presence or absence of bacteria in the normal vulva, vagina, 

 and uterus. 



This has been investigated by many workers whose researches make apparent 

 that the vulva at birth is germ free, but after seven to eight hours it contains 

 micro-organisms which have probably been acquired from the secretion of the 

 mother's vagina, the air, and the water of the first bath. As a rule the follow- 

 ing organisms are described as being present in the normal vulvar secretion : 

 Obligatory aerobes : Albococcus tetragenus, B. coli, and B. pseudodiphtheriticus. 

 Aerobes and facultative anaerobes : Albococcus albus and B. vagina. Obligatory 

 anaerobe ;a Streptococcus, probably S.fcetidus. 



With regard to the vagina this appears to be free from micro-organisms at 

 birth, at which time its secretion is acid, which is said to be due to carbonic acid, 

 and is also bactericidal, an action which cannot be due to leucocytes, which are 

 normally absent. 



Some twelve hours after birth the first bacteria can be found therein. The 

 secretion remains acid during life, but is now due to lactic acid, which is said 

 to be present in a strength of 0*4 per cent., and appears to be associated with 

 an oTga.msm, Bacillus vagina Doderlein, 1893. 



