1952 



DISEASES OF THE GENERATIVE SYSTEM 



The normal adult secretion has a bactericidal action when tested against 

 staphylococci, streptococci, and bacteria, but saprophytic organisms can grow 

 therein and may be obhgatory or facultative anaerobes, but are generally charac- 

 terized by having acidophile tendencies. Anaerobic organisms are common, 

 but obligatory aerobes are not frequently met with. Pathogenic organisms are 

 relatively seldom found in the normal secretion, being generally Staphylococci, 

 B. coli, and B. pseudodipMheriticus. 



With regard to the normal vaginal secretion during the puerperium, its 

 bactericidal powers are markedly increased by the lochia, and they do not return 

 to normal until several days after the birth of the child. Notwithstanding 

 this fact, obhgatory and facultative anaerobic streptococci, staphylococci, 

 and bacteria are to be found, as has already been indicated, and this fact appears 

 to us to be of the greatest importance when considering the method of infection 

 of puerperal fever. 



The secretion of the normal uterus is, by a consensus of opinion, considered 

 to be sterile. 



It would thus appear as though Geddes was correct in throwing 

 the responsibility of puerperal infection upon the attendants, as 

 both autogenetic and heterogenetic infections are probably due to 

 them in some way, but the former is much more difficult to prevent 

 than the latter. 



With regard to the latter, the researches of Chalmers and Atiyah 

 have thrown suspicion upon cow and horse dung as sources of 

 infection, and this has been confirmed by the work of Chalmers 

 and Marshall, who found the same organisms in bovine and equine 

 fseces. 



There are three native uses of cow and horse dung, and they are 



1 . Cow-dung Poultice. — This is commonly used by natives throughout the 

 Sudan, and is placed on any painful region of the body, and is, at times, applied 

 to the lower part of the abdomen and even to the external genitalia of the preg- 

 nant woman, and in this way may bring about an infection of the vagina with 

 bovine types of streptococci. 



2. Cow-dung Wash. — In many parts of the tropics it is not uncommon for 

 the natives to use a cow-dung wash for the floors and walls of dwelling-rooms 

 for the purpose of keeping away biting insects and also white ants, and although 

 the practice does occur in the Anglo-Egyptian Sudan it is not so common as 

 in other parts of Africa and in parts of Asia. 



Cow-dung, however, is used in Khartoum and Omdurman as a wash for the 

 tops of ovens, and especially of those used for baking bread, and also for the 

 walls of outhouses, especially those used for storing grains. 



3. Zibla. — It is also used at times in lieu of horse-dung as a constituent of 

 a mixture called zibla which is applied to roofs and walls. 



As this wash dries it must form dust, which must pollute the air 

 and be driven hither and thither by the strong winds, which are 

 often present in certain areas of the Sudan, and as the researches 

 of Andrewes and Horder have demonstrated that streptococci are 

 resistant to desiccation, it is possible that the dust derived from dried 

 cows' dung may contaminate the sterile instruments and hands 

 of the attendants on the parturient woman, and so bring about 

 puerperal infections, which would belong to the heterogenetic type. 



Once the disease has been started it is always possible for new 

 cases to be infected from previous cases by the agency of attendants, 

 and in this way an epidemic may arise at any time, or, failing this, 

 the infections may be kept up indefinitely by the same means. 



