PATHOLOGY 



1953 



Pathology. — The post-mortem anatomy shows some of the features 

 well known in Europe. 



Symptomatology. — ^There seems to be no doubt that the same 

 organisms can cause the mild ' febris in puerperio/ and the severe 

 ' febris puerperaHs.' 



Why there should be such a difference is not clear, and must 

 depend in some way or another upon the general bodily condition 

 of the patient, and perhaps upon the strength of the streptococcal 

 strain, which, as is well known from laboratory experiments, varies 

 considerably. 



Be this as it may, there can be no doubt that one and the same 

 organism infecting the uterus can cause the mild ' febris in puerperio ' 

 or ' milk fever ' and the more severe and even fatal ' febris puer- 

 perahs,' the symptoms of which vary according as to whether there 

 is a local, more or less extensive infection, or a septicaemia. 



Prognosis. — A prognosis may be arrived at by observing improve- 

 ment or the reverse in the clinical symptoms, but more accurate 

 decisions may be deduced by a study of the opsonic indices taken 

 daily, provided that the causal organism is known and is available 

 in pure culture, the index, as already stated, remaining low or 

 sinking in serious or fatal cases, but rising as improvement sets in. 



Diagnosis. — -It is of the utmost importance that any fever attack- 

 ing a puerperal woman in the tropics should be assumed to be 

 puerperal fever until it is proved to be something else. 



The presence of one of the varieties of puerperal fever can be 

 confirmed : — 



1. By microscopical examination of stained smears of the intra -uterine 

 exudate taken aseptically by a sterile swab passed through a sterile speculum 

 inserted into a previously douched vagina. 



2. By cultural examinations in ascitic broth of the same exudate taken in 

 the same way, and incubated aerobically and anaerobically at 37° C. and 

 examined at the end of twenty-four and forty-eight hours. 



3. By a low opsonic index in the case of the streptococcal infections as 

 tested against the causal organism. This of course is especially applicable 

 in small or large local epidemics, when the causal organism will be available in 

 pure culture in the local bacteriological institute. 



With regard to the differential diagnosis, the most important 

 fever which requires attention is malaria occurring in the puerperium, 

 and this should be capable of easy differentiation by: — 



1. An examination of peripheral blood smears for the parasites, 

 or, if they cannot be found, by — 



2. A differential leucocytic count, with the discovery of a distinct 

 mononucleosis which cannot be explained by other protozoal infec- 

 tions, such as amoebic dysentery, kala-azar, etc. 



3. Enlargement of the spleen, not due to one of the forms of 

 tropical splenomegaly. 



If these three tests fail to decide the presence or absence of 

 malaria, then a few doses of quinine should be administered, and 

 can do no possible harm, and may even benefit the patient if a puer- 

 peral infection due to streptococci or bacteria is present. In our 



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