1954 DISEASES OF THE GENERATIVE SYSTEM 



experience this quinine is best administered by intramuscular 

 injections, with or without oral administration, and should, in 

 nervous patients, be associated with a dose of sodium bromide. If 

 the temperature rapidly declines and the symptoms improve with 

 the quinine therapy, then the diagnosis of malarial fever may be 

 made, but if, as has more often happened in our experience, the 

 fever continues, then the disease is not solely caused by malarial 

 parasites. If there is reason to suspect that the puerperal fever is 

 septic3emic in type, or if early enteric fever in its broadest sense is 

 feared, then the diagnosis can be effected by removing aseptically 

 I c.c. of peripheral blood from a vein and immediately adding this 

 to nutrient broth medium contained in a flask, half of which is then 

 incubated aerobically at 37° C, while the other half is incubated 

 anaerobically at the same temperature, and both are examined at 

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



By these methods, and by these alone, as far as our experience 

 goes, can a case of puerperal fever be accurately diagnosed. 



Treatment. — ^The aim of the rational treatment of puerperal fever 

 must be to: — 



1. Kill the causal organisms. 



2. Neutralize their toxic effects. 



3. Promote the normal action of the patient's organs. 



In order to kill the causal organisms they must be attacked in the 

 positions in which they are living, and as this is usually the wall of 

 the uterus, it is necessary to give the patient an anaesthetic as soon 

 as possible and to thoroughly investigate the walls of the uterine 

 cavity in order to discover any portions of placenta, membranes, 

 or blood-clot, and at the same time to observe whether there is any 

 abscess formation in the vicinity of the uterus and also whether there 

 is any inflammation of the tubes, both of which conditions being 

 treated if present. 



Usually all that is necessary is the removal of offending sub- 

 stances from the uterus by means of a mild and modified form of 

 curettage, followed by a thorough antiseptic irrigation of its cavity, 

 which is then drained. 



After this the vagina and uterus should be irrigated twice or three 

 times a day with an antiseptic solution in bad cases, and less fre- 

 quently in mild cases. 



With reference to the second heading — viz., the toxic effects of 

 the organisms — if these are at all marked they should be combated 

 at once by means of injections of antistreptococcal serum if these 

 are the causal organisms, and by saline, subcutaneous, or intravenous 

 injections, which should be given early and not reserved until too 

 late for beneficial results to follow. 



The third point is a matter of common knowledge, and need not 

 delay us here. 



