17,1 Rustia: Autoinfection during Puerperium 123 
Among the fifteen strains of hemolytic streptococcus found 
antepartum and differentiated further by means of carbohydrate 
fermentation, eleven were shown to be Streptococcus pyogenes, 
according to Holman’s classification. Of these eleven, four had 
caused infection during the puerperium, two of which were re- 
covered in pure culture, and the other two were associated with 
Staphylococcus aureus. Of the three nonhemolytic 'strepto- 
cocci isolated antepartum, one was found to cause fever during 
the puerperium. 
These facts seem to show beyond doubt that autoinfection 
plays an important role in the causation of puerperal infection, 
whether due to hemolytic or to nonhemolytic streptotococcus. 
CONCLUSIONS 
1. Healthy pregnant, parturient, and puerperal women who 
have not been previously examined may normally harbor pa- 
thogenic streptococci in the genital canal. 
2. The so-called autoinfection does really exist, but it should 
not be emphasized to such an extent as to impair the importance 
of aseptic and antiseptic procedures in handling obstetrical 
cases. 
REFERENCES 
Holman, W. L. The classification of streptococci. Journ. Med. Res. 34 
(1916). 
Walton and Medalia. Hemolytic streptococcus and puerperal septicemia. 
Surg., Gynecol, and Obstetr. 15 (1912). 
Williams, J. W. Puerperal infection considered from a bacteriological 
point of view, with special reference to the question of autoinfection. 
Am. Journ. Med. Sci. 106 (1893). 
