Puerperal Fever and Pyrexias

A classification is made of 219 cases notified as puerperal fever or puerperal pyrexia. Of these, 71 were local uterine infections; 47, pelvic or general peritonitis; 11, pelvic cellulitis; 20, septicæmia or pyæmia; 12, pyelitis, and 58, febrile conditions not due to infection of the genital tract. Fatal cases were all due to general peritonitis or blood infections and the general death-rate for infections of the genital tract is 21·4 per cent. Of 32 maternal deaths, 7 followed abortion; 11 occurred in primiparæ, the preponderance of whom showed more or less severe trauma, and 13 in multiparæ in whom trauma was absent in the great majority. Similar antecedent circumstances were found in recovered cases of puerperal infection; from these figures an attempt is made to assess the importance of trauma in the production of sepsis. Two cases of puerperal scarlet fever are described and the transmission of infection in puerperal sepsis is discussed. A study has been made of sensitiveness to the hæmolytic streptococcal toxin in 103 cases of puerperal sepsis and the results do not bear out the suggestion that infection by the streptococcus in the puerperium is correlated with toxin sensitiveness.