Sinclair, Sir William J.: Semmelweis. His Life and his Doctrine (Manchester, 1909)
VI. Publication or "Die Aetiologie"
IMPORT OF CHILDBED FEVER 205 to frequent examinations made with the object of ascertaining the position of the foetus. A proof of this is that before the introduction of chlorine disinfection nearly all the patients after labour, protracted in the dilatation period, died of puerperal fever. Infection seldom takes place during the expulsion stage because the surface of the uterus cannot then be reached. In the third stage, or after-birth period, and during the puerperium, the inner surface of the uterus is accessible, and at this time especially, the atmospheric air loaded with decomposed animal organic material may gain access to the internal genitals and set up infection.” Reference is again made here to the curious knee-joint case of 1847. “ In the after-birth period and during lying-in, the infection may be produced by the bed-linen coming into contact with the genitals which have been injured in the process of parturition. ...” Self-infection: The decomposed animal organic material which when absorbed brings on puerperal fever is in rare cases not conveyed to the individual from without but originates within the affected individual owing to the retention of organic material which should have been expelled in child-bed. Before its expulsion decomposition has already begun, and when absorption occurs puerperal fever is produced by Self-infection. These organic materials are the lochia, remnants of decidua, blood coagula which are retained within the cavity of the uterus. Or the decomposed animal organic material is the product of a pathological process, for example, the result of a forcible use of the midwifery forceps causing gangrene of bruised portions of the genital organs and consequent child-bed fever by Self-infection. “ When we declare that child-bed fever is a resorption fever in which as the result of absorption a blood- poisoning occurs, and then exudation follows, we do not imply that puerperal fever is peculiar to the lying-in
