Excerpt from The American Journal of Obstetrics and Diseases of Women and Children, Vol. 38: July-December, 1898
This takes place only when the germs are introduced from without; but the presence of such foreign bodies - as they then are - in the uterus certainly ofiers a much more favorable field for the location of germs than the empty and well-contracted endometrium. I am confident, however, that it is not always the fault of either the physician or the nurse if septic germs enter the genital tract after parturition, because I have seen several cases - three of them in my own experience - in which there was absolutely no possibility of the introduction of germs into the vagina, simply because in my cases I had not been for weeks in contact with anything of a septic character, not to mention that the most careful antiseptic precautions had been taken during the whole confinement, and still putrescence of coagula took place and a well-marked sapremia developed, which was speedily and permanently relieved by the removal of the putrid clots. Now, in these cases I believe confidently that the septic germs, wherever they came from and however they got there, were sucked into the gaping vagina during change of position of the patient - say, from the back to the side, or vice versa, or after a fecal evacuation - when the rela tions between the pelvic viscera and intraabdominal pressure changed so that the gaping vulva was placed in a favorable condition for the entrance of air by suction. Anybody who has heard the air expelled from the vagina after an examina tion through the Sims speculum, with the patient in the left semi prone or in the knee-chest position, during which exami nation it had of course entered, can easily understand how a change of position might permit air to enter the vagina through the gaping puerperal vulva. Finally, I have seen one instance in which I am perfectly sure by exclusion that the infection was brought about by the woman herself. She had intense puerperal sepsis, of which she ultimately died, and absolum no other cause could be found, after a careful inves tigation of all the circumstances surrounding the case, than a felon on the index finger, which had burst shortly before labor, the woman admitting that she had introduced another finger of that hand into the vagina to relieve an itching which she had experienced shortly after her confinement. I am aware that I may be criticised for entertaining these views both as to atmospheric and as to auto-infection; but if they are not correct I am at a loss to comprehend the source of infection in some cases that l have seen.
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