Puerperal Fever, Or Childbed Fever, a disease which attacks lying-in women, generally attended by an inflammation of the peritoneum, or of the uterus and its appendages, of a dangerous character. The name puerperal fever was given by Strother in his work on fevers (1716). Hippocrates gives accounts of cases of death in lying-in women which resembled the puerperal fever of to-day, as do Celsus, Galen, Avicenna, and others down to near the 17th century. From observations extending through the last two centuries it has been generally believed that the disease often prevails epidemically. It has been observed that lying-in women, attended by physicians coming from cases of erysipelas, gangrene, or sloughing sores of any kind, or from making post-mortem dissections, are very liable, sometimes almost certain, to be attacked with puerperal fever. These facts have caused several good authorities to regard the disease as due to the absorption of septic matter by an abraded surface on the body of the patient. Denman, an English obstetrician, is said to have been the first to assert that puerperal fever is often propagated by the medical attendant; and this view of the subject has been recently more particularly examined, and, with others in regard to its propagation by septic contact, adopted in Germany. That absorption may occur, there must be a fresh wound or abraded surface; if granulations have taken place, absorption is prevented.

Now fresh wounds exist in every parturient woman in consequence of laceration or abrasion during labor, and infection may take place by decomposition in the tissues of the patient, or it may have an external origin. The authorities who embrace these views do not therefore regard puerperal fever as contagious in the usual sense of the word, that is, spread by a specific contagion; but admit that it is manually transferable, while the septic matter may be brought from an external source in which puerperal fever is not present. - The virulence of cases which have been called puerperal fever has varied very greatly at different times and in the practice of different physicians, and the post-mortem appearances of the fatal cases have been unlike. Sometimes there would be found extensive lesions, not only in nearly all the pelvic viscera, but in other parts of the body. Sometimes there would be peritonitis alone, or with very few complications, and sometimes only the uterus would present much evidence of inflammation; and in some of the most rapidly fatal cases no evidence of established inflammation would be found.

Moreover, the number of recoveries would be great in the practice of some physicians, and many of the cases would present symptoms indicating little more than inflammation of the con-nective cellular tissue of the pelvic cavity. It will therefore be seen that the subject is one of the most difficult and perplexing which writers on obstetrics have to meet. No system of classification has been generally agreed upon, but several authorities, with the sanction of Sir James Y. Simpson and others, embrace within the term puerperal fever all those lesions of pelvic organs and tissues which in the puerperal state, under favorable circumstances, are liable to engender and propagate septic poison. But it is asserted by many high authorities that there is a form of the disease which is characterized from the first by symptoms indicating the operation of a virulent poison, and which has received the name of malignant puerperal fever, or puerperal typhus. This may be regarded as the true epidemic puerperal fever.

Those who maintain these views also believe in the contagiousness of the disease, and in their classification they separate epidemic puerperal fever from such affections as are specially named puerperal metritis, puerperal peritonitis, puerperal phlebitis, puerperal pelvic cellulitis, and puerperal septicaemia and pyaemia. The symptoms of epidemic or malignant puerperal fever usually commence with a chill between the first and third days after delivery, rarely being deferred to the fifth day, although sometimes to the eighth or ninth; but this is not one of the most important symptoms, for it is sometimes so slight as not to attract attention. In some cases, however, it is very severe and lasts 30 or 40 minutes or longer, and during the chill the pulse is small and quick; afterward it becomes fuller but more compressible, ranging from 110 to 150. There is more or less delirium, and vomiting is quite common. Sometimes these symptoms are intensified, and the patient succumbs to the attack in 24 or 48 hours.

In cases of the epidemic disease postmortem examination will sometimes reveal not many pathological changes, but sometimes they are quite extensive and similar to those in septicaemia and pyaemia. In cases of puerperal peritonitis, there may be nothing found except indications of inflammation of the peritoneum; but in cases of septicaemia and pyaemia there will usually be found abscesses in different parts of the body. The uterus will be found oedematous, and its lymphatics are usually distended with purulent contents, which are often traced to ulcers on the neck of the womb. There are often dilatations in the lymphatics as large as a hazel nut, filled with pus; and there are frequently abscesses in the body of the uterus causing perforations into the peritoneal cavity. The cellular connective tissue becomes inflamed and filled with serum, and often pelvic peritonitis follows this, and may extend to the general abdominal cavity, its contents becoming more or less adherent to each other from the formation of false membrane. Changes occur in other cavities besides that of the peritoneum; extravasations of blood are often found beneath the lining membrane of the heart and the mucous membrane of the intestines.

There is also often found pericarditis and inflammation of the joints, most frequently in the shoulder and knee, the pus undermining the surrounding parts, often to a great extent. Embolism of the blood vessels is common, especially in the lungs, the thrombi which form in these organs breaking up and passing on into the circulation. Pneumonia is frequent, with a great tendency to gangrene, caused by the presence of putrid emboli. The spleen is frequently enlarged, of a pulpy, greasy consistence and of a chocolate color; and the liver presents marks of fatty infiltration, embolism, and disintegration of liver cells. - The treatment in all these puerperal diseases depends upon the extent and intensity of the attack, and upon the organs involved, and consists to a great degree in prophylactic measures, such as cleanliness, including the prevention of the reabsorption of septic matter, and a bland but not innutritious diet. The medical attendant should exercise the most extreme care not to approach the lying-in chamber after attending cases of erysipelas or scarlet fever, or any other contagious disease.

If he has recently attended a post-mortem dissection, he should bathe his person, use carbolic or salicylic acid gargles, and change his entire clothing. - See "Clinical Lectures on Diseases of Women," by Sir James Y. Simpson, M. D. (Edinburgh, 1871); "A System of Midwifery," by William Leish-man, M. D. (Glasgow, 1873); "On the Nature, Signs, and Treatment of Childbed Fever," by Charles D. Meigs, M. D. (Philadelphia, 1872); "The Puerperal Diseases," by Fordyce Barker, M. D. (New York, 1874); "Erysipelas and Childbed Fever," by Thomas C. Minor, M. D. (Cincinnati, 1874); and "A Manual of Midwifery," by Dr. Karl Schroeder (New York, 1875).