The patient is usually more or less shocked by the time the bleeding has been controlled and needs the rest, quiet and stimulation that are ordinarily employed in such cases. She should be well wrapped in blankets and surrounded with hot water bottles placed outside the blankets, watched constantly and moved frequently; salt solution or strong coffee are sometimes given by enema, or saline infusions or intra-venous injections may be given. The patient must be kept warm and quiet and pressed to drink large amounts of fluids.
But above all the nurse must remember that severe hemorrhage from a relaxed uterus can almost always be prevented if the fundus is kept hard, by massage when necessary, during the first hour or so after delivery.
Puerperal infection is usually regarded as a condition which results from the entrance of infective bacteria into the female generative tract during labor or the puerperium, to distinguish it from other infections which may occur coincidently with the puerperal state, but not necessarily be related to it.
Puerperal infection is one of the most destructive and most dreaded of the complications which may overtake the obstetrical patient, and has evidently been so considered since the days of Hippocrates. Until recent years this veritable scourge was so utterly baffling that it was regarded as more or less of a dispensation of a Divine Providence and therefore to be accepted with the same philosophical resignation as earthquakes and cyclones.
In dramatic contrast to this unresisting attitude is the present knowledge concerning the cause and prevention of this disease, and the general belief that it is a wound infection and therefore practically preventive; that it is to be ascribed to the carelessness of mankind rather than to the indifference of Providence.
This change is due very largely to the devoted work of three men who were deeply stirred by the tragic frequency with which young women laid down their lives in so-called “child bed fever.” These men were Ignaz Semmelweiss, Oliver Wendell Holmes, better known to Americans as poet and humorist, and Louis Pasteur, each contributing his own special observations to the sum of knowledge which was to mean so much to mothers of the future. Also the theories of Lister concerning antisepsis and the inauguration of the use of sterile rubber gloves by Dr. Halsted, of Johns Hopkins Hospital, has had the same life-saving effect upon obstetrical patients as upon all surgical patients.
In 1843, Oliver Wendell Holmes read a paper before the Boston Society for Medical Improvement, entitled “The Contagiousness of Puerperal Fever.” In this paper he presented striking evidence that in many instances, something was conveyed by doctor or nurse, from an ill person to a maternity patient with puerperal fever as a result. He was attacked and ridiculed for his theories and some of the leading obstetricians declared that it was an insult to their intelligence to expect them to believe that creatures too small to be seen by the naked eye could work such havoc.
In 1847 Ignaz Semmelweiss, of the Vienna Lying-in Hospital, decided as a result of some of his investigations that puerperal infection was a wound infection, and that the infecting organisms were introduced into the birth canal on the examining finger of the doctor or nurse, after contact with an infected patient or cadaver. Accordingly he required that all vaginal examinations be preceded by washing the hands in chloride of lime, after which precautions the mortality from infection dropped from 10 per cent. to less than 1 per cent. In 1867 Semmelweiss offered his theories and conclusions in a masterly work on this subject, the title of which may be translated as “The Etiology, Conception and Prophylaxis of Child-Bed Fever,” but the actual cause of the disease was still unknown.
But about 1879 Pasteur demonstrated what is now known as the streptococcus, in certain patients suffering from puerperal fever.
“Pasteur,” wrote M. Roux, “does not hesitate to declare that that microscopic organism (a microbe in the shape of a chain or chaplet) is the most frequent cause of infection in recently delivered women. One day, in a discussion on puerperal fever at the Academy, one of his most weighty colleagues was eloquently enlarging upon the causes of epidemics in lying-in hospitals; Pasteur interrupted him from his place. ‘None of those things cause the epidemic; it is the nursing and medical staff who carry the microbe from an infected woman to a healthy one.’ And as the orator replied that he feared that microbe would never be found, Pasteur went to the blackboard and drew a diagram of the chain-like organism, saying: ‘There, that is what it is like!’ His conviction was so deep that he could not help expressing it forcibly. It would be impossible now to picture the state of surprise and stupefaction into which he would send the students and doctors in hospitals, when, with an assurance and simplicity almost disconcerting in a man who was entering a lying-in ward for the first time, he criticised the appliances, and declared that the linen should be put into a sterilizing stove.”[[13]]