Slowly, but very slowly, the teachings of these earnest men were adopted by the medical profession, with the result that in well-conducted, modern hospitals the precautions which have been described in preceding chapters are rigidly observed. And to-day, one woman in about 1,000 in such hospitals dies of puerperal infection, instead of one in ten, as in the early days. In the year 1864, 23 per cent. of the patients at the Maternité, in Paris, died of puerperal infection.
But unhappily, the decline in the occurrence of puerperal infection, in this country is largely confined to the hospitals, for in the homes throughout the land the disease is almost as common as it was in the days of our fathers, or even grandfathers. Of approximately 20,000 deaths from childbirth in this country during 1920, about one-half, or possibly 10,000 were from puerperal infection.
To the nurse there is considerable significance in Pasteur’s characterization of the infected young mother as an “invaded patient,” for the nurse’s preparation for labor and her care of the patient during the puerperium should be enormously influential in preventing this “invasion.” In this connection she may well ponder Miss Nightingale’s assertion that “The fear of dirt is the beginning of good nursing.” Certainly the obstetrical patient cannot be well cared for unless the nurse has this fear in her heart.
Puerperal infection, then, in the light of present information, is regarded as a wound infection caused by the streptococcus, gonococcus, colon bacillus, gas bacillus or any other pus producing organism. Of these, the streptococcus infection is the most frequently seen and is also the most serious, about 10 per cent. of such infections resulting fatally; while the gonorrheal infection, though seldom ending in death, usually causes sterility.
Infection during the puerperium occurs most often in the uterus, and, if mild, may amount to nothing more than endometritis, or inflammation of the uterine lining. In more serious cases, the inflammation may spread to the tubes and ovaries; may cause abscesses in the broad ligament and general peritonitis. A streptococcus infection may spread through the lymphatics and cause general septicemia.
Infection of the raw and bleeding placental site may occur at any time during labor or the ten days following, though the danger of infection decreases steadily after the first day postpartum.
Symptoms. The symptoms vary greatly according to the infecting organism and according to the site and extent of the inflammation. In mild types of infection, the patient may be entirely normal for the first three or four days and then complain of chilliness or even have a chill; her temperature will be slightly above normal, finally reaching about 101° F., where it hovers for ten days or two weeks, after which it drops again to normal and the patient recovers.
The severe type, which is so dreaded, is the one in which the patient is normal until the third or fourth day when she complains of tenderness, chilliness, weariness, and of being generally wretched. She may complain of chilliness but more often has a chill.
The pulse is usually rapid and the temperature goes up somewhat abruptly. (Chart [3].) The condition of the lochia depends upon the infecting organism. In streptococcal infection the lochia is often greatly decreased in amount and almost odorless, while in colon bacillus infections the lochia is profuse and foul-smelling. The attack may be very acute and result fatally in a few days, or it may gradually subside and the patient recover.
