Femina, A Work for Every Woman

by John A. Miller

Pasteur, Lister, Nægle and others, regard the decomposition in the tissues as a direct result of the vegetation of the bacteria. “Decomposition and fungus are inseparable; the one ceases when the other is removed. Processes of this nature set up by bacteria are best distinguished as fermentations.” Professor Ziegler, of the University of Tuebingen, says: “The healthy organism is always beset with a multitude of non-infectious bacteria. They occupy the natural cavities accessible from without, and especially the alimentary canal. They feed on the substances lying in their neighborhood, whether brought into the body or secreted by the tissues. In so doing they set up chemical changes in these tissues. While the organs are acting normally, these fungi work no mischief to the tissues in which they lie, or to the system generally. The products of decomposition set up by such non-specific micro-organisms are either harmless or are conveyed out of the body before they begin to be active.

“Settlements of this kind may, however, become of importance, if the bacteria proceed to develop to any unusual extent. This happens when the contents of the natural cavities in question remains unchanged for any great length of time, or when (as in catarrh) the normal secretion undergoes some alteration. The products of bacterial fermentation may then accumulate to an excessive amount, and products may be found which do not normally occur. Highly poisonous substances are formed in many of the bacterial decompositions. One of the most speedily fatal diseases, septicæmia, is due to blood-poisoning of the system with the products of bacterial putrefaction, or sepsis.

“Putrid or septic poison may be absorbed by wounds as well as by mucous surfaces. Septicæmia, which has just been cited as an instance of septic poisoning, is generally due to wound infection. It is due to the absorption of products of bacterial decomposition formed in a wound contaminated by bacteria.

“Infectious bacteria have the power of settling, not merely in the ingesta and secretions or in dead tissue, but also in living tissue. This happens chiefly in the mucous membrane of the lungs. The uninjured skin is protected against invasion by the horny epidermis. Many bacteria can settle in perfectly healthy mucous membrane. In the case of others we must imagine that they do not find a proper soil for their development, unless the mucous membrane is injured or altered. Of course, injury or alteration of this kind may serve to make the outer skin or any other accessible tissue, the starting-point of a bacterial invasion (wound infection). All that is necessary is that a bacterium should reach a spot that affords the conditions for its development. If this occurs, it multiplies and forms colonies or swarms. These may, according to the species of the fungus and the nature of the soil, remain in aggregation, forming heaps or masses, or may spread through the tissues. In general terms we may say that local settlements of bacteria will sooner or later bring about degeneration and necrosis of the affected tissue. When this may occur, and how widely it may spread, are circumstances depending on the nature of the bacteria and of the tissue.

“The inflammatory processes set up by bacterial action may be of very different intensity and extent in different cases. It may be slight or transient, or may be severe and issue in suppuration and an abscess.”

The above quotation is perhaps as concise and complete an explanation as the space in this article will permit, and if thoughtfully considered, it will be the means of understanding what is to be said of the disease under consideration.

Pelvic cellulitis is oftener found in childbirth, premature labor and abortion, for the reason that it is a wound infection, and the female organism, is always more or less wounded under these circumstances. In confinement the cervix is always more or less torn, and septic matter deposited there often speedily spreads along the lymphatics and veins to the pelvic cellular tissue, in fact, the entire uterine surface forms a suitable soil for bacterial growth. The vagina is also more or less injured or bruised through parturient efforts; this may be in the nature of a laceration or an abrasion of its mucous surface.

Outside of the above causes, the infection may be of traumatic origin, the most common causes being operative measures on the vagina or womb of a cutting, scraping or stitching nature, that were not carried out under strictly antiseptic precautions, guaranteeing the exclusion of septic germs. Dilation of the cervix with sponge tents or with instruments or probes that were not perfectly cleansed, causes infection and a decomposition of the retained secretions, which, becoming absorbed, leads to pelvic cellulitis. In surgical operations and puerperal conditions in which infection has been positively excluded, by careful antiseptic measures, pelvic cellulitis is impossible.

The inflammation in this disease is excited by the irritating influences of products of septic decomposition; these may have been introduced into the system at the time of confinement or of an operation, or they may have been in the vaginal tract before the operations were commenced. This teaches an important lesson, which few seem to have learned; it is this, that the strictest antiseptic regulations in a confinement or operation are of no avail, if the patient herself is not first thoroughly disinfected before the operation begins.

In the German Empire there is a legal provision giving full instructions for the necessary disinfection of the lying-in woman and her attendant; if there were such a wise provision in this country, we would not hear of so many deaths of women in childbed, from blood poisoning. At the Copenhagen International Medical Congress (1884), Professor Esmarch, one of the most celebrated of German surgeons, said that “humanity demands antiseptic treatment of wounds and wounded.” I believe that the time will soon come that antiseptic regulations in the treatment of diseases will not only be compulsory, but that a neglect of the same, causing death by blood poisoning, will make the attendant liable for exemplary damages.