The first culture, of March thirteenth, contained only the organism of furuncles; the next one, that of the fifteenth, contained an organism resembling that of furunculosis, but which always differed enough to make it easy usually to distinguish it. In this way; whilst the parasite of furuncles is arranged in pairs, very rarely in chains of three or four elements, the new one, that of the culture of the fifteenth, occurs in long chains, the number of cells in each being indefinite. The chains are flexible and often appear as little tangled packets like tangled strings of pearls.
The autopsy was performed on the seventeenth at two o'clock. There was a large amount of pus in the peritoneum. It was sowed with all possible precautions. Blood from the basilic and femoral veins was also sowed. So also was pus from the mucous surface of the uterus, from the tubes, and finally that from a lymphatic in the uterine wall. These are the results of these cultures: in all there were the long chains of cells just spoken of above, and nowhere any mixture of other organisms, except in the culture from the peritoneal pus, which, in addition to the long chains, also contained the small pyogenic vibrio which I describe under the name ORGANISM OF PUS in the Note I published with Messrs. Joubert and Chamberland on the thirtieth of April, 1878. [Footnote: See preceding paper.]
Interpretation of the disease and of the death.—After confinement, the pus that always naturally forms in the injured parts of the uterus instead of remaining pure becomes contaminated with microscopic organisms from outside, notably the organism in long chains and the pyogenic vibrio. These organisms pass into the peritoneal cavity through the tubes or by other channels, and some of them into the blood, probably by the lymphatics. The resorption of the pus, always extremely easy and prompt when it is pure, becomes impossible through the presence of the parasites, whose entrance must be prevented by all possible means from the moment of confinement.
Second observation.—The fourteenth of March, a woman died of puerperal fever at the Lariboisiere hospital; the abdomen was distended before death.
Pus was found in abundance by a peritoneal puncture and was sowed; so also was blood from a vein in the arm. The culture of pus yielded the long chains noted in the preceding observation and also the small pyogenic vibrio. The culture from the blood contained only the long chains.
Third observation.—The seventeenth of May, 1879, a woman, three days past confinement, was ill, as well as the child she was nursing. The lochia were full of the pyogenic vibrio and of the organism of furuncles, although there was but a small proportion of the latter. The milk and the lochia were sowed. The milk gave the organism in long chains of granules, and the lochia only the pus organism. The mother died, and there was no autopsy.
On May twenty-eighth, a rabbit was inoculated under the skin of the abdomen with five drops of the preceding culture of the pyogenic vibrio. The days following an enormous abscess formed which opened spontaneously on the fourth of June. An abundantly cheesy pus came from it. About the abscess there was extensive induration. On the eighth of June, the opening of the abscess was larger, the suppuration active. Near its border was another abscess, evidently joined with the first, for upon pressing it with the finger, pus flowed freely from the opening in the first abscess. During the whole of the month of June, the rabbit was sick and the abscesses suppurated, but less and less. In July they closed; the animal was well. There could only be felt some nodules under the skin of the abdomen.
What disturbances might not such an organism carry into the body of a parturient woman, after passing into the peritoneum, the lymphatics or the blood through the maternal placenta! Its presence is much more dangerous than that of the parasite arranged in chains. Furthermore, its development is always threatening, because, as said in the work already quoted (April, 1878) this organism can be easily recovered from many ordinary waters.
I may add that the organism in long chains, and that arranged in pairs are also extremely widespread, and that one of their habitats is the mucous surfaces of the genital tract. [Footnote: When, by the procedure I elsewhere described, urine is removed in a pure condition by the urethra from the bladder, if any chance growth occurs through some error of technic, it is the two organisms of which I have been speaking that are almost exclusively present.]
Apparently there is no puerperal parasite, properly speaking. I have not encountered true septicemia in my experiments; but it ought to be among the puerperal affections.