Fourth observation.—On June fourteenth, at the Lariboisiere, a woman was very ill following a recent confinement; she was at the point of death; in fact she did die on the fourteenth at midnight. Some hours before death pus was taken from an abscess on the arm, and blood from a puncture in a finger. Both were sowed. On the next day (the fifteenth) the flask containing the pus from the abscess was filled with long chains of granules. The flask containing the blood was sterile. The autopsy was at ten o'clock on the morning of the sixteenth. Blood from a vein of the arm, pus from the uterine walls and that from a collection in the synovial sac of the knee were all placed in culture media. All showed growth, even the blood, and they all contained the long strings of granules. The peritoneum contained no pus.
Interpretation of the disease and of the death.—The injury of the uterus during confinement as usual furnished pus, which gave a lodging place for the germs of the long chains of granules. These, probably through the lymphatics, passed to the joints and to some other places, thus being the origin of the metastic abscesses which produced death.
Fifth observation.—On June seventeenth, M. Doleris, a well-known hospital interne, brought to me some blood, removed with the necessary precautions, from a child dead immediately after birth, whose mother, before confinement had had febrile symptoms with chills. This blood, upon cultivation, gave an abundance of the pyogenic vibrio. On the other hand, blood taken from the mother on the morning of the eighteenth (she had died at one o'clock that morning) showed no development whatever, on the nineteenth nor on following days. The autopsy on the mother took place on the nineteenth. It is certainly worthy of note that the uterus, peritoneum and intestines showed nothing special, but the liver was full of metastatic abscesses. At the exit of the hepatic vein from the liver there was pus, and its walls were ulcerated at this place. The pus from the liver abscesses was filled with the pyogenic vibrio. Even the liver tissues, at a distance from the visible abscesses, gave abundant cultures of the same organism.
Interpretation of the disease and of the death.—The pyogenic vibrio, found in the uterus, or which was perhaps already in the body of the mother, since she suffered from chills before confinement, produced metastatic abscesses in the liver and, carried to the blood of the child, there induced one of the forms of infection called purulent, which caused its death.
Sixth observation.—The eighteenth of June, 1879, M. Doleris informed me that a woman confined some days before at the Cochin Hospital, was very ill. On the twentieth of June, blood from a needle-prick in the finger was sowed; the culture was sterile. On July fifteenth, that is to say twenty-five days later, the blood was tried again. Still no growth. There was no organism distinctly recognizable in the lochia: the woman was nevertheless, they told me, dangerously ill and at the point of death. As a matter of fact, she did die on the eighteenth of July at nine in the morning: as may be seen, after a very long illness, for the first observations were made over a month before: the illness was also very painful, for the patient could make no movement without intense suffering.
An autopsy was made on the nineteenth at ten in the morning, and was of great interest. There was purulent pleurisy with a considerable pocket of pus, and purulent false membranes on the walls of the pleura. The liver was bleached, fatty, but of firm consistency, and with no apparent metastatic abscesses. The uterus, of small size, appeared healthy; but on the external surface whitish nodules filled with pus were found. THERE WAS NOTHING IN THE PERITONEUM, WHICH WAS NOT INFLAMED; but there was much pus in the shoulder joints and the symphysis pubis.
The pus from the abscesses, upon cultivation, gave the long chains of granules—not only that of the pleura, but that from the shoulders and a lymphatic of the uterus as well. An interesting thing, but easily understood, was that the blood from a vein in the arm and taken three-quarters of an hour after death was entirely sterile. Nothing grew from the Fallopian tubes nor the broad ligaments.
Interpretation of the disease and of the death.—The pus found in the uterus after confinement became infected with germs of microscopic organisms which grew there, then passed into the uterine lymphatics, and from there went on to produce pus in the pleura and in the articulations.
Seventh observation.—On June eighteenth, M. Doleris informed me that a woman had been confined at the Cochin Hospital five days before and that fears were entertained as to the results of an operation that had been performed, it having been necessary to do an embryotomy. The lochia were sowed on the 18th; there was not the slightest trace of growth the next day nor the day after. Without the least knowledge of this woman since the eighteenth, on the twentieth I ventured to assert that she would get well. I sent to inquire about her. This is the text of the report: "THE WOMAN IS DOING EXTREMELY WELL; SHE GOES OUT TOMORROW"
Interpretation of the facts.—The pus naturally formed on the surface of the injured parts did not become contaminated with organisms brought from without. Natura medicatrix carried it off, that is to say the vitality of the mucous surfaces prevented the development of foreign germs. The pus was easily resorbed, and recovery took place.