Vol. 60, 1909 - University of North Carolina at Chapel Hill

ABSTRACTS. 337
spinal fluid of epileptics. Later Donatli cases of normal puerperium, and that these
injected whole brain into the little animal streptococci may be haemolytic, yet in 70
intraperitoneally with no effect. He in- per cent, of the cases in which typical
jected animals with 10 per cent. sol. cholin haemolytic streptococci are found in the
and neurins and got typical fits. Buzzard lochia in the first days of the puerperium
and Allen did the same with the following fever will be present, while in cases in which
conclusions: 1. Repeated small injections during the first days they are found in
produce neither fits nor paralysis. 2. Larger masses and in pure culture, fever is almost
doses produce fits, but the dose must be very invariable. The examination of the blood
much greater than is ever found present in may also show the presence of infection, if
thecerebro spinal fluid of epileptics or para- the organisms are found in large numbers
lytics. 3. It is impossible for the fits of and on repeated examinations; the blood
epilepsy to be due to this cause. Handels- culture gives, if possible, conclusive eviman
injected guinea-pigs, and concludes as dence as to the bacteriological etiology of
follows: 1. Subdural, or intracerebral in- the disease, and also shows the severity of
jections produce fits which are not quite the infection. In discussing the prognosis,
like epileptic fits. 2. The symptoms were Zangemeister dwells upon the importance
only produced by doses much higher than of the signs at the beginning of the puerthe
amount found by Donath in the human perium, and considers that absolute sleepcerebro-
spinal fluid. 3. A single intra- lessness on the first night almost always
venous injection of cholin, even in a very goes before the outbreak of a severe infeclarge
dose, produced no efi'ect. Handels- tion. The greatest importance amongst
man next reviews the many chemical meth- prophylactic measures is given to the limiods
which have been used for the detection tation as far as possible of internal e.xamahd
estimation of the salt. He reviews the inations and of operations during labor;
work of Molt, Halliburton, Gunprecht, where these are necessary, rubber gloves
Donath, Otolski, Hammarslei, Salkowski, are to be worn. In addition to the avoid-
Maruzzi, McLean, Stauck, Rosenheim, ance in every w^ay of infection, the meas-
Kaufmann, Kutciier, and many others. He ures of prophylaxis include the absence, as
criticises the methods and modifies tliem. far as possible, of anything tending to
His chemical investigations led him to the lower the resistance of the organism, as,
following conclusions: "in all probability for instance, long-lasting narcosis, severe
no cholin is present in the cerebro-spinal loss of blood, intense chilling of the body,
fluid or in such small quantities as to be etc. The uterus after the birth should be
chemically unmeasurable," and he there- empty, and be kept empty, but if part of
fore concludes that "probably cholin plays the membranes are retained their presence
no part in the production of epileptic fits in is less dangerous than exploration of the
man." uterus to remove them. Zangemeister looks
upon active local treatment as not only use-
Puerperal Fever.-Zangemeister ( Bei- less but dangerous; where svmptoms of inhefte
zur Med. Klinik.) defines puerperal fection show themselves it is to be rememfever,
deals with its causes, with the differ- bered that the bacteria are either already
ent paths by which the infective processes limited in the endometrium, in which case
may spread, and with the diagnosis, prog- such measures as washing out, curetting,
nosis, and treatment of the different forms etc., are useless, or that they have already
of the disease. The most important forms spread beyond the limit of the endometrium,
of lymphangitis puerpealis, for the diagnosis and local treatment holds out no prospect
of wliich the distinguishing facts are given, of altogether removing them and may lead
are (1) endometritis puerperalis, (2) para- to their further spread. Where there is remetrilis
exsudativa, (3) the most severe tention of placental remains, together with
form leading quickly to peritonitis and gen- fever, Zangemeister advises that if the ineral
sepsis; it is to be remembered that with fection be recent a conservative treatment
peritonitis there is often no very high tem- should be adopted; if possible, until either
perature, and the most sev.- re cases may the uterus spontaneously empties itself or
end fatally without rise of temperature, at least until the infection has limited itself
The diagnosis of thrombophlebitis depends and the danger of propagation of the infecusually
in the beginning on the presence of tion from operative interference is reduced
high fever without any localization or pain; to a minimum. From experiments on anithe
subjective condition is in contrast with nials it appears that in the severe cases
the high temperature. Bacteriological in- which might be expected to end fatally
vestigation is of great interest in the proof something is to be hoped from the method
of puerperal infection. Although it has of extirpation of the uterus, if the cases
now been slicnvn that streptococci are pres- can be diagnosed sufficiently early. When
ent in the uterus in three-quarters of the abscesses form the pus is to be evacuated,