William Squire

Croup and Diphtheria

meeting last year, the author pointed out the analogy of a poison derived from this source, and one derived from without. Only one case of puerperal fever had occurred, which could be clearly traced to the medical man having attended a similar case. This was pointed out as very satisfactory, because formerly the conveyance of this disease was largely owing to the attendants. After considering the influence of maniacal symptoms on the puerperal state, the cases were gone into which seemed to have no external origin, of which, twenty were reported. There were some in which symptoms appeared early in labour, of which, the symptoms appeared of a different kind to those which came on about the third to the fifth day. Some of the others were simply local, and probably traumatic, while others belonged to the typical puerperal fever. The various causes which might have produced dyscrasia in these, were alluded to; and, in conclusion, the author thought that the cases showed that the parts bruised and abraded by the forces of labour, tended to recovery; that if any animal poison, such as of zymotic disease, were imbibed by the patient, the system might be so rapidly affected, that death might ensue before the ordinary symptoms showed themselves; or that they might show themselves in a more or less modified form, or in a manner so distinct that its origin escaped detection; that, under these influences, the parts which should have recovered tended to serous effusion, which might go on to suppuration; or inflammation might arise at once or separately in the uterus or its neighbourhood, viz., metritis, cellulitis, peritonitis, etc., and from these the system might -again be affected by pyoemia and all its secondary affections, embolism, phlegmasia dolens, etc.; so that the patient was not only subjected to the influence of the primary poison, and to the local troubles thence resulting, but also to secondary blood-disturbance, the effect of the local mischief. So, also, offensive lochia would poison the system, and cause local irritations; but these, again, might affect the blood by pyxmia, etc. In like manner, any depressing influence, mental, aerial, functional, etc., would tend to retard recovery of the bruised parts, so that they might go on to serous effusion, suppuration, etc., and end, perhaps, in pycemia and its results. Looking to the fact that, out of 86 severe puerperal diseases, more than three-fourths had been connected with exposure to animal poisons of one kind or another, the author endeavoured to impress upon all the great importance of removing these causes from the parturient woman, and particularly alluded to separation where scarlet fever existed in her house. The discussion on Dr. Hickss paper was postponed till the next meeting.