THE PROPHYLACTIC USE OF SENSITIZED BACTERIAL VACCINES IN PUERPERAL SEPSIS
Authors: S. T. Champtaloup
Journal: BMJ (1914)

ARNOLD LEA1 -mentions three main factors which mnust be observed to secure a furtlher dimninution in puerperal infection and m-ortality.Tllese are:1. -Complete disinfection oni the part of these attendinAthe lyiog-in woman.2. Tlllie efficient disinfection of the external parts during labou-r, and the miaintenanice of cleanliness diUi-ing the first ten days after delivery.3. The limitation of examiiin-ation, and tlle avoidanice of operative interference as far as possible.Several cases of puerperal sepsis whicll have recenltly becei brouglht to miiy notice, alnd in -which all these precautions wvere faithifully observed, lhave led mc to in- vestigate tlhe subject witlh a view to prophylactic treatinent.Bacteria, of Femzale Gecnital Canal (luring NYormnal Preflgnancy.A great deal of resealclh has been devoted to the study of the bacterial flora of the fem:ale geniital canal during pregnancy, andc many contradictory reports have been publishe.d.It is well known that the vulva and vagina, and even tlhe uretlhra, may contain a very varied flora during noirnmal pregncancy, but in the main, research has been devoted to the detection of organismus wlich may be capable of producing infection.It is obvious that if such ale present, tlhere, are considerable possibilities for infection of the uterus duLiing or slhortly after labour.The pyogenic o-ganisnIs usually found singly or in combination are various streptococci, staphiylococci, and the Bacilluts coli, anld tllese are acconmpanied by a varying number of saproplhytic biicteria.The streptococcal gi'oup is probably one around whichl the most divergent opinions arise, and wlhile some workers report the presence of streptococci in 10 to 30 per cent. of cases, others, inieluding Kronig2 and Whitridge Williams,2 assert that if sufficient precautions are taken, no pyogeuic organisms, excepting occasionally the gonococcus, will be found in the vagina dutring pregnancy.IKronig2 has, howeveer, iJn a later paper, demonstrated the presence of streptococci in 20 per cent. of cases.It is, I thlinik, nowv generally accepted that the divergent results llitlcicto obtained wvere due to the methods em- ployecl, and tljat by tlhe use of suiitable culture iledia, streptococci can be detected in the vagina in a considerable ptoportion of pregnant womnen.A study of several of our recent cases suipports tllis view, for it seenms impossible (other-Wise to explain the streptococcal infectioln from whllich tlhev guffered.1rf7jp lovWer 4at of the cervical canal mnay conitain organismsi, but these do not appear to be able to penetrate the protective zone of the cervical secretion durina pregnanIcy.The cavity of the uterus is sterile during norlmlal pregnancy.We' thuS see that even in a normal pregnancy tlhere lie serious possibilities, in the lower genital canal, anid it is these posgibilities, and the accidents whlichl lhappen from tim6 to-timie, that have led me to bring forward the following suggiestions.Br .jriology of the Genital Tract (luring NormnalThe locliial dischlarge was formerly believed -to be sterile ih thc_ early days of the puerperiurmi.According to Leal organismns frequently ascend into the uiterine cavity after the first forty-eight hours, anid from tlle fourtlh to the niintlh day are present in considerable numAbers.Tlle organismi are nmainly tile saprophytic bacteria of the :Read before the Section of Public Health an(d State Medicine, Aes-tralasian-Medicdal Congress, Tenth Sessionl, held at Aucklan'd, lcbriiarv.1914.vagina, but very frequently organisms indistinguislhable from-those -causing wound infection are alsa present, and these include streptococci.Lea further states that I JuNB,6,