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PROGRESS OF MEDICAL SCIENCE 


70S 

was such as to lead to the suspicion of pregnancy with tuberculous 
peritonitis. The patient’s condition was so had that operation was 
declined, and death soon followed. At autopsy, extensive tuberculous 
disease was present, with extra-uterine pregnancy at the position of 
the left tube. The pregnancy had gone nearly to term and the placenta 
was attached interiorly and posteriorly along the rectum. The original 
implantation of the ovum had been on the lower and posterior aspect 
of the left tube. The tube had ruptured, but evidently without occa¬ 
sioning disturbance. 


The Prophylactic Use of Vaccines in Puerperal Sepsis.—In the 

Hrilish Med. Jour., June 0, 191*1, Cha.mtai.oui* describes his researches 
and experience in the prevention of puerperal sepsis by vaccines. As 
regards the pregnant woman, lie, with others, lias found that various 
sorts of pathogenic bacteria are present in the vagi during pregnnnov. 
In sepsis the streptococci and staphylococci with allied bacteria are 
most frequently present. In collecting material from the interior of 
the uterus for diagnosis, the writer has found the following method 
useful: He sends to the physician in charge a glass tube, containing a 
wire swab. A mark is made on the wire handle, when the swab end is 
just within the uterine end of the glass tube, another mark 2 inches 
further away, so that the practitioner knows just how much of the swab 
end is projecting beyond the glass tube when in the uterus. The uterine 
end of the glass tube is lightly plugged with cotton, to which a string is 
attached. The whole swab is placed in a good-sized test-tube, plugged 
with cotton, sterilized in the autoclave to avoid the charring of the 
cotton or the string. After sterilization the glass tube is removed from 
the test tube, and its uterine end dipped in sterile molten paraflin, 
which cools and forms an impervious cap. Instructions are issued 
with the swab outfit, stating that the uterus should be drawn down 
with forceps and the os exposed to view. After cleaning the os with 
sterile gauze the swab is passed until the end reaches the fundus. It 
is then withdrawn an inch and traction applied to the string, which 
pulls away the paraflined cotton cap. The swab is carefully pushed 
out of the glass tube by means of its projecting outer end and the 
interior of the uterus well swabbed. Finally the swab is drawn into 
the glass tube and that replaced in the sterile test-tube, in which it 
was sent out. If in town, the swab is carried in a vertical position to 
the laboratory, ami if in the country it is carefully packed in that 
position and sent by the quickest means available. This method has 
proven successful and is suflicicntly simple to be used in the average 
case. In some cases blood cultures can be taken and are of great value. 
In one, the streptococcus and bacillus coli were found in intra-uterine 
cultures and present in the blood. The writer distrusts all commercial 
imported sera, and he has not seen good results from antistreptococcus 
serum, although freshly prepared. He further believes that the indis¬ 
criminate use of vaccines in all sorts of cases is exceedingly injurious. 
He employs vaccines sensitized to the individual patient, with good 
results. While some investigators use living sensitized vaccines, be 
has not risked that, but kills bacteria employed in making these vac¬ 
cines. He urges the prophylactic use of these vaccines and illustrates 
it by the report of an epidemic of five cases of puerperal sepsis in a 



OIISTKTIIH'S 709 

maternity hospital. The first arose in a imiltipara, anil the inetliml of 
infeetion could not l>e ascertained. The intrn-uterine use of the swuli 
showed streptococci and sta|)hylococci. The patient did well with the 
use of streptococcic vaccine. Four other eases in the same institution 
contracted the infection, hut all recovered. Two remaining eases 
developed fever soon after confinement and were immediately treated 
with vaccines. The temperature promptly fell. The patients then 
remaining in the institution, hut not yet confined, were given vaccines, 
and passed through labor and the puerperal period without compli¬ 
cations. t'hnintnloup believes that Health Departments, which now 
give antityphoid vaccines and diplheria antitoxin for general use, 
should add to this sensitized streptococcic vaccines for prophylactic 
use in obstetrics. His experience indicates that doses of 100, Hot), and 
500 million of this vaccine, may he given at -IS-hour intervals, ten to 
fourteen days before the expected date of confinement. 


The Treatment of a Uterine Abscess by Sensitized Bacilli.— 
HitoroirroN-Ai.cocK reports in the llrilish Mnl. .lour., June (I, 1911, a 
ease recently treated at the St. lands Hospital of Paris, as follows: 
The patient was a married woman, aged fifty-live years, who complained 
a long-continued vaginal discharge of pus. On examination a probe 
could he passed through the cervix into an abscess cavity, which had 
developed following a hysterectomy. The pus from this cavity con¬ 
tained pure cultures of llaeillus protons. The patient’s treatment was 
limited to daily vaginal douches for cleanliness, and seven injections 
at intervals of three or four days of a culture of the bacilli made from 
the pus. The first dose being equal to 100,000,(XH), the last to 2,000- 
000,000. The bacilli were heated to 00° ('. for an hour before adminis¬ 
tration. Slight reaction followed the injections on the eighth day 
after the last injection, and sensitized vaccine was prepared from the 
patient’s blood. At this time a vaginal examination was again made, 
and the llaeillus protctls found in lessened quantity, but pure culture. 
On the tenth day after the last injection of dead bacilli the sensitized 
vaccine was given, one injection weekly for four weeks, the dose from 
■100,000,000 to 1,000,000,000. Very slight reaction followed and the 
abscess cavity was washed out with dilute antiseptic solution. After 
the fourth vaccine injection the discharge of pus entirely censed, but 
for security four other injections were given. At the date of writing, 
six months laid elapsed, the patient remaining in excellent conditions. 

The Treatment of Hemorrhagic Disease of the Newborn by Direct 
Transfusion of Blood,— Lkspinassk (Jour. Amrr. Mill. Assoc., June, 
13, 1911) reports fourteen cases of hemorrhage in the newborn treated 
by direct transfusion of blood. The arm of the donor is placed beneath 
the left thigh of the infant, the palmer aspect of the hand uppermost, 
so that the radial artery of the donor and the femoral vein of the baby 
may lie joined. During transfusion the child’s color greatly improves, 
it becomes vigorous, gains from eight to fourteen ounces in weight 
and is usually strong enough to nurse, ily weighing the baby before 
and after transfusion, the amount of blood received must vary from 
eight to fifteen ounces. These patients are not hemophiliacs and they 
usually recover rapidly after transfusion, and do well. The smallest