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44
A definition of the disease is much to be desired. Is the term
to include cases of puerperal sapraemia, of raised temperature
occurring during the puerperium presumably due to infection of
the uterus and genital passages, and conditioned by such infection,
or is the term to be confined to cases of undoubted puerperal
septicaemia ?
At one large hospital, 10 cubic centimetres of blood are taken
from the basilic vein in suspected cases, and a culture made upon
a suitable medium. If the culture proves positive, the case is
notified as one of puerperal fever. If no growth results, the case
is not notified. Under such circumstances, while waiting to learn
the result of the culture it is possible for a student who has been
attending the original case to infect a second case. This method
has additional grave drawbacks. An example will make this
clear.
A culture made during the life time of a patient disclosed no
growth. After death, however, the womb was found in a diseased
condition, there was long standing heart disease and a streptococcus
was isolated from the blood. Although the case had not
been notified as one of puerperal fever, yet it was signed up as
such on the death certificate.
It is obvious that the test by culture as a necessary antecedent
to notification is out of the question in private medical practice.
There is ground for the belief that some medical men notify
cases of puerperal fever only when the patient is seriously ill or
likely to die, for it must be remembered that a case of puerperal
fever is usually regarded as reflecting discreditably upon the
cleanliness and care exercised by the doctor during a confinement.
The Public Health Department is concerned with the preven2
tion of disease—its policy therefore is to include under any specific
disease term, borderland cases, and any cases which may be confused
with such specific disease, or offer difficulties in diagnosis.
A familiar example of this policy is seen in the extension of
notification to chicken pox during times of small pox epidemics.