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129
1. This was a ten weeks' abortion in a woman aged 45, who
had five previous pregnancies—the last being a twin pregnancy in
1933 which terminated at 36 weeks. The woman had developed
phlegmasia alba dolens following this confinement and was ill for
six months. The home circumstances were poor. Before the
abortion occurred other members of the family had been under
treatment for influenza, and the woman's first symptoms—of sore
throat with rise of pulse and temperature—were diagnosed as
influenza. The doctor was recalled two days later because complete
abortion had occurred, and the following day the patient
complained of pain in the epigastrium and left side of the abdomen
(T. 99. P. 120. Resp. 32). She was sent to hospital the same day
as a case of pleurisy. On admission she was gravely ill (Temp.
101.6 deg.) with dyspnoea. An offensive discharge was washed out
of the uterus, and in spite of treatment the patient died four days
later of septicaemia. There was no evidence that the abortion was
procured.
2. The non-fatal case associated with abortion occurred in a
woman of 37 years who had five previous full time pregnancies,
and was apparently in good health when this incomplete abortion
occurred at 15 weeks. Part of the placenta was removed manually
two days later, and she was sent to hospital for further treatment.
She remained in hospital two weeks.
The available information regarding the two notified cases of
puerperal fever following full time deliveries is as follows:—
3. Primigravidae, age 22. Normal delivery, attended by
midwife. Doctor called for moderate post-partum haemorrhage
one hour after completion of third stage. Slight rise of temperature
on fourth day—attributed to congested state of breasts. On
eighth day rise of temperature and rigor. On ninth day seen by
obstetric consultant—tenderness and rigidity in left iliac fossa—
indefinite swelling in pelvis—uterus involuting normally—lochia
normal—sent to hospital as a case of ascending salpingo-oophoritis
(?) or parametritis (?) Diagnosis in hospital—moderately severe
infection with haemolytic streptococci and other pathogenic organisms
of the genital tract, with some spread to the pelvic peritoneum
and pelvic cellular tissues. In hospital five weeks. Complete
recovery.