Professor Xiaofeng’s Zhang Experience in Treating Postpartum Body Pain

Postpartum physical pain is common in clinic, mostly manifested in pain, numbness or weight, swelling and so on of limbs and joints during puerperium, and some of them fail to heal over the years, becoming stubborn “puerperal fever.” Mr. Zhang has been a doctor for more than 30 years. He has superb medical skills and has unique opinions on postpartum diseases. The author is lucky to follow-up. Now, his experience in syndrome differentiation and treatment of postpartum body pain is analyzed as follows, and the tested case is attached.

Virtues in Scientific Practice*

This chapter relocates the debate about the theoretical virtues to the empirical level and argues that the question of whether the virtues (and what virtues, if any) have epistemic import is best answered empirically, through an examination of actual scientific theories and hypotheses in the history of science. As a concrete example of this approach, the chapter discusses a case study from the mid-nineteenth-century debate about the transmissibility of puerperal fever. It argues that this case shows that the virtues are at least sometimes epistemic, but also that neither scientific realists nor anti-realists get it quite right: the virtues, even if epistemic, are not necessarily truth-conducive, but neither are they merely pragmatic. It also argues that the discussion of puerperal fever shows that the virtue question, as it is currently featured in the scientific realism debate, ought to be reformulated. We should examine not just whether a given scientific theory has virtues or not, but rather how debates among competing theories, all of which have some virtues, get resolved.

Marriage and Children

The chapter describes Venizelos's activities after his return to Crete from Athens in 1889. Family affairs were important, starting with marriage to Maria in December 1890, followed by the birth of Kyriakos (1892) and Sophocles (1894). Maria died of puerperal fever after the birth of Sophocles. Venizelos took this hard, his friends reporting his excessive display of grief, and statement that he would never marry again. This was a time of family concerns but also of legal work. He argued for exerting pressure on the Ottomans for reconvening the Assembly, but acting always within the law. In his legal practice he took on unpopular cases where necessary, and was quick to defend his honor when it was attacked. Meanwhile he extended his range of friends, mainly among liberals, and including the consuls general of the Powers, in which his improving English and French and skill at bridge paid off. He made clear e.g. to the journalist Dimitrios Kaklamanos his belief that Crete must adapt to circumstances and to the policies of the Powers.

Post Caesarian Pelvic Abscess, A Rare Entity not to Miss

Post caesarean pelvic abscess is a rare complication which may present without typical features of endometritis. It should remain as one of the differential diagnoses in any patient with refractory puerperal fever. Despite the use of antibiotic prophylaxis, it still can occur causing significant maternal morbidity requiring a complicated course of management with the need of an intensive care unit, drainage of pus under ultrasound guidance or sometimes may need surgical re-exploration or even hysterectomy. We report a case of pelvic abscess in a young lady following caesarean section who presented with puerperal pyrexia. She did not respond to broad spectrum antibiotic treatment and underwent ultrasound-guided transabdominal drainage of the pelvic abscess following which she had rapid clinical improvement and good recovery.

Out-of-season increase of puerperal fever with group A Streptococcus infection: a case–control study, Netherlands, July to August 2018

We observed an increase in notifications of puerperal group A Streptococcus (GAS) infections in July and August 2018 throughout the Netherlands without evidence for common sources. General practitioners reported a simultaneous increase in impetigo. We hypothesised that the outbreak of puerperal GAS infections resulted from increased exposure via impetigo in the community. We conducted a case–control study to assess peripartum exposure to possible, non-invasive GAS infections using an online questionnaire. Confirmed cases were recruited through public health services while probable cases and controls were recruited through social media. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) with logistic regression analysis. We enrolled 22 confirmed and 23 probable cases, and 2,400 controls. Contact with persons with impetigo were reported by 8% of cases and 2% of controls (OR: 3.26, 95% CI: 0.98–10.88) and contact with possible GAS infections (impetigo, pharyngitis or scarlet fever) by 28% and 9%, respectively (OR: 4.12, 95% CI: 1.95–8.68). In multivariable analysis, contact with possible GAS infections remained an independent risk factor (aOR: 4.28, 95% CI: 2.02–9.09). We found an increased risk of puerperal fever after community contact with possible non-invasive GAS infections. Further study of this association is warranted.

A rare association of puerperal ovarian venous thrombosis with pseudomembranous colitis

Ovarian venous thrombosis is a rare but serious complication associated with early puerperium. The risk of this complication increases with associated puerperal infection or inflammatory condition. The present case report is of a 36-year-old lady who presented after emergency caesarean with puerperal fever and abdominal pain along with diarrhoea post antibiotic cover. Patient presented with moderate ascites and uterine subinvolution on examination. Contrast enhanced computed tomography (CECT) showed evidence of bowel wall edema due of colitis along with ovarian vein thrombosis. Patients had persistent symptoms despite receiving an empirical course of injectable cephalosporins. Stool culture confirmed growth of Clostridium difficile. Patient developed a rare infection after a course of antibiotic i.e. pseudomembranous colitis caused by Clostridium difficile. Patient then received a course of injectable vancomycin after which colitis subsided. This case increases our vigilance on management of puerperal fever which could get complicated with life-threatening events like deep vein thrombosis.

Döderlein. Die Scheidensecretuntersuchungen. (Centralblatt für gynäkologie, No. I, 1894). Examination of vaginal secretions

In the beginning, D. is reviewing the results of studies by Burguburu, Williams, and Burckhardt. These results are quite similar to those presented by the author in his monograph Vaginal secretion and its significance in the development of puerperal fever. Then D. proceeds to the analysis of the above article by Krnig. The last day about the constant acidity of the vaginal secretion (which does not agree with the research of Dderlin and others) he explains by the property of the applied sensitive reactive papers, as well as by the amphoteric reaction.

Why Semmelweis's doctrine was rejected: evidence from the first publication of his results by Friedrich Wieger, and an editorial commenting on the results

We present English translations of two French documents to show that the main reason for the rejection of Semmelweis's theory of the cause of childbed (puerperal) fever was because his proof relied on the post hoc ergo propter hoc fallacy, and not because Joseph Skoda referred only to cadaveric particles as the cause in his lecture to the Academy of Science on Semmelweis's discovery. Friedrich Wieger (1821–1890), an obstetrician from Strasbourg, published an accurate account of Semmelweis's theory six months before Skoda's lecture, and reported a case in which the causative agent originated from a source other than cadavers. Wieger also presented data showing that chlorine hand disinfection reduced the annual maternal mortality rate from childbed fever (MMR) from more than 7 per cent for the years 1840–1846 to 1.27 per cent in 1848, the first full year in which chlorine hand disinfection was practised. But an editorial in the Gazette médicale de Paris rejected the data as proof of the effectiveness of chlorine hand disinfection, stating that the fact that the MMR fell after chlorine hand disinfection was implemented did not mean that this innovation had caused the MMR to fall. This previously unrecognized objection to Semmelweis's proof was also the reason why Semmelweis's chief rejected Semmelweis's evidence.

Gustav Adolf Michaelis (1798–1848)

Professor Gustav Adolf Michaelis was an outstanding German obstetrician-gynecologist, one of the founders of scientific obstetrics. He gained worldwide recognition for his studies on the “sacral rhombus”, named after him the “rhombus of Michaelis”. Dr. Michaelis was an honest, hardworking and rather critical person, so in 1847, he did not instantly accept the ideas of Ignaz Philipp Semmelweis’s on “preventing puerperal fever”. Only in 1848, Michaelis introduced the compulsory chlorine hand washing in his clinic and made sure that mortality had dropped significantly. He was very depressed when he realized how many women (including his beloved niece) died from postpartum fever due to unsanitary obstetric practices. On August 8, 1848, Gustav Adolf Michaelis committed suicide.