Excerpt from The American Journal of Obstetrics and Diseases of Women and Children, Vol. 38: July-December, 1898

The differential diagnosis must not be overlooked, since it is possible, and indeed not uncommon, that a local pelvic inflammation, which may then be of the extraperitoneal character, may be the cause of the chill and fever. A digital examination will of course reveal the existence or absence of such a pelvic inflammation. The accidental presence of an appendical inflammation must also be borne in mind at this time, as there is no reason why such an occurrence might not be met with during the puerperal state as well as at any other time. I have seen and recorded just such a case. Of course, if there is an absence of any pelvic reason for the chill and pyrexia, other organs of the body, such as the blad der, kidneys, lungs, etc. Should be examined for a possible solution of the difliculty. To the formation of a correct diagnosis it is absolutely essential that an examination of the genital organs should be made: first, with the finger to ascer tain whether there is any lesion of the external organs, of the vagina or the cervix, and then to determine whether the cavity of the uterus is empty or whether there is contained in it some septic focus, such as portions of the placenta, membranes, coagula, or whether the endometrium presents the peculiar spongy, thickened, and f arrowed feel of puerperal septic endo metritis. If thought advisable a specular examination may be made of the vagina and cervix, which may reveal a laceration of those parts, the surface of the wound presenting a yellow or brownish gangrenous appearance. Although in some quarters true diphtheria of such lesions of the vagina and cervix has been considered a not unusual condition, I myself confess that I have seen but very few cases in which I could interpret the peculiar appearance of the wound as indicative of diphtheria proper, and then only when it was unquestionable that the in faction had been transmitted from diphtheritic sore throat in some other member of the family. Usually the uterus is found more or less dilated and not in the condition of normal contrac tion corresponding to the time after delivery. If septic endo metritis is the cause of the constitutional infection, the walls of the uterus are very much thickened and the parametria usually infiltrated and pufiy.

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