Puerperal Septicaemia treated with Sensitised Vaccine

Kai Tiaki : the journal of the nurses of New Zealand, Volume X, Issue 4, 1 October 1917, Page 219

Puerperal Septicaemia treated with Sensitised Vaccine

Emily H. Siedeberg

By

, M.B.

Mrs. E. ? aged 39, admitted, to Hospital on 6th January, m her fifth pregnancy. Previous pregnancies : — First and third normal ; m the second she had post-partum haemorrhage, thrombosis m the left leg and mastitis ; m the fourth she had measles three months before delivery, albuminuria and troublesome varicose veins. Puring this fifth pregnancy she gave a history of pleurisy m the early months, later an illness which had been called congestion of the liver, with which she was ill for two and a half months, then excessive vomiting, headaches, and high blood pressure, no albumin. Labour had already begun when she was admitted to the Hospital. It was a vertex presentation, normal m every way. The baby, a female, weighed 8 lbs., but was badly afflicted with snuffles, and occasionally took slight convulsive turns, m which she became blue and cold. She died when a month old. The patient's temperature remained, normal for three days, and on the fourth day suddenly rose to 103.6 with severe headache, lochia free, no odour. An intra uterine swab was sent to the Bacteriological Department, which reported " Numerous streptococci m direct smears and m cultures." The next day, 10th January, at 8 p.m., 25cc. of polyvalent serum were given subcutaneously. There was a slight reaction, and by 11 a.m. the next day the temperature had fallen to 99.6. The dose was repeated, but the temperature steadily rose to 103.4 during the day. It was still the same at noon the next day, when a third dose was given. Within twelve hours there was a slight drop to 102, only to rise still higher to 104.8 at noon next day, 13th January. No serum was given that day. The temperature fell, so that by 8 a.m. on the 14th it was 100.2. By this time Dr. Champtaloup had prepared an autogenous sensitised vaccine, and the first dose of fifty million bacteria was given at 12 noon on the 14th, just as the temperature was rising. Being a sensitised vaccine, much larger doses can be given than with an

ordinary streptococcal vaccine, and at more frequent intervals, without risk to the patient. No reaction was felt after the first dose, and the temperature continued to rise. By midnight it was 103.4, but it then dropped next morning to 98.8. As it was rising by noon a dose of seventyfive million bacteria was given. In about an hour the patient complained of cold feet, and a feeling of illness, although she had hot bottles about her. She slept for two hours, but had confused dreams, and when she awoke she saw everything blue. She also complained of occasional sudden pains m her chest, with difficulty m getting her breath, possibly due to small emboli. The same and slightly stronger doses up to one hundred and ten million bacteria were given at intervals of two days during the next nine days, the temperature always rising to 103 deg. or over, and falling to between 100 deg. and 101 deg. the next morning. During this time different symptoms were complained of, sometimes acute pain m all the joints, sometimes acute pain at the back of the neck, sore throat, and distressing hot flushes. Round several of the injection spots a small area of redness developed. As the vaccine treatment seemed to be having no effect, and the injections were distressing to the patient, I decided to stop them. The only result was that the temperature went still higher, and did not fall m the morning. Dr. Champtaloup then advised me to try much smaller doses again ; and the first dose of forty-five million bacteria was given on 24th January, when the temperature was 104 deg. at 11 a.m., and she was feeling very weak and ill. A slight reaction, sending the temperature to 104.6, occurred within an hour, then the temperature fell rapidly, and that evening for the first time m two and a half weeks the evening temperature was lower than the morning. By 11 a.m. next day the temperature was normal. As it gave a slight indication of rising at noon, when it was 99 deg., the same small dose was repeated. The temperature fell to subnormal, and continued so for three days. This was

rather uncanny after the daily high temperatures we had been having, and had it not been that her general condition was excellent, and that she was now sleeping and eating well, we might have been alarmed at such a sudden fall to subnormal. Four days afterwards, no more vaccine having been given, the temperature rose to 100.8, and again the same dose was repeated. After that the temperature remained m the ninety-nines, and although two more small doses were given, it was more as a precaution than a necessity. From the time that the first small dose

was given all her distressing symptoms vanished. The same night she had a peaceful night, free from all pain m the joints and neck, and no sore throat. Her recovery from then on was rapid with no set-backs. This case is interesting and instructive from the point of view of dosage. The large doses had no effect m reducing the temperature ; they produced a big swing up and down, and caused distressing symptoms, but her condition remained serious. From the day that the first small dose was given, her recovery was rapid. {Erom the New Zealand Medical Journal.)