Introduction 1 2 3 4 5 9 10 14 15 17 Biography of Johann Joseph Scherer Versuche über die Wirkung einiger Gifte auf verscheidene Thierclassen 18 Chemische und Mikroskopische Untersuchungen zur Pathologie angestellt an den Kliniken des Julius-Hospitales zu Würzburg 15 1 18 Fig. 1 Title page of Scherer's 1843 book  The 1843 cases 'Untersuchungen von krankhaften Stoffen bei der im Winter 1842–1843 in Würzburg und der Umgegend herrschenden Puerperal-Fieber-Epidemie' Streptococcus pyogenes Another patient, the 28-year-old, 7 months pregnant (second pregnancy) Margaretha Glück, was, after being icteric, nauseous, vomiting and complaining about epigastric pain for 8 days, admitted to the lying-in birth clinic on 6 February 1843. Four days later she was transferred to the hospital with severe nosebleeds and generalised exanthema or purpura. In the evening she suffered from severe gastric bleeding and epistaxis, showing rapid pulse, cold extremities and dizziness. The next morning, she was transferred back to the birth clinic, where she gave birth to a premature child (30 weeks) and suffered from a severe post-partum fluxus. She was again transferred to the hospital with the following symptoms: cold clammy skin, tachycardia, severe lochia and persistent exanthema or purpura, but without signs of an acute abdomen. During the night of February 11, she became aphasic and restless, followed by chills and profound sweating. On the morning of February 13, she further deteriorated and bilirubinuria was detected. The next day she was comatose, finally developed rattling breathing and convulsions. Death occurred during the following night. Autopsy revealed a small intracerebral haematoma, normal lungs without pulmonary oedema, ascites and an anaemic, foul smelling uterus filled with purulent and decayed tissue and pus. Blood was also obtained directly from the heart during autopsy and lactic acid was found. In this case we could think of a haemorrhagic shock and cerebral haemorrhage due to clotting disorders possibly resulting from either acute fatty liver of pregnancy/HELLP syndrome, idiopathic thrombocytopenic purpura, thrombotic microangiopathy (TTP/HUS) or DIC. The case was most likely complicated by a sepsis (endometritis). Scherer himself diagnosed this case as septic endometritis. In the conclusions of his 1843 book, Scherer attached high importance to the fact that he found lactic acid in cases of puerperal fever, which he had not found before in healthy persons. He held the opinion that lactic acid was formed in blood during bodily deterioration in severe diseases like puerperal fever. Lactic acid was thus described for the first time in human blood and was demonstrated for the first time as a symptom of septic and haemorrhagic shock. 16 The 1851 article 2 Verhandlungen der Physikalisch-Medicinischen Gesellschaft in Würzburg’  17 Ameisensäure, Essigsäure und Milchsäure, die gleichfalls von mir schon früher als in der Milzflüssigkeit vorkommend bezeichnet wurden Fig. 2 left right  Further research 19 22 23 19 Allgemeinen Wiener Medicinischen Zeitung 'Handbuch der Physiologischen Chemie 24 25 26 27 29 30 Ich erlaube mir, den Inhalt meiner Arbeiten, die von Gaglio nur ganz flüchtig, von Berlinerblau gar nicht berührt sind, in Kürze zu reproduciren 31 11 32 33 34 35 15