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4736

NORTHWESTERN LANCET.

ORIGINAL ARTICLES.

ST

PELVIC SUPPURATIONS: THEIR MENT BY VAGINAL INCISION AND DRAINAGE.*

BY WILLIAM E. GROUND, M. D.

West Superior, Wis.

MEDICA

Though abscess of the womb had been mentioned by tius and Paul of Egina, yet no systematic FEB 4 8pt of study of pelvic pathology was made 1899

It seems to be the failing of civilized man to make a complicated out of a very simple matter, to seek intricate solutions for easy problems, a far away revelation for immediate conditions. The spirit of mystification has been so long a part of our social and intellectual fabric, that it is hard of expurgation. It seems almost necessary to our development that we find truth by remote byways, that we seek and delve and suffer and die, that one faggot of truth might burn. I think no difficulty will be experienced in seeing this principle personified in the development of surgery. To let the mind run back over the ages that were evolving the present perfected state of our science is enough to fill us with amazement. How many

martyrs it took to discover the circulation of the blood; how much agony to develop anesthesia; how many lives to prevent suppuration. I do not mean by this to point the finger of scorn at our grand profession, for its shortcomings and failures pale into insignificance when compared with the history and development of religion and politics and natural sciences. I simply recognize it as a means by which our present advanced state of civilization was attained. Whether necessary or not I will not presume to say; I can only say it is to be deplored. The history of gynecology has not been one unblotted sheet. It has taken as much to develop gynæcology as it has her parent surgery, for without the principles of modern surgery, gynecology would never have gotten out of its swaddling clothes. I will not take up your time reiterating the various crazes of the faddists; these you know too well now; for whatever may have been the mistakes or delays in true progress, it is at least pleasant to know that the age of mere speculation and ignorant mysticism is passing; that the accurate knowledge and fuller certainties of the present day have been achieved by anatomical and pathological research together with patient clinical studies in the sickroom and operating theatre. The groundwork, then, of all true progress in medicine and surgery is founded upon exact anatomical and pathological detail. Outside of this is mere groping empiricism.

*Read before the Inter-County Medical Society, November 9, 1897.

until 18 About this time Bourdon described Fluctuating Tumors of the True Pelvis," and a

I

or so later Doherty called attention to inflammations of the uterine appendages, and in 1844 Calvi wrote on "Intrapelvic Phlegmonous Abscesses," while in the same year Churchill and Lever contributed to our knowledge of this subject. Any one who reads the literature of gynæ cology at this time, and even at a much later date, will be impressed with the fact that these writers considered all pelvic inflammations, exudations and abscesses as due solely to inflammation and suppuration in the cellular tissue of the true pelvis. Hence such terms as pelvic abscess, periuterine phlegmon, parametritis and pelvic cellulitis were applied to the same thing, viz: inflammation of the pelvic cellular tissue. In 1857, Bernutz, while making a post mortem on a woman who had died of so-called periuterine phlegmon, observed that the tumor, instead of being formed by inflammation of the pelvic cellular tissue, was really composed of the uterus, broad ligament, bladder and sigmoid flexure all matted together, the cellular tissue of the uterus and broad ligament not being involved. In 1862 Bernutz and Goupil set forth their ideas regarding pelvic inflammations as primarily affecting the tubes, ovaries and pelvic peritoneum. After much discussion on both sides, it is now conceded that the vast majority of pelvic suppurative disease is the result of infection through the uterus and Fallopian tubes, that outside of the introduction of sepsis into the lymph circulation by way of rents and tears after operation, abortions and deliveries at term, pelvic cellulitis is a very rare disease. The recognition of the fact that a large majority of the septic conditions requiring operative interference were located in the Fallopian tubes and immediate vicinity gave an impetus to the abdominal route as a means for relief. While I contend that the suprapubic opening of the abdomen has been resorted to too freely in the past, I am free to admit that it has been a necessary part of the evolution of intrapelvic surgery. For without the opportunity for minute inspection afforded an unobstructed view from above, many pathological details would have remained conjectural that are now clearly defined.

The idea of removing the products of extrauterine pelvic suppuration by vaginal incision and drainage has been a practical matter only a comparatively short time. To Landau, in Europe, and Henrotin, in this country, is due the credit of bringing this operation to the profession as a regular surgical procedure, although Emmett, 30 years ago, made a practice of puncturing pelvic phlegmons. It will be well to bear in mind in this connection the difference in the effectiveness

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