I

4736

How many

NORTHWES MES LANCET.
ORIGINAL ARTICLES

Thoingh abscess of the womb had been mentioned

by tius and FEB 4

Paul of Ægina, yet no systematic 1909 attempt of study of pelvic pathology was inade

until 18. About this time Bourdon described PELVIC SUPPURATIONS: THEIR REFRARE

:

fluctuating Tumors of the True Pelvis," and a

of so later Doherty called attention to inflamMENT BY VAGINAL INCISION

mations of the uterine appendages, and in 1844 AND DRAINAGE.*

Calvi wrote on "Intrapelvic Phlegmonous Ab

scesses,” while in the same year Churchill and BY WILLIAM E. GROUND, M. D.

Lever contributed to our knowledge of this sub

ject. Any one who reads the literature of gynæ cWest Superior, Wis.

ology at this time, and even at a much later date,

will be impressed with the fact that these writers It seems to be the failing of civilized man to considered all pelvic inflammations, exudations and make a complicated out of a very simple matter, abscesses as due solely to inflammation and supto seek intricate solutions for easy problems, a far puration in the cellular tissue of the true pelvis. away revelation for immediate conditions. The Hence such terms as pelvic abscess, periuterine spirit of mystification has been so long a part of phlegmon, parametritis and pelvic cellulitis were our social and intellectual fabric, that it is hard of applied to the same thing, viz: inflammation of the expurgation. It seems almost necessary to our de- pelvic cellular tissue. In 1857, Bernutz, while velopment that we find truth by remote byways, making a post mortem on a woman who had that we seek and delve and suffer and die, tliat one died of so-called periuterine phlegmon, observed faggot of truth might burn. I think no difficulty that the tumor, instead of being formed by inwill be experienced in seeing this principle person- flammation of the pelvic cellular tissue, was really ified in the development of surgery. To let the composed of the uterus, broad ligament, bladder mind run back over the ages that were evolving and sigmoid flexure all matted together, the celthe present perfected state of our science is lular tissue of the uterus and broad ligament not enough to fill us with amazement.

being involved. In 1862 Bernutz and Goupil set martyrs it took to discover the circulation of the forth their ideas regarding pelvic inflammat:ons as blood; how much agony to develop anæsthesia; primarily affecting the tubes, ovaries and pelvic how many lives to prevent suppuration. I do not peritoneum. After much discussion on both sides, mean by this to point the finger of scorn at our it is now conceded that the vast majority of pelvic grand profession, for its shortcomings and failures suppurative disease is the result of infection pale into insignificance when compared with the through the uterus and Fallopian tubes, that outhistory and development of religion and politics side of the introduction of sepsis into the lymph and natural sciences. I simply recognize it as a circulation by way of rents and tears after operameans by which our present advanced state of civ- tion, abortions and deliveries at term, pelvic ilization was attained. Whether necessary or not cellulitis is a very rare disease. The recognition I will not presume to say; I can only say it is to of the fact that a large majority of the septic conbe deplored. The history of gynæcology has not ditions requiring operative interference were lobeen one unblotted sheet. It has taken as much cated in the Fallopian tubes and immediate vicinto develop gynæcology as it has her parent surg- ity gave an impetus to the abdominal route as a ery, for without the principles of modern surgery, means for relief. While I contend that the supragynæcology would never have gotten out of its pubic opening of the abdomen has been resorted swaddling clothes. I will not take up your time to too freely in the past, I am free to admit that reiterating the various crazes of the faddists; it has been a necessary part of the evolution of inthese you know too well now; for whatever may trapelvic surgery. For without the opportunity have been the mistakes or delays in true progress, for minute inspection afforded an unobstructed it is at least pleasant to know that the age of mere view from above, many pathological details would speculation and ignorant mysticism is passing; have remained conjectural that are now clearly that the accurate knowledge and fuller certainties defined. of the present day have been achieved by anatom- The idea of removing the products of extraical and pathological research together with pa- uterine pelvic suppuration by vaginal incision and tient clinical studies in the sickroom and operat- drainage has been a practical matter only a coming theatre. The groundwork, then, of all true paratively short time. To Landau, in Europe, progress in medicine and surgery is founded upon and Henrotin, in this country, is due the credit of exact anatomical and pathological detail. Out- bringing this operation to the profession as a regside of this is mere groping empiricism.

ular surgical procedure, although Emmett, 30