The ovaries are in delicate sympathy with all the other pelvic organs, and when these are affected there may be more or less pain in one or both of these glands. They may be even the seat of a neuralgic affection without any structural change in the organ or in the neighboring organs. This would be simply a reflex sign of a general debilitated condition, and to mistake all these for ovarian disease and to make it an excuse for their removal, is not warranted by careful observation. Electricity is now coming to the front as one of the most valuable remedies for just this class of affections, and I will give a detailed account of the nature of this remedy and the requirements for its successful application, which persons who speak lightly of its virtue, never acquire nor take the pains to possess.
CHAPTER XXIII.
PERIMETRITIS AND PELVIC PERITONITIS.
The peritoneum is a delicate, thin, serous membrane, that lines the whole internal surface of the abdomen and envelopes more or less completely all the abdominal organs, so that the viscera glide smoothly against each other with the least possible friction. The peritoneum dips down almost midway into the true pelvis, and its boundaries constitute also the limit of the abdominal cavity. That portion of the general peritoneum, which partly invests all the pelvic organs, is distinguished from the other by the term pelvic peritoneum. When the entire membrane becomes the seat of inflammation, the affection is a general peritonitis, but when the inflammation is limited to the organ that it infolds, the prefix peri, signifying around, is compounded with the name of the organ, and the suffix itis is added, which indicates that the peritoneal covering of such an organ is inflamed, hence, the term peri-metra-itis means inflammation of the peritoneum around the womb.
Pelvic peritonitis means that the peritoneum of the entire pelvic cavity is involved in the inflammatory process. This may include the peritoneal covering of all the other pelvic organs besides that of the womb as well as the peritoneal folds, that enter into the formation of the broad and other ligaments of the pelvic organs.
Perimetritis is rarely an independent uncomplicated disease, but oftener a complication of inflammation of the womb, the Fallopian tubes, ovaries, or of the cellular tissue that surrounds the organs and in which they are imbedded. The pelvic peritoneum and the cellular tissue are so intimately connected with each other by means of their vessels, nerves and lymphatics, that an inflammation easily runs from one tissue to another.
If we now inquire into the causes which induce this disease, we shall find that there is not a single inflammatory disease of any of the pelvic organs that may not lead to its inauguration. Metritis after an abortion or a confinement is a fruitful source, so are all the other causes that operate in exciting metritis indirectly concerned in this affection. Since etiology or the causation of diseases has been made a special study in connection with this subject, some startling discoveries have been made in regard to the origin of pelvic peritonitis.
Dr. Noeggerath, of New York, has found in the majority of cases that came under his observation, that pelvic peritonitis, either acute or chronic, is due to gonorrhœal infection. He claims that gonorrhœa in the male is in the majority of instances incurable; although it may be apparently cured, it continues as a latent affection which regularly infects his female companion. This shows itself at first as a slight vaginal catarrh, which gradually and stealthily spreads to the cavity of the womb, thence to the Fallopian tubes and ovaries and afterwards involving the pelvic peritoneum, for it must be remembered that the Fallopian tubes open directly into the peritoneal cavity.