Femina, A Work for Every Woman

by John A. Miller

Pelvic cellulitis generally develops itself in an acute form, and the symptoms are very similar to those of pelvic peritonitis, and, like the latter affection, there is always an exudation of inflammatory material in these cases, so that the meshes of the tissues become soaked like a sponge with water. The invasion of the infection is usually signalized by a distinct chill or rigors followed by an increased bodily temperature and a correspondingly rapid pulse. The commencement of a parametritis is not often without distinct symptoms that affect the nervous system. The patient feels uncomfortably depressed, a tired, worn-out feeling overcomes her, she loses her appetite, and there is pain in the pelvic cavity. This pain is partly due to an accompanying peritoneal irritation, or in some cases to a circumscribed inflammation of the peritoneum. Often the pain runs down the groin, along the course of the great vessels and nerves; this is occasioned from the exudation pressing on the trunks of these structures in the pelvis. Pain in the small of the back, and painful defecation, with an irritable bladder, are due to the same cause.

Phlegmasia alba dolens, or what was called before the dawn of modern pathological science, milk leg, is only another form or a complication of pelvic cellulitis. This occurs where the infectious inflammatory process runs along the cellular or connective tissue of the large vessels and nerves, to the connective tissue of the thighs; this is a very easy matter, because the vessels and nerves are imbedded in cellular tissue, and as the vessels leave the pelvis at the groin, this tissue is continuous with that of the extremities. When the inflammation gets into the thighs, it invades either the subcutaneous cellular tissue, that is, the connective tissue under the skin, or it runs along the trunks of the nerves and vessels; the affected limb becomes then edematous or swollen, hence the vague term of milk leg, because the milk has never anything to do with it. One time it was supposed that this affection is only possible after confinement, but this is an error, because phlegmasia alba may develop at any time from purulent infection, originating from any cause.

The so-called puerperal or childbed fever is also nothing more nor less than an infection of purulent secretion.

The extent of the exudation varies greatly, both in the pelvis and in the limbs. In the pelvis it is sometimes only a little swelling on each side of the womb, and between the folds of the broad ligaments, small nodules the size of walnuts can only be felt, while in other cases the entire pelvic roof is covered and soaked with the inflammatory effusion. The consistence of these swellings or tissues feels at first doughy or soft, but after the absorption has been going on for a while, it becomes as hard as a board. If the exudation begins to suppurate and an abscess forms, then the surrounding tissue becomes soft again, so that the fluctuation of an elastic tumor becomes recognizable.

In the majority of cases the inflammatory process becomes circumscribed in the pelvis, the fever subsides, and the pain and sensitiveness in the pelvis disappear. The exudation has also a circumscribed limit, becoming harder and smaller, until it finally has become entirely absorbed. In another class of cases, the swelling remains stationary for a long time and a solid tumor remains in the pelvic cavity, that may be mistaken for an ovarian or fibroid growth, but in the course of a long time, it may gradually become absorbed. In a certain proportion of cases the course of the disease becomes protracted or chronic, because the effusion is very slow to disappear. In these cases there is danger of general septic infection or septicæmia, and of a spreading of the cellular inflammation to the general peritoneal membrane, which would prove, quite likely, fatal. If the inflammation is violent and the infection intense, suppuration and abscesses will destroy the cellular tissue, and if the lower extremities become involved, the circulation in the affected limb may become permanently injured. The cellular tissue around the veins, or even the veins themselves, become more or less affected by the inflammatory process, so that the veins become compressed or constricted from the cicatrization around them, or their caliber may become obliterated from inflammation of the walls of the veins, thus offering a permanent impediment to the return of the blood to the heart; the affected limb now remains swollen, and the swelling may entirely subside in the recumbent posture at night, but during the day it returns again, to make the leg thick and clumsy.

TREATMENT.

Prevention in these affections is much better than cure. The treatment of a recent case of pelvic cellulitis must be energetically antiseptic. The seat of the infection must be discovered; the vagina or cavity of the uterus, as the case may be, must be thoroughly washed out with a 1 to 2,000 corrosive sublimate solution. After a thorough disinfection, the inflammation and pain can be checked or controlled by the application of ice bags; this is the remedy par excellence to check acute inflammatory processes. These bags are preferably of rubber, about 4x6 inches in size, and when filled with ice and before applied it is more comfortable to the patient to envelop the bag in a thin layer of flannel, which takes off the clammy coldness. The patient should be kept perfectly quiet and the bowels daily moved by a mild purgative. After the sensitiveness and the fever have subsided, the absorption of the hardened inflammatory remnants is promoted by the daily employment of hot sitz baths and the application of tincture of iodine to the inguinal regions, as well as the use of iodoform suppositories.

The employment of blistering fluids or plasters is of no particular value either to check the inflammation or promote the absorption.

If there are symptoms of suppuration forming abscesses, these should be freely opened into the vagina and their cavities thoroughly rinsed out with a disinfecting solution.