The most careful attention must be given to the hygienic surroundings of the patient, the diet liberal and of the most nutritious character. The appetite should be sharpened by the administration of the bitter tonics, the best of which is probably the old tincture of bark (Huxham's). Quinine should be given in doses sufficient to control the temperature when necessary, and for its tonic properties. The blood should be improved by the exhibition of iron, arsenic, and the bichloride of mercury in the form of the mixture of the four chlorides, first used, I believe, by Tilt of London. There can be no doubt as to the value of the combination in cases of plastic exudations. The following is the formula which I am in the habit of using:
| Rx. | Hydrarg. chloridi corrosivi, | gr. j; |
| Liq. arsenici chloridi, | fluidrachm j; | |
| Tr. ferri chloridi, Acid. muriatici diluti, aa. | fluidrachm iv; | |
| Syr. simplici, | fluidounce ij; | |
| Aquæ, q. s. ad | fluidounce vi. |
M.—Sig. Dessertspoonful, well diluted, after meals.
The dose of the arsenic and bichloride of mercury can be increased, after it is found that the mixture does not disagree with the stomach, to six drops of the former and a sixteenth to a twelfth of a grain of the latter. The effect of the medicine must be carefully watched, however. After the remedy has been taken two weeks it should be discontinued and some other form of tonic substituted for a week or two. The syrup of the iodide of iron, or the iodide of iron in pill form, will serve well as the substitute. If the patient should tire of the above or the remedies should not agree, some other form of tonic must be given. I have found the following an excellent tonic pill:
| Rx. | Strychniæ sulphatis, | gr. j; |
| Acidi arseniosi, | gr. j; | |
| Quininæ sulphatis, | gr. xlviii; | |
| Ferri sulphatis, | gr. xlviii; | |
| Ext. hyoscyami, | gr. xij; | |
| Ext. gentianæ, | q. s. |
M. et ft. pil. No. xlviii.—Sig. One to two pills after each meal.
As soon as practicable the patient should have a change of air and scene.
Perimetritis.
Having treated the subject of inflammation of the pelvic tissues generally, in the acute form, under the head of Parametritis, with sufficient fulness to answer the purposes of the practical physician, whether the disease dominate the connective tissue or the peritoneum covering it, I shall, under the head of Perimetritis, consider the subject in its chronic aspect principally.
DEFINITION AND SYNONYMS.—I have defined parametritis to be an inflammation of the cellular or connective tissue near the uterus and beneath the pelvic peritoneum, including principally the locality close to the lateral margin of the uterus between the layers of the broad ligaments, although embracing also all of the various spaces where connective tissue abounds—viz. between the peritoneal folds which form the utero-sacral and utero-vesical ligaments. I cannot more clearly or more simply define perimetritis than by stating that it means an inflammation of the peritoneum which serves as a covering and boundary-line for the connective-tissue spaces involved in parametritis. As the term parametritis is used to conveniently express the idea of the existence of an inflammation in the connective tissue near the uterus, so the term perimetritis conveniently and tersely expresses the idea that the inflammatory process exists around the uterus in the pelvic peritoneum. In the acute form it is difficult to differentiate between them clinically, nor is it necessary, from a therapeutic standpoint, to do so. The term perimetritis is synonymous with pelvic peritonitis.