A system of midwifery : including the diseases of pregnancy and the puerperal state / by William Leishman.

  • Leishman, William, 1834-1894.
Date:
1873
Catalogue details

Licence: Public Domain Mark

Credit: A system of midwifery : including the diseases of pregnancy and the puerperal state / by William Leishman. Source: Wellcome Collection.

    823/858 (page 805)
    Treatmeni.—The management of pelvic cellulitis and pelvi-jDeritonitis depends, in the first place, and very obviously, upon the nature of the case. It will depend, moreover, upon Avhether the symj)toms are acute or chronic; Avhether the disease is progressive or stationary; and ■whether there is already evidence of the formation of an abscess. It is quite clear, therefore, that on many points, the ordinary principles of surgical treatment must be our guide; but, in so far as the treatment to be pursued is identical with what a moderate acquaintance with clinical surgery would indicate, we shall not follow the subject. There are, however, many special practical considerations, most of which ex- perience alone can teach; but to one or two of these we may here briefly advert. Of the symptoms which call for promjDt treatment, none is of more importance than local pain,.. If the seat of the pain reaches above the brim, nothing is more grateful to the feelings of the patient, than the application to that region of poultices and fomenta- tions, which may bejprinkled Avith laudanum,.or other^vise modified to suit the exigencies of the case. When the tumour is more truly pelvic, and can only be felt from the vagina, the_ vaginal douche sometimes gives temporary relief, and in other instanceTniedicated pessaries, such as were recommended by Sir James Simpson, may be~eniployed. Ber- nutz strongly advocated the_internal use of conium, and it may even be necessary, to use some of the preparations of opium. The sufferings of the patient are sometimes greatly aggravated by the pressure which, the tumour exercises on neighbouring viscera, especially the bladder and the rectum, when the functions of these parts may be seriously interfered with. The exact nature of tliis class of symptoms will entirely depend upon the anatomical relations which the tumour bears to contiguous parts. When the pressure is forwards, in the direction of the pubic symphysis, the suffering which results from pres- sure upon the neck of the bladder is sometimes excruciating, and as ■ one result of this may be constant calls to micturate, which is often effccted with very great difficulty, the suff'ering which is thus produced may be intense. In some instances, the bladder can only be emptied by the regular use of the catheter. Wlien the pressure takes the other direction, the suff'ering is not so severe, but there is almost always more or less of pain in th^back: In some cases there is obvious mechanical interference with the function of the bowels, the diflSculty in the act of defsecation, and the flattened condition of the faeces, shewing clearly the nature of the case, In some instances, there is apt to be obstruc- tion of a more serious nature, as in pelvi-peritonitis, involving the bowel, when the patient suff'ers much, both from obstruction and\om flatulent distension. In every such case, the actioji of the bowel;^.