File:A textbook of obstetrics (1899) (14591652069).jpg

Identifier: textbt00hirs (find matches)
Title: A textbook of obstetrics
Year: 1899 (1890s)
Authors: Hirst, Barton Cooke, 1861-1935
Subjects: Obstetrics
Publisher: Philadelphia : Saunders
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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ptoms that willjustify the diagnosis of diffuse suppurative peritonitis, the abdo-men must be opened without a moments more delay thanis necessary for an aseptic operation. Even with the utmostpromptness the operation will almost always be too late, for theinflammation extends so rapidly and at first insidiously that bytin- time a diagnosis is possible1 the progress o( the disease cannot be stayed. It must be admitted, however, that an occasionalsuccess is possible by timely surgical interference.2 1 By diphtheric endometritis is meant a dirty, grayish- or greenish-brownexudate on the endometrium, containing mixed micro organisms, and not necessaril) tin- Klebs LOffler bacillus. For a report of one and the mention of four cases of true diphtheria of the genitalia see Williams, Amer. Jour, of I >bstet.,n August, 1898. 8 Hirst, A Diffuse, Unlimited, Suppurative Peritonitis in a Child-bearingWoman Cured by Abdominal Section, Medical News, 1894. A unique casein my experience. PLATE Io.
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PL HRFERAL SE RS/S. 68J Again, in the presence of exudate, adhesions, or unnaturalenlargement of any pelvic structure, suppuration may be sus-pected if the physical signs do not improve and if the tempera-ture, pulse, and general condition indicate a continuance of septicinflammation. It is hardly necessary to .state that if pus formsit must be reached and evacuated irrespective of its situation.Just how long to wait, however, is a question requiring experi-ence, good judgment, and a special study of each individual casefor its correct answer. Knormous pelvic and abdominal exudates may disappear ;adhesions may melt away ; enlarged and inflamed tubes, ovaries,and uterus may resume their proper size, functions, and conditionon the subsidence of the inflammation ; but in these favorablecases distinct signs of improvement manifest themselves in a fewdays, and the course of the disease is comparatively short. Amere protraction of septic symptoms is in itself suspicious, alongwith local sig

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