A text-book of practical obstetrics / by Egbert H. Grandin ... with the collaboration of George W. Jarman.
- Grandin, Egbert H. (Egbert Henry), 1855-
- Date:
- 1898
Licence: Public Domain Mark
Credit: A text-book of practical obstetrics / by Egbert H. Grandin ... with the collaboration of George W. Jarman. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
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![nosis between local and general peritonitis. Examination of the uterus with the finger to exclude septic focus there; palpation of the appendages, particularly by rectum, and, in case of doubt, with the assistance of deep surgical anaesthesia,—these and every other means should be used to clear the scene. Notwithstanding all these differential diagnostic means, there are a certain proportion of cases whore the physician will still re- main in doubt as to whether he is dealing with a local or with a genera] peritonitis. Then, in remembrance of the fact that, if the affection be local although simulating general peritonitis, the woman's chance of life depends, in all probability, on his speedy action, gloomy as is the prognosis, it is his duty to resort to the single therapeutic measure which affords a gleam of hope. It must never be forgotten that surgery is full of surprises, and that our finite methods of diagnosis must often be supplemented and aided through resort to most desperate measures. Local peritonitis presents itself under two forms,—as extra- peritoneal and as incapsulated intraperitoneal. The latter, how- ever, is really extraperitoneal in the sense that it is shut off from the general peritoneal cavity by adhesions, being originally intra- peritoneal. Etiologically the true extraperitoneal exudate which may suppurate is not usually associated with tubal or ovarian in- fection, whilst the latter form is generally the sequela. This is the main reason why a true cellular abscess carries a less grave prognosis than the intraperitoneal and yet extraperitoneal variety. The symptomatology of true pelvic abscess—that is to say, of abscess in the pelvic cellular tissue—may be as aggravated in type as the intraperitoneal form: and yet the outcome of surgical treat- ment is much more favorable. Whenever the local and the general symptoms point to the existence of pus in the pelvic cellular tissue, the sooner it is evacuated the better. As a rule, the point of election for operating will be the vagina, since it is here that an abscess of this character usually points. The operation is performed as follows: Thorough asepsis of the external genitals having been secured, under the guidance of](https://iiif.wellcomecollection.org/image/b21022501_0590.jp2/full/800%2C/0/default.jpg)
