Licence: In copyright
Credit: A manual of midwifery / by Alfred Lewis Galabin. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
874/982 (page 844)
![arise from any septic origin. This is so far true that they may be due to a traumatic cause, such as the effects of difficult instrumental delivery. Even in this case, however, though there may be no virulent infection conveyed from without, yet the spreading cellulitic inflammation is probably associated with the jDresence of micrococci, especially in those cases which end in suppuration. The explanation may be that, when the vitality of the tissues is lowered by mechanical injury, organisms whose germs are commonly present are able to multiply in them. Again, parametritis not imfrequently appears to owe its origin to some exposure, or over-exertion, or coitus, too soon after delivery. Rut, in most such cases, the exciting cause only calls into activity a morbid [>rocess which had already existed in some latent degree. It is probable, therefore, that, in the ])uorpcral woman, parametritis and perimetritis never occur altogether apart from some se])tic element, although there may have been neither any conveyance of special poison, nor manifest decomposition in the genital passages. Some degree of ])arametritis is often associated with grave forms of septicsemia. Rut, if the ])arametritis is extensive, .and forms the main feature in the case, it is usnally implied that there is no gener.al septic infec- tion; and tliat, if any sj)ccial infection has been received, its effects are limited to the local inflanim.ation. Parametritis is thus an examj)lc of a condition which cannot be excluded from the group of .septic diseases, but yet the prognosis of which is generally favourable. Apart from pi’egnancy, ])rimary ]),arametritis hardly occurs, unless as the result of septic absor[>tion from some wound or operation on tlie uterus. Home parametritis, however, is often associated with perimetritis, and arises by extension of inflam- mation from the salpingitis which was an antecedent to the ])crimetritis. In the puerperal woman either parametritis or perimetritis m.ay be jjrimary, and the former is generally associated with some peri- metritis, from extension of the inflammation from the cellular ti.ssue to tlie peritoneum covering it. 4’he symptoms of primary puerpci’al perimetritis resemble those of general peritonitis, except that they are less severe, and pain and tenderness are limited to the neighbourhood of the pelvis. In parametritis, as in other forms of puerperal pyrexi.a, the onset is generally within the first five days. It is not, indeed, uncommon to meet with cases in which the onset is insidious, and which only attract attention at a much later period, sometimes several weeks after delivery, when the woman has begun to get about. Rut, in most such cases, there has been, shortly after delivery, pyrexia with slight pain, the cause of which as been overlooked. 4’he attack generally commences with rigor and sudden rise of](https://iiif.wellcomecollection.org/image/b21932645_0874.jp2/full/800%2C/0/default.jpg)
