A report on the scientific work of the surgical staff of the Women's Hospital in the State of New York.
- New-York Woman's Hospital
- Date:
- 1918
Licence: Public Domain Mark
Credit: A report on the scientific work of the surgical staff of the Women's Hospital in the State of New York. Source: Wellcome Collection.
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![vic examination reveals considerable disturbance in the uterine adnexa, usually unilateral. An illustrative case of this type of pyo- salpingitis was in the case of Mrs. W., the history being as follows: She was forty-seven years of age and still menstrually active. She was seized with a sudden attack of pain in her left side which was very severe, necessitating the administration of several] hypodermics of morphine. The physician who saw her was unable to make a definite diagnosis because no source of pelvic infection was appre- ciable at the time of the attack. Abdominal examination showed extreme tenderness over the left lower quadrant of the abdomen. Bimanually a mass could be made out in the left side of the pelvis. The patient says that she has been perfectly well for many years, that she had not suffered with any pelvic disease, that she had been mar- ried twenty-three years and had never conceived. At the time of operation a typical tuboovarian abscess was discovered, which was removed and the pus cavity drained. The right tube was the seat of a chronic obliterative salpingitis. Later questioning of the patient disclosed a typical history of gonorrheal infection. Here was a case where the infection must have been lying dormant for many years, only to start up anew and give rise to an acute recurrent attack of pyosalpingitis. In these pus collections, as a rule, no mi- crodrganisms can be demonstrated. They are safe surgical risks. In connection with this subject the question may be asked in what manner do these acute recurrent pyosalpingitis cases arise? There is no doubt that the question of immunity is an important factor. Is it not possible that in these cases the immunity that has developed during the first attack 2: infammation has lasted for many years? Although the lurking ::{ection was present it never showed itself by a reaction until ths ‘:arnunity, so to say, has dissipated itself, and when that has occurr.-4 the infection broke out again and gave rise toanewattack. This phase of immunity is but slightly understood. We are very well aware of the existence of an immunity but in what manner this acts and how long it lasts, how it keeps in abeyance the lurking infection in the system, are still matters that are very little understocd. Etiology.—The etiology of pyosalpingitis may be classed under two headings. First, those caused by gonorrheal infection and second those caused by pyogenic infection. Those belonging to the first class are by far the more numerous. It has been esti- mated by competent observers that 66 per cent. of all gynecological infections are due to the gonococcus. The gonococcus, we must admit, soon disappears from the field of infection but, so to speak, prepares the field for the succeeding pyogenic infection and for the](https://iiif.wellcomecollection.org/image/b32758650_0173.jp2/full/800%2C/0/default.jpg)
