A System of midwifery : including the diseases of pregnancy and the puerperal state / by William Leishman.
- William Leishman
- Date:
- 1875
Licence: Public Domain Mark
Credit: A System of midwifery : including the diseases of pregnancy and the puerperal state / by William Leishman. 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.
749/824 page 733
![XLVI.] DIAGNOSIS. 738 arises from this source, especially, perhaps, in confounding tumor with mere hardness. The same remark applies to any investigation which may be made from the vagina; and it is, in every case, of the highest importance that we should determine if any connection exists between an enlargement observable from above and one which is made out from below. In the case of a solid tumor, free from serious adhesions, this is very readily recognized by such method of investigation—the impulse communicated from one direction being readily transmitted to the other. If it be a cyst or abscess, fluctuation is thus sometimes dis- tinguished, without any difficulty, between the two hands, which are simultaneously employed in the examination. But, in the case of mere diffused fulness, or hardness, or a tumor which is bound down by adhesions, the difficulty of diagnosis is increased, to an extent which is only fully recognized by those who have devoted most attention to such matters. Pelvic cellulitis, peri-uterine phlegmon, or parametritis,—and accept- ing those expressions as synonymous,—indicates, as already stated, an inflammation of the subperitoneal cellular tissue, possibly radiating thence, and always involving a tendency to the formation of abscess. Until within a comparatively recent period} every mysterious tumor or enlargement following delivery, was. without much hesitation, referred to this category. Recent investigation seems, however, to assign to it a much less important position. To no one is modern science more indebted, in reference to this subject, than to M. Ber- nutz; but there can be little doubt that that experienced and able ob- server undertook to prove too much, when he thrust aside pelvic cel- lulitis,—merely admitting the possibility of its existence,—to make room for his own idea of pclvi-peritonitis. It is a dangerous thing to prove too much,inasmuch as anything approaching to exaggeration is apt to attach discredit,even to investigations which are otherwise of the high- est importance. But, freed from this blemish, no impartial critic deny that M. Bernutz has rendered to this particular department of Bcience the most eminent service, in boldly exposing the fallacies which attach to the familiar idea of pelvic cellulitis. The slightest dissection, --ays the writer referred to. shows that the cellular tissue subjacent to the peritoneum i< so thin and scanty that it is impossible to separate the serous from the uterine (issue : and that, consequently, it cannot be the seat of Swellings, which, according to \|. Xonat's observations, attain, in the >pace of a few hours, to the Bize of a hen's i-:i^. The only other possible position for the so-called ante- and retro-ntcrinc phlegmons is the small band of cellular tis8Ue situate at the junction of the neck with the body of the uteris, and this we can hardly credit, unless it he proved by an undoubted post- mortem examination, which has never vet been adduced. In the ab- sence, then, of direct proof. I may lie allowed to doubt the existence of this affection as described by M. Nonat. 1 have for four year- asked for proof of this proposition; and. as no one has yet been able t give it. 1 shall assert that the swellings we are now considering,are certainly not formed by the inflammation of the thin ring of cellular tissue which encircles the upper portion of the neck of the uterus. In the o.xcep-](https://iiif.wellcomecollection.org/image/b21016112_0749.jp2/full/800%2C/0/default.jpg)
