CHRONIC INFLAMMATORY AFFECTIONS OF THE UTERINE ADNEXA.
Under this term we include the various affections which follow on attacks of cellulitis or pelvic peritonitis—that is to say, those cases where clinically we detect thickening around the uterus, in the cellular tissue or uterine ligaments, (chronic cellulitis, chronic pelvic peritonitis), as also those cases where the ovaries and tubes are surrounded by remnants of exudation (peri-oophoritis, peri-salpingitis), and are to a greater or less degree bound down to the floor of the pelvis. In such instances, whether the primary disease emanated from the uterus, or tubes, or the ovaries, or not, the condition is certainly aggravated by these so-called thicken ings, and it is against these, in particular, that routine non-surgical methods of treatment have been directed. It must be confessed that, aside from simple chronic cellulitis, these means (iodine, glycerin tam pons, the hot douche, etc.), almost always prove ineffectual, and there fore it is why of late years laparotomy followed by the loosening of the adhesions and removal of the tubes and of the ovaries, has been so fre quently, in the opinion of many too frequently, resorted to. There is to-day no question of greater importance to woman than as to whether in the instances under consideration there can be palliation short of laparo tomy, especially since it is evident to-day that in no given case can it be asserted that laparotomy with its risk will certainly cure. The impor tance of this subject warrants detailed consideration, for if we can show that electricity can palliate as effectively as laparotomy, in the class of cases under consideration, then there will remain no justification for a measure which a not inconsiderable number of gynecologists are of the opinion has become too much a matter of routine.
At the outset, let it be understood that the remarks which follow are not at all applicable to eases where there exists an enlarged tube probably filled with pus, for here no one questions the justifiability of laparotomy. We are speaking purely of instances where careful examination reveals only thickening of or in the region of these organs—that is to say where, although the symptoms may be as aggravated, there is no ever-present risk of rupture of what may be termed an abscess into the peritoneal cavity. In other words the results of peritonitis are the main factors we
are here concerned with, and to understand the rationale of any proposed method of treatment it is necessary to bear in mind the nature of the pathological changes which accompany the condition.
In these chronic inflammatory affections of the uterine adnexa.the constant and characteristic symptom is pain, often so intense as to render life unendurable. This pain is largely due to the fact that the essential organs, the tubes and the ovaries, are included in the remnants of exuda tion, their function being, furthermore, thus impaired, and again the pelvic nervous supply is pressed upon by the same remnants. A further factor uniformly present is pelvic congestion, which, as we have seen, is a frequent source of discomfort if not actual pain to the woman. Not withstanding these local conditions the women menstruate—that is to say, in accordance with the prevalent view, they ovulate—and therefore, although diseased, these women are not, as is so often stated, incapable of conception, an argument which we frequently hear advanced in justifi cation of a laparotomy which per se has sterilized them. The question, indeed, is narrowed down to this, the finding of a method of treatment which will loosen adhesions, cause the absorption of inflammatory remnants, quiet the pain, relieve the local congestion, and at the same time not risk the life of the woman or render her absolutely incapable of procreation. Evidently laparotomy for the removal of the appendages will not satisfy the above aim. Will electricity do so ? Be it understood that we are not arguing that there is any method by means of which a restilutio ad integrum may be affected; we seek simply for some sub stitute for the radical operation of extirpation, a substitute, that is to say, which will palliate the local conditions and the symptoms while not unsexing the woman.