Nourishment during the early period should be limited to milk, bouillon, punch, lemonade, beer.
Such is the treatment which ordinarily suffices in case of metritis and pelvic peritonitis. There is one point on which we specially insist.
When indurated masses appear around the uterus recovery is very slow. If the exudation suppurates, the fever persists for many days, the chills are frequent, the temperature rises every evening, sometimes with very acute exacerbations. Often diarrhcea and vomiting set in. The abscess once open, notable amelioration ensues, and then either it discharges freely and the patient convalesces well, or else after the lapse of a few days the discharge of pus ceases, the abscess refills, and chill and fever reappear. These phenomena may be repeated a number of times, grad ually sapping the woman's strength, and often she dies of hectic. It is sometimes of advantage to enlarge the cavity, but this is not always pos sible. When the abscess, as is the rule, opens by the vagina or rectum, enlargement presents more risks than advantages, and it is only when the opening is in the abdominal wall that it is sometimes of advantage to en large it, or even to incise it deeply without awaiting spontaneous opening.
[We would disagree somewhat with Charpentier. Abscess in the pelvic cellular tissue or encysted in the peritoneum, should be opened as soon as it points, the cavity washed out and drained, or if small, it should be packed with iodoform gauze. In other words, abscess in this locality should be treated on the same surgical principles as are applicable to ab scess in other parts of the body. There is every advantage to the woman, for we not only save her strength and control the hectic, but we also forestall possible rupture into the rectum, or worse still into the general peritoneal cavity. The treatment of such abscesses really belongs to works on gynecology, and we will not enter upon it here. It is well to state that recent views tend to the teaching that many such abscesses are intra peritoneal and result from tubal or ovarian disease, and this brings up the question whether for cure abdominal section and removal of the puru lent sac is not the preferable and necessary method. For an answer to
this question, however, we must refer to recent and current literature. It should be stated, however, that the majority of puerperal exudations tend, under proper treatment, towards spontaneous cure.—Ed.] If, on the contrary, the exudations tend towards absorption, it is still only after weeks or months that convalescence is assured.
In one or another case our general treatment is the same. Revulsion over the exudation by iodine, fly-blisters, and sulphate of quinine and general tonic alimentation. The patient, however, must remain in bed as long as there exists induration at all painful. After an examination at the outset, to make our diagnosis, we abstain from local interference, unless there be special indication, until the patient is convalescing, and we do not allow our patients to rise until the uterus is fairly movable.
Although, in general, recovery is generally complete, the patient often complains for long of abdominal pains, the result of traction on the pelvic organs, by the adhesions which have formed between Them, the intestines and the pelvic walls.
b. Peritonitis.—The treatment of this affection is similar to that of metritis at the outset, leeches, quinine, belladonna ointment. The qui nine, however, should be given in larger dose, at least thirty grains daily. But peritonitis is accompanied by gastric and intestinal disorders, nausea, vomiting, tympanites, against which numerous agents have been recom mended. Doulcet, Willis, Leake, Fincke, Osiander, and others, have advocated an emeto-cathartic, and we have ourselves in certain instances given it with success. Puzos, Helm, Denman, Chaussier, Gordon, advise purgatives.
It is not uncommon, indeed, for the patients to suffer from obstinate constipation. Calomel and jalap have been often used. We believe in being very reserved in their use, for as a rule, a profuse diarrhcea suc ceeds the constipation, and Hervieux has noted an alternation between the diarrhcea and the vomiting.