INFLAMMATION OF THE BROAD LIGAMENTS OF THE PELVIC PERITONEUM AND PELVIC CELLULAR TISSUE.
T. G. Thomas writes that it is most probable that Archigines, who was famous in the second century, refers to these dis eases, and that his view was afterwards accepted by Oribasius (326-403) and Aetius (550) and Paul Aegina (670). But in all of these writings only abscess of the uterus is mentioned, and only Paulus speaks of cases in which the pus was located above the os uteri. Matthews Duncan thinks that many indications in these writings referred to this class of diseases. But the name pelvic cellular tissue is not mentioned, and therefore the true nature of these diseases was no more recognized than in the writings of the XVIth and XVIIth centuries.
Mauriceau was the first to speak clearly about post-puerperal tamers, and Puzos (1760) described the disease somewhat more distinctly. The first thought the process was due to retained lochia, the second to metas tases of the milk in puerperal women. Puzos' idea was retained until our century, and was sustained by Ritgen, A. E. Siebold, Busch and many of their contemporaries. German writers, as F. B. Osiander (1794), Kranefuss, Mikschik, Kyll, A. E Siebcdd, Busch, Kiwisch and others, according to W. Schlesinger's history, long ago exhaustively mentioned these diseases. Later, French physicians, Berard, Dupuytren Bourdon, Marchal de Calvi, Verjus and others, recognized the connection of these diseases with a morbid state of the uterus. Our knowledge regarding these diseases was greatly increased by the writings of Nonat, who began his investigations on this matter in the year 1846; he described the sub acute and chronic forms of the process, and observed its occurrence aside from the puerperal state. From this time on this disease was repeatedly and completely treated of by French, German, and English writers, such as Gallard, Gosselin, Bernutz and Goupil, Doherty, Churchill, Lever, Bennet, West, Simpson, Matthews Duncan, Kiwisch, Scanzom, R. Ols hausen, Spiegelberg, W. A. Freund and others.
The disease has been described under different names, depending upon the prevailing opinion with regard to its origin, and the stage of the dis ease considered as-the most important. Doherty described it as chronic inflammation of the uterine appendages; Nonat as peri-uterine and lateral phlegmon; Churchill as abscess of the uterine appendages, and Marchal de Calvi as phlegmonous pelvic abscess. These denominations, to which Simpson added the name of cellulitis, maintaining that in these cases an inflammation of the pelvic cellular tissue precedes the pelvic abscess, were in general used until Virchow's investigations on this subject.
Virchow, who claimed that such terminology was defective in that it did not indicate the separation between the peritoneal and sub-perito neal pelvic disease, proposed for the inflammatory disease of the pelvic cellular tissue the name parametritis. He says: " There are several organs
having appendages which are not included under the anatomical name of the organ itself, but are described as surrounding connective tissue, cap sule or appendages. If we have to deal with pathological processes in these appendages or their surroundings, we are at a loss how to name them. Thus the kidneys lie in a capsule of fat, which at times becomes the seat of an independent inflammation, suppuration and exudation, and likewise the bladder and the uterus are surrounded at their lower and lateral por tions by loose fat and connective tissue, which at times become diseased independently, more frequently secondarily, but in such a way that this becomes the main change. For such processes I propose the names pam nephritis, paracystitis and parametritis. As we are now accustomed to use the terms pericystitis, perimetritis, perisplenitis, etc., for inflamma tions of the free covering of the organs, which nearly correspond to the terms peritonitis vesicalis, uterina, linealis; and as it must be admitted that for these kinds of affections a separate name is required, it is evi dently necessary also to designate inflammations of the adherent and ad jacent structures specifically. This is especially necessary with regard to the uterus. For the loose connective tissue and fat which binds down the vagina and the neck of the uterus laterally, at the same time forming the basis of the broad ligament, is the most frequent seat of disease, and yet it would be erroneous to speak in such a case of a disease of the broad ligament. The name parametritis will do away with the Since that time the name perimetritis is used for inflammation of the peritoneum, which covers the uterus and its surroundings, and the name parametritis for inflammation of the connective tissue surrounding the uterus. But as the inflammatory disease of the pelvic peritoneum rarely limits itself to the covering of the uterus, but usually extends to the ad jacent peritoneal covering, and since as the disease of the connective tis sue is rarely confined to the neighborhood of the uterus, but often ex tends to distant localities, assuming there greater intensity than in the immediate neighborhood of the uterus, many authors consider the names perimetritis and parametritis insufficient, and use the older names for the diseases in question. So Barnes proposed the name pelvic cellulitis for .inflammations of the pelvic cellular tissue, and for inflammation of the peritoneum which lines the pelvis and invests its organs, the name pelvic peritonitis. Many authors have accepted his proposition, and at present for inflammatory diseases of the pelvic peritoneum, the names perimetritis and pelvic peritonitis, and for inflammatory diseases of the pelvic cellular tissue, the name parametritis and pelvic cellulitis are used synonymously.