Treatment. —To prevent peri- and paramotritis antiseptics should be thoroughly used during labor, after delivery, and in case of all operations and manipulations on the vagina and uterus.
The treatment of both forms in most respects is the same, but differs according to the stage.
In the acute stage the object is to limit the local inflammation and exudation that takes place in the pelvis, which is best accomplished by antiphlogistics.
Venesection, in former times so highly recommended, is at present abandoned; but local blood-letting has even now many advocates. Scan zoni recommends for this purpose the application of ten to twelve leeches to the region where the symptoms are most pronounced. After the first two weeks following child-birth, or in processes independent of the peral state, he recommends the application of leeches to the vaginal portion. Olshansen and Spiegelberg also recommend the application of leeches to the inguinal region and vaginal portion.
Our own experience is limited to the comparative observation of a great number of cases at the maternity clinic of Vienna. In Prof. Spfsth's clinic ten to twelve leeches were always applied to the inguinal region in puerperal diseases with manifest local symptoms and very violent pain in the pelvis, while in Prof. C. Braun's clinic blood-letting was never practised in puerperal cases. This experience proved beyond doubt that local depletion markedly relieved the pain; but it is difficult to decide whether the extension of the local process was favorably influenced by it. In non-puerperal cases of a marked local nature, especially where the cervix or the whole uterus is involved, we make use of scarification or the application of six to eight leeches to the vaginal portion, and repeat this procedure if necessary. The hyperaemic tense appearance of the vaginal portion in these cases vouches jor the usefulness of this procedure.
Application of ice is especially useful in the acute stage of pelvic peritonitis. We have only seen good results follow this treatment. The patients soon feel relief from their pain and ask that the application be repeated. Absolute rest is of the greatest benefit in the acute stage. We usually elevate the knees of the patient, protect the abdomen by hoops, and cover the same with from four to six thicknesses of damp cloth upon which a moderately heavy ice-bag or Lister's ice-coil is placed. In this
way we have often continued the application day and night for several days.
In cases where there are no impacted faeces, we prevent peristaltic movements of the intestine with opium or morphine. In the beginning of the disease, if we suspect impacted faeces, we try to move the bowels by enemeta of tepid water. After such a procedure the patient sleeps for several hours and awakes refreshed.
Even after subsidence of acute symptoms it is advisable to direct the patient to keep quiet, and provide for regular and liquid stools, for it is often observed that after exertion or difficult defecation the acute symp toms recur; and, it should be stated, this may happen even with perfect rest in bed.
Only mild cathartics should be used in these cases, as salines, rhubarb, castor oil, etc.
Many physicians claim good results from rubbing the lower part of the abdomen and the inner aspect of the thighs with blue ointment. We have often applied this remedy combined with opium or morphine, with out favorably modifying the course of the disease. Many English physicians expect good results from blistering the abdominal wall once, or repeatedly. Bernutz advises abstention from local depletion during the acute stage, and to blister the whole abdomen. Courty also is con vinced of the efficacy of this remedy. Wet cups are also recommended by some. We have never tried either.
Chronic Exudations.—In a large number of cases, attended by a slight fever in the beginning, and in which only small masses of exudation form in localities corresponding to lacerations of the cervix, treatment is hardly necessary. After the violent pain subsides we apply, instead of cold, moist heat (Priesnitz's compress), and keep the bowels open. Often in from ten to fourteen days the exudation masses disappear. If this should not happen, we must resort to resorbents. With the continued use of Priesnitz's compresses we order sitz and warm baths (92 to 94° F.). Baths are of advantage when there is no pain in the pelvis, on walking, and when absence of fever shows that the acute process has terminated. By the early use of the bath we have frequently observed return of the acute stage and extension of the exudation.