Lately Schlesinger completed these investigations by injecting the labia majors and their surroundings, determining by this the mode of diffusion of blood extravasations in the surroundings of the vagina.
Since the results obtained by injections correspond to observations made on the living body, there can be no doubt that the pelvic connec tive tissue serves as a medium for the diffusion of blood extravasations and pus accumulations, and that it also exerts an influence on the spread of inflammatory processes; but certainly it is not the only rule for the exten sion of inflammation, which lionig himself admits. The lymphatics and blood-vessels play in this respect certainly a more important role.
Pathology of inflammation of the Pelvic of the peritoneum covering the uterus and its appendages, and lining the pelvic cavity, presents different conditions, depending upon whether the disease was acute or chronic, and whether it came early or late under observation, and upon the nature of the infection which caused the dis ease. In one case all the organs covered by the pelvic peritoneum may be involved, in another only the covering of one or another of the organs may be greatly affected. Thus the tubes, especially at their abdominal end, the ovaries, or the peritoneal covering of the uterus, may be acutely affected, the inflammation extending irregularly to the surrounding peri toneum. Based on observations, we may from a pathological standpoint readily divide inflammatory diseases of the pelvic peritoneum, according as one or the other organ is more intensely involved, into peri salpingitis, perioophoritis, and perimetritis.
But as very often several organs of the pelvis are equally affected by the inflammation, and portions of the surrounding peritoneum frequently and irregularly participate in the affection, and as all have the same cause, a more or less diffused inflammation of the pelvic peritoneum is also properly named pelvic peritonitis.
The process does not materially differ from inflammation of other parts of the peritoneum. The vessels of the affected peritoneum at first are injected, and sero-albuminous or sero-fibrinous exudation takes place on the free surface, from which either smaller or larger flakes separate, or a membranous deposit forms. At the beginning, the exudation is clear, but soon becomes turbid from pus elements, which rapidly increase in severe cases, changing the exudation to a thick creamy mass.
The acute septic forms are usually only noticed shortly after parturition or abortion, and as a rule are fatal. Here we treat mainly of cases arising
during the puerperium, having a prolonged course, or of such which are apparently recovered from, but which leave changes in the pelvis, which readily change into other affections.
In post mortems on women w'b frequently find remains of a circum scribed peritonitis. By inflammation of the peritoneum, new connective tissue, richly supplied with blood-vessels, is rapidly formed, covering the affected parts with a pseudo-membrane, and by its contraction displacing the organs of the pelvis or binding them firmly together. In this way the organs (tubes and ovaries) may form a tumor-like mass in which the in testine may become entangled. The frequent occurrence of these condi tions, for instance, in more than half of the necropsies on women, (and F. Wickel found them in 33 per cent, of all post mortems,) makes it evident that they may run their course during life without severe symptoms or ex tensive exudations. This form of the disease is well designated by the name adhesive pelvic peritonitis.
Between the adherent organs, in recent cases, pus centres are fre• quently found, or by the adhesions of the organ spaces may be formed, filled, according to the course and cause of the process, with serous or sanious fluid, pus or ichorous material. The encapsulation of these masses usually takes place in Douglas's often forming there large tumors resembling an hematocele. These instances are frequent, and to them the term exudative peritonitis is applied.
Masses of exudation,when encapsulated in large quantities, may remain unchanged for a long time; exceptionally, from one or another cause, they result in the formation of pus. The ultimate termination varies; under certain circumstances the pus may change into an ichorous liquid, or by retrogressive changes undergo absorption; it may remain enclosed for months or years in small compartments, a constant danger-source of ex tensive disease, or it may spread in larger quantities and form intra-peri toneal abscesses. Such abscesses are usually observed behind the uterus, and are named retro-uterine abscesses or retro-uterine pyocele. The pus may evacuate externally through the rectum, vagina, or in rare cases through the bladder, or the pseudo-membrane, which encapsulates and separates the same from the peritoneal cavity, may become destroyed and the rupture occur into the peritoneal cavity.