The American text-book of obstetrics for practitioners and students . -theritic,* ulcerative, suppurative ; in dissecting metritis, sloughing intra-uterinemyomata, or in suppurative metritis with the abscess pointing into the uterinecavity; in phlebitis, lymphangitis, and in direct infection of the is most likely to perform an unnecessary operation in diphtheritic endo-metritis (PI. 49). The writer has thus erred several times. By the time thatsymptoms justify surgical intervention in this condition it is always too late. It is extremely difficult to lay down correct rules fo
The American text-book of obstetrics for practitioners and students . -theritic,* ulcerative, suppurative ; in dissecting metritis, sloughing intra-uterinemyomata, or in suppurative metritis with the abscess pointing into the uterinecavity; in phlebitis, lymphangitis, and in direct infection of the is most likely to perform an unnecessary operation in diphtheritic endo-metritis (PI. 49). The writer has thus erred several times. By the time thatsymptoms justify surgical intervention in this condition it is always too late. It is extremely difficult to lay down correct rules for the guidance of aphysician in any situation involving so much responsibility, and of necessity sodependent upon many circumstances, as that seeming to require a very serioussurgical operation in the midst of an adynamic fever with, very likely, pro- * By diphtheritic endometritis is meant a dirty, grayish- or greenish-brown exudate onthe endometrium, containing mixed micro-organisms, and not necessarily the Klebs-Loefflerbacillus (see PI. 49). CELIOTOMY. . .. OBSTETRIC 81 BOER )\ 505 found depression, rapid pulse, high temperatun— in short, with everything asurgeon leasl desires in the face of a major operation. Firsl and foremost, then, the attendant should avoid the operative tn-:ii-incut of puerperal sepsis it possible, and should not Beek an excuse for surgi-cal intervention merely in the cardinal symptoms of septic infection—hightemperature, rapid pulse, and general depression. He should demand -metangible evidence of those forms of sepsis thai are amenable i surgical treat-ment. Bui tlie physician of to-day, while reluctanl to operate upon a patientunder the leasl favorable circumstances and on his guard against unnecessaryur harmful surgery, musl be prepared in the event of certain symptoms orcomplications to operate with the leasl possible delay. Tims, on the very firsi appearance of symptoms that will justify the diag-nosis of diffuse suppurative peritonitis
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