. Diseases of women. A clinical guide to their diagnosis and treatment. e opening beingminute, they are overlooked; and that when they burst intothe rectum, the opening is above the semilunar folds, andtherefore cannot be seen: and if the pus be mixed with thefaeces, it may pass unnoticed. 4. Lastly, an abscess may form, but not biu-st; its contentsmay become inspissated, and remain quiescent for years,after which some accidental cause may rekindle inflamma-tion, forming what Sir James Paget has termed a residualabscess. PARAMETRITIS. 271 THE RARE KINDS OF PUERPERAL PARAMETRITIS. I have descri
. Diseases of women. A clinical guide to their diagnosis and treatment. e opening beingminute, they are overlooked; and that when they burst intothe rectum, the opening is above the semilunar folds, andtherefore cannot be seen: and if the pus be mixed with thefaeces, it may pass unnoticed. 4. Lastly, an abscess may form, but not biu-st; its contentsmay become inspissated, and remain quiescent for years,after which some accidental cause may rekindle inflamma-tion, forming what Sir James Paget has termed a residualabscess. PARAMETRITIS. 271 THE RARE KINDS OF PUERPERAL PARAMETRITIS. I have described parametritis of the common kinds. Ishall now less fully describe some of the rarer forms. Theyare so rare that my experience of them is not large enoughto enable me to paint a very detailed picture of them. Iwill first mention cases exceptional in their acuteness. Sacrum Rectui Foramen of sacrum Pouch of Douglascontaining fluid Parametric eel- |||lular tissue Vaginal roof ir left lateral fornix Anterior vaginalwall Obturator intern us Levator ani Ramus ot ischium. Fig. 93.—Section through pelvis, near outlet, showing continuity of cellular tissuewithin pelvis, through sacro-sciatic notch, with that outside it. (Alter Barbour.) Rapidly spreading inflammation of cellular tissue.— Sometimes the inflammation begins soon after delivery,spreads quickly to the peritoneum, and the patient dieswithin two or three days. This disease is what used to becalled phlegmonous erysipelas, or erysipelas of the cellulartissue, and the spread of which along the limbs could often,in pre-Listerian times, be watched in hospitals. (We nowknow, thanks to Fehleisen, that this disease is not the sameas cutaneous erysipelas, and therefore we no longer call it 272 DISEASES OF WOMEN. erysipelas.) Virchow recognised the identity of acute puerperalinflammation of cellular tissue with this disease, and there-fore called it erysipelas malignum internum. His accountof its pathology is based on the dissect
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