Salpingitis and pelvic cellulitis

A DISCUSSION of the inAammatory diseases of the femaIe is found in the writings of the ancients. Dr. Howard A. KeIIyl has said “The history of the treatment of peIvic abscess is frought with the deepest interest, for it exhibits in miniature a11 the phases of the growth of gynecoIogy at Iarge.” Due to Iack of understanding of the pathoIogy of peIvic infection, the earliest attempts in treatment were represented by extreme conservatism. Not unti1 the earIy part of the nineteenth century was any attempt made to evacuate pus, when RCcamier ( I 830-1840) practiced vagina1 puncture and drainage. This was before the days of anesthesia, a decade before Marion Sims popuIarized the vagina1 specuIum, and thirty years before Lister appIied to surgery the principIes of Pasteur. Recamier made few records, Ieaving to his pupi1, Bourdon, the inspiration to carry on this simpIe and earIiest operation for the treatment of peIvic infection. In 1886 Saroyenne advocated the use of a spear pointed trocar, diIatation of the drainage tract to admit two fingers, and the insertion of a two way rubber tube with daiIy irrigations of the abscess cavity With the advent of abdomina1 surgery by Lawson Tait in I 880, an actua1 view and understanding of the Iesion was obtained for the first tme, and there deveIoped a period of radicaIism, shocking to those who had practiced conservatism. By the year 1890, though a reIativeIy high mortahty accompanied this method, the abdomina1 route had been adopted in many cIinics as the best way of treating most cases of inffammatory disease of the peIvis. There fohowed in r8go-1891, a short period of uItra-radicaIism, unscientific and extreme, in which vagina1 panhysterectomy was advocated by Peon and Segond. In a condition cIinicaIIy characteristic of Iarge peIvic abscesses which might be mistaken for maIignant tumors, hard, noduIar and adherent, Peon performed vagina1 panhysterectomy. When the uterus couId not be removed in toto he dug it out piecemea1, controIIing the bIeeding by cIamps Ieft in pIace for forty-eight hours, irrigation being started on remova of the hemostats. The method of Peon met with IittIe favor; even Segond, his admirer, couId not view the operation with compIete approva1. It was never wideIy accepted, and came graduaIIy into Iimited use. From 1890 to 1892 the opinion of groups or schooIs was divided as to which of the three methods was suitabIe: vagina1 drainage, Iaparotomy with extirpation of the adnexa, or the vagina1 hysterectomy of Peon with remova of the tubes and ovaries. There were strong advocates of each. In September, 1892 the first Internationa Congress of GynecoIogists and Obstetricians met in BrusseIs. Representatives from practicaIIy a11 the European societies and from America were present. One of the chief subjects for discussion was the treatment of peIvic suppuration. The first paper was by Segond who advocated the operation of Peon, in a11 cases in which the Iesion was biIatera1. He admitted, however, that though the operation had greatIy enriched the gynecoIogic repertoire, it shouId not be used excIusiveIy. Peon, who was in the chair, supported his own work. Travers of London expressed the