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CONTRIBUTORS TO VOL. XXXII.
AM ENDE, CHARLES G., New York, N. Y.
KING, A. F. A., Washington, D. C.
J. M. BALDY, M.D., Professor of Gynecology in the Philadelphia Polyclinic; Surgeon to the Gynecean Hospital ; Gynecologist to the Pennsylvania Hospital,
DURING February, 1887, there came under my care a patient presenting the following history: The second or third day after confinement she complained of a chill, and was found to have a tender and tympanitic abdomen, together with a quick pulse and high temperature. Under general treatment these symptoms abated somewhat and she disappeared from observation for several weeks. One month from the date of her confinement she again demanded aid. At this time she was so emaciated as to be hardly recognizable. Her temperature was over 102°, her pulse over 130; she was having continued chills and creeps, hectic, night-sweats, and sleepless nights; her abdomen was swollen, tympanitic, and intensely painful, her bowels loose and fetid; micturition and defecation both painful-she was evidently fast approaching death. An examination of the soft
Read before the American Gynecological Society, May 27th, 1895.
parts showed no signs of a recent laceration; the uterus was subinvoluted, and on the left side there was a large, boggy mass, firmly adherent, tortuous, and extremely tender. An abdominal section followed, when the left Fallopian tube and ovary were found distended with pus and were removed. The patient made a speedy and thorough recovery. To the best of my knowledge this case was the first one upon whom an abdominal section was deliberately and knowingly performed for puerperal septicemia. It was reported in full to the Philadelphia County Medical Society, June 22d, 1887, and the report published in the Transactions of the Society.
The case is an excellent representative of one class of patients suffering from puerperal septicemia upon whom an abdominal section is not only advisable but essential, if the lives of a certain proportion and the future health of the balance are to be taken into consideration. The practice of removing the uterine appendages which contain pus accumulations at this period of a woman's life has become so thoroughly established since the report of the above case as to need but casual mention, whether that pus accumulation existed prior to the pregnancy or occurred sụbsequent to this condition. Curettage and gauze packing of the uterine cavity, catheterization of the Fallopian tubes, vaginal or rectal incision and drainage together with all other socalled conservative methods may well be left in the hands of the timid. Where there is pus it must be evacuated, and it is much safer, in the largest proportion of cases, to evacuate it at a point of election than to allow it to empty itself, with all the chances of immediate danger to life as well as the remote consequences. There is one other point of so-called conservatism the folly of which it is well to emphasize-the“ waiting policy," on the supposition that the patient can be " built up and prepared for the operation.” The patient is in her present threatening condition of health on account of the absorption of septic materials into her blood, in many cases she is exhausted and her life in danger, and a continued absorption of the septic matter from the accumulations in the pelvis may mean the difference between life and death. The dangers of further absorption far outbalance the good that may be obtained from medication, and delay for this reason is not justifiable.
So much for true pus cases; but there is another and larger class in which there is infection of the Fallopian tube the