Pelvic cellulitis is oftener found in childbirth, premature labor and
abortion, for the reason that it is a wound infection, and the female
organism, is always more or less wounded under these circumstances. In
confinement the cervix is always more or less torn, and septic matter
deposited there often speedily spreads along the lymphatics and veins
to the pelvic cellular tissue, in fact, the entire uterine surface
forms a suitable soil for bacterial growth. The vagina is also more or
less injured or bruised through parturient efforts; this may be in the
nature of a laceration or an abrasion of its mucous surface.
Outside of the above causes, the infection may be of traumatic
origin, the most common causes being operative measures on the vagina
or womb of a cutting, scraping or stitching nature, that were not
carried out under strictly antiseptic precautions, guaranteeing the
exclusion of septic germs. Dilation of the cervix with sponge tents or
with instruments or probes that were not perfectly cleansed, causes
infection and a decomposition of the retained secretions, which,
becoming absorbed, leads to pelvic cellulitis. In surgical operations
and puerperal conditions in which infection has been positively
excluded, by careful antiseptic measures, pelvic cellulitis is
impossible.
The inflammation in this disease is excited by the irritating
influences of products of septic decomposition; these may have been
introduced into the system at the time of confinement or of an
operation, or they may have been in the vaginal tract before the
operations were commenced. This teaches an important lesson, which
few seem to have learned; it is this, that _the strictest antiseptic
regulations in a confinement or operation are of no avail, if the
patient herself is not first thoroughly disinfected before the
operation begins_.
In the German Empire there is a legal provision giving full
instructions for the necessary disinfection of the lying-in woman and
her attendant; if there were such a wise provision in this country,
we would not hear of so many deaths of women in childbed, from blood
poisoning. At the Copenhagen International Medical Congress (1884),
Professor Esmarch, one of the most celebrated of German surgeons, said
that “humanity demands antiseptic treatment of wounds and wounded.” I
believe that the time will soon come that antiseptic regulations in the
treatment of diseases will not only be compulsory, but that a neglect
of the same, causing death by blood poisoning, will make the attendant
liable for exemplary damages.