Prevention in these affections is much better than cure. The treatment
of a recent case of pelvic cellulitis must be energetically antiseptic.
The seat of the infection must be discovered; the vagina or cavity
of the uterus, as the case may be, must be thoroughly washed out
with a 1 to 2,000 corrosive sublimate solution. After a thorough
disinfection, the inflammation and pain can be checked or controlled
by the application of ice bags; this is the remedy _par excellence_
to check acute inflammatory processes. These bags are preferably of
rubber, about 4x6 inches in size, and when filled with ice and before
applied it is more comfortable to the patient to envelop the bag in a
thin layer of flannel, which takes off the clammy coldness. The patient
should be kept perfectly quiet and the bowels daily moved by a mild
purgative. After the sensitiveness and the fever have subsided, the
absorption of the hardened inflammatory remnants is promoted by the
daily employment of hot sitz baths and the application of tincture
of iodine to the inguinal regions, as well as the use of iodoform
suppositories.
The employment of blistering fluids or plasters is of no particular
value either to check the inflammation or promote the absorption.
If there are symptoms of suppuration forming abscesses, these should be
freely opened into the vagina and their cavities thoroughly rinsed out
with a disinfecting solution.
In the case of phlegmasia dolens alba I have used cold water compresses
fortified by ice bags with brilliant results, but only after all the
other treatments that are laid down in different treatises had been
tried, and failed to give the slightest relief. Among these were hot
fomentations, large repeated doses of morphine, and liniments of
everything that is usually prescribed to relieve pain; for the pain in
phlegmasia is sometimes excruciating.
My experience of the beneficial effects of ice bags and cold-water
compresses in the acute stages of pelvic cellulitis and perimetritis,
led me to believe that the same measures would be useful when the
cellulitis was in the cellular tissue of the extremities, which
constitutes phlegmasia dolens, ignorantly termed milk leg. This
appeared to be heroic treatment to the patient, who dreaded the shock
and feared bad consequences, but she finally consented.
The following was my method: an ordinary large towel was dipped into
iced water, wrung out and clapped around the affected limb, a heavy
flannel roller bandage was then applied from the toes upward to the
groin; flannel is preferable, because it does not get hard when moist
and remains softer under similar conditions than cotton material. On
the most painful parts, like the inner aspects of the thighs, the back
of the flexure of the knee, or popletial region, and the calf of the
leg, I laid rubber bags filled with ice in addition to the cold-water
compresses; these were kept in place by a circular binder independent
and outside of the roller bandage.