Peri-vaginal Abscesses 901 



6. Pkri-vaginal Abscesses. 



In diflBcult labor, much of the violence to the genital tract is 

 concentrated upon the vagina and the pelvic portion of the uter- 

 us. These parts may be caught between unyielding portions 

 of the -fetus and the bony walls of the pelvis, and become 

 more or less seriously contused, abraded or lacerated. In addi- 

 tion to these injuries, the obstetrist may irritate the parts 

 in some measure with his hands and arms, and with instru- 

 ments and apparatus, especially with coarse cords or straps for 

 the exertion of traction. Under these conditions the walls of 

 the vagina are liable to become seriously infected. The septic 

 material, finding its way deeply into the tissues, eventually in- 

 duces the formation of abscesses in the walls of the vagina itself 

 or outside in the pelvic connective tissue. More anteriorly, the 

 infection of the vaginal walls may cause adhesions between the 

 vaginal or uterine peritoneum and the walls of the pelvis, and 

 lead to the formation of abscesses between these two layers of 

 adherent peritoneum or in the adjacent connective tissues. 



The abscesses occur with greatest frequency, according to our 

 observations, along the floor of the vagina in the region of the 

 bladder, and, when very extensive, press upon that organ and 

 interfere with urination. They may so involve the walls of 

 the bladder as to cause a rupture of that organ, either into the 

 vagina or the peritoneal cavity. The abscesses may rupture 

 into the vagina, rectum, or peritoneal cavity. 



The symptoms of peri-vaginal abscesses consist at first chiefly 

 of a stiffness in the posterior portions of the body, with a disin- 

 clination to move, accompanied by general febrile disturbances, 

 including . elevation of temperature, loss of appetite and general 

 dullness. The vulva is usually swollen, and upon separating 

 the lips, the mucous membrane is usually found to be swollen 

 and dark colored. Defecation is painful, if not difiicult, be- 

 cause of the extreme sensitiveness of the parts, accompanied 

 by more or less extensive swelling. If the abscesses are forming 

 between the pubis and the vaginal floor, the act of urination is 

 almost inevitably accompanied by pain and difiiculty. 



Upon manual exploration of the vagina, the parts are found to 

 be very hot and sensitive, while at some point, most probably 

 along the vaginal floor, extensive, hard swellings may be felt. 



