[Reprinted from the American Gynecological and Obstetrical Journal 
for May, 1896.] 
REPORT OF FOUR CASES OF PELVIC ABSCESS 
FOLLOWING LABOR.* 
L. J. Hammond, M. D., Philadelphia. 
The point of particular interest to me in these cases is their aeti- 
ology, as I think the histories show beyond question that their origin 
was entirely the result of puerperal septicaemia. Two of them—the 
first and second—are also of interest to me as showing that with ex- 
tensive inflammatory changes, involving the uterine appendages, a 
woman can become pregnant, carry the product of conception to full 
term, and be delivered of a healthy child. 
Case I.—Mary B., aged twenty-three years ; in perfect health until 
after the delivery of her first child in 1889. Her getting up was very 
slow, the history given me showing there was some septic infection. 
From this time she suffered greatly from pain in the right iliac fossa, 
which was always greatest at the approach of the menstrual period. 
She began to menstruate eight months after the birth of the child. 
She became pregnant the second time May 9, 1892, and was deliv- 
ered January 1,1893, of a healthy male child weighing eight pounds -f-. 
The labor was a rapid one, lasting only about two hours. When I 
reached the house the child was born. The placenta was delivered 
a few minutes afterward by the Crede method without any trouble. 
This was the first time I had seen the patient, 1. aving been attended 
during her first labor by a midwife. The usual aseptic precautions 
were taken, and, with the exception of very severe after-pain, noth- 
ing unusual seemed to present itself until, twenty-four hours later, 
when I made my first visit after the delivery, I found her suffering 
greatly from pain, which was confined mostly to the right side, the 
* Read before the Philadelphia Obstetrical Society, March 5, 1896. 
Copyright, 1896, by J. D. Emmet, M. D. 2 
Z. J. Hammond, M. D. 
uterus markedly subinvoluted and distinctly felt well over to the right 
and a free flow mixed with large clots. The pulse was no and the 
temperature ioo°. Vaginal examination, which was made for the 
first time, disclosed a large mass on the right side, the uterus firmly 
fastened, and an old bilateral tear of the cervix; also considerable 
laceration of the peringeum, which had been neglected from the first 
labor, there being no acute laceration whatever. The temperature 
and pulse continued to mount higher and higher, and her general 
condition grew worse, until the eleventh day after confinement when 
she was placed on the table, the abdomen was opened, and in passing 
the finger behind the uterus the abscess was ruptured and at least ten 
ounces of pus were removed. The pus cavity was high up on the right 
side, behind and to the right of the cornua of the uterus. There was 
considerable loss of the uterine tissue at the seat of abscess, due, I 
think, rather to the presence of the pus than to its being in the uterine 
walls primarily, as the abscess was unquestionably the result of leak- 
age of pus from the tube. The abdominal cavity was flushed with large 
quantities of hot water, a glass drainage-tube inserted and allowed to 
remain twenty-four hours, and the abdominal incision closed. The 
patient made a very satisfactory recovery. Eight months ago I again 
delivered her of a healthy female child, from which labor she made a 
perfectly natural convalescence and is well at this time. Examination 
of the uterus eight weeks after the birth of this last child showed it 
to be much smaller. There was, however, considerable fullness, but 
no pain and but slight tenderness. Dr. B. C. Hirst, who was present 
at the operation, agreed with me that it was impossible to remove the 
appendages. On removal of the glass tube it was found broken about 
its center. The lower portion, however, was readily removed by pass- 
ing a hsemostat through its center and separating the blades at the 
same time traction was made. 
Case II.—Mulatto, aged twenty-four years; had three children. 
After the birth of the second child, during which she was attended by 
a midwife, she grew ill, complaining of severe pain in the pelvis, which 
from her history was not localized. I saw her with Dr. W. W. Moor- 
head two months after the delivery of the third child, and found her 
confined to her bed, where she had been almost constantly since her 
delivery. Examination disclosed a large accumulation filling up the 
entire floor of the pelvis, the uterus slightly subinvoluted and resting 
against the bladder (in other words, it was held firmly against the 
bladder by the large abscess behind it). Cceliotomy was done the 
following day and not less than a quart of pus was emptied from a Report of Four Cases of Pelvic Abscess following Labor. 
3 
left broad-ligament abscess, the uterus slightly larger than the average 
uterus of a multipara. The appendages in this case were also so firm- 
ly adherent that I made but slight effort to free them, owing to the 
extreme condition of the patient. The usual flushing and drainage of 
the abdominal cavity were here used, and the patient’s convalescence 
was continuous though slow. The drainage-tube was removed on the 
third day. The tube track, however, did not close for about seven 
weeks, there being some pus discharged from it during this period. 
The patient is perfectly well, or was when I saw her some months 
ago. She was delivered of a healthy female child four months ago 
and made a perfectly natural convalescence. 
Case III.—Colored, aged eighteen. Nine days after the delivery 
of her first child I saw her with a student who had been present at her 
confinement, when I obtained the following history : Delivered of a 
stillborn child after labor of ten hours ; no untoward symptom until 
third day after delivery, when she had a chill, followed by tempera- 
ture of 103,0 sweats, pain in right side, foetid lochia, and all the symp- 
toms that are well known to accompany acute purulent infection. 
Vaginal examination on the ninth day, when I saw her, disclosed a large 
boggy mass confined to the right side, great tenderness over the same 
region on palpation, temperature 104°, pulse 120; the breasts were 
also engorged and very painful. After thorough depletion by the 
bowel for twenty-four hours, the abdominal cavity was opened and 
about three ounces of pus, together with the tube and ovary, were re- 
moved. The left appendages were free and therefore not disturbed ; 
the abdominal cavity was flushed with large quantities of water, 
drainage-tube inserted, and the wound closed. The drainage tube 
removed in twenty-four hours, the patient made an uninterrupted re- 
covery. The case showed some evidences of specific disease, though 
it did not seem to play any part in causing this condition, which was 
undoubtedly due to infection through the laceration of the cervix, 
which, though slight, was nevertheless sufficient, I think, to serve as a 
focus of infection. There was also slight laceration of the perinaeum. 
Case IV.—Annie G., aged twenty years ; in good health until the 
delivery of her first child seven weeks ago (December 28th). Exten- 
sive laceration of the cervix and perinaeum, neither of them having 
been repaired, as she was attended by an old woman. After having 
suffered for six weeks after the delivery, she was seen by my brother, 
Dr. W. C. Hammond, when she gave the following history : High 
fever; great pain over the entire abdominal cavity, with greatest 
tenderness over the left iliac region. At this visit he found the tem- 4 
L. J. Hammond, M. D. 
perature 103°, pulse 140, very feeble ; clammy skin, vomiting, consti- 
pation, and the woman generally in a very serious condition. He at 
once began the free use of stimulants and thorough irrigation of 
the birth track, and, as soon as the woman could stand it, depletion by 
the bowel with saline. The abdominal cavity was opened one week 
later, when two abscesses were found, one within the broad ligament, 
the other above and posterior to the uterus on the left side. Adhesions 
of the omentum were so great that a portion of it had to be ligated 
and cut olf. The uterus was very large, and, together with the ovary 
and tube, drawn well over to the left and firmly bound down by 
strong adhesions, many of which were broken up ; but the woman’s 
condition was so extreme that nothing further was done except to 
empty the abscess cavities, break up adhesions, and flush the cavity 
with large quantities of water. The patient seemed to be doing well 
for twenty-four hours, with the exception of the high pulse-rale, which 
continued from 140 to 160 ; the temperature, however, dropped to 
ioi°, and never went above that, the patient dying the third day. 
The death was unquestionably due to exhaustion, as the patient’s 
condition was so extreme that I feared she would not even stand the 
ether ; the lower bowel was thoroughly agglutinated by the inflamma- 
tory exudate arising from the general peritonitis which the woman 
had largely passed through when she was first seen by the doctor. 
While the surgical intervention in three of these cases is little more 
than opening an abscess, the subsequent history of them seems to 
justify such a procedure, which might seem to some to be lacking in 
completeness. In two of the cases, however, it was not possible to 
have accomplished the removal of appendages without greatly lessen- 
ing the possibilities of recovery of the patients ; and since the oper- 
ation two of them have borne children, I would hesitate to do more 
in other cases of the same character. 
In cases like the third, where it is possible to remove the diseased 
appendage without greatly prolonging the operation, I think it would 
be bad surgery to allow it to remain. 
In the fourth case the diseased structures could only have been re- 
moved by prolonging the operation, which would unquestionably have 
terminated the life of the patient much sooner than it did.