REPRINT FROM THE ATLANTA MEDICAL AND SURGICAL JOURNAL. 
SOME OBSERVATIONS UPON PELVIC CELLULITIS. 
(Read before the Medical Association of Georgia, April 22, 1887.) 
BY VIRGIL O. HARDON, M. D., PROFESSOR OF OBSTETRICS AND 
DISEASES OF WOMEN AND CHILDREN, ATLANTA MEDICAL COL- 
LEGE, ATLANTA, GA. 
I propose in this paper to offer some views upon the subject of 
pelvic cellulitis from the stand-point of my owh experience and 
observation. In presenting these views I desire to say in advance 
that they are offered less with the purpose of insisting upon their 
correctness than with the aim of subjecting them to criticism and' 
experiment at the hands of fellow-practitioners. Since these' 
views have grown out of clinical phenomena which have pre- 
sented themselves in my own practice, I shall endeavor to fortify 
them by reports from my case-book, and thus to avoid the charge 
of theorizing and of a -priori reasoning. 
ACUTE PELVIC CELLULITIS. 
Case i.-On the 21st of January, 1887, I was- requested by 
Dr. N. O. Harris, of this city, to see with him Minnie L., a pros- 
titute twenty-four years of age, who had borne a child three 
months before. The history of the patient showed that her 2 
menses had always been of normal character up to her preg- 
nancy, and that she had never suffered from any symptoms 
which would indicate pelvic disease of any kind. Since her labor 
she had had tenderness of the abdomen and pain in walking and 
in micturition. Her general health, however, had been good. 
On the day before I saw her she was seized with pain in the 
back, pelvis, hips, abdomen and thighs. This pain was acute 
and excessive. Micturition and defecation became very painful, 
especially the latter. She had a slight chill, followed by high 
fever, thirst and complete loss of appetite. When seen by me 
she was in bed, tossing and moaning with pain, which was re- 
ferred principally to the pelvic region. Pulse 120, temperature 
101, skin hot and dry, face flushed, tongue coated. Vaginal and 
rectal examination were rendered impossible by excessive ten- 
derness of the parts. The following morning she was fully an- 
aesthetized and a complete examination effected. The vagina 
was hot and dry. The cervix was lacerated on the left side. 
The womb was low in the pelvis and was pushed forward against 
the bladder. In the posterior fornix, and occupying the whole 
space between the cervix and the rectum, could be felt a rounded, 
bulging mass which had a boggy, oedematous feeling. By a 
finger in the rectum this mass could be outlined and felt to extend 
upward about an inch. No fluctuation could be detected, and 
when pressed by the finger the mass could not be displaced up- 
ward. Considering the condition to be that of pelvic cellulitis 
in the stage of serous infiltration, I decided to attempt to draw 
off the serum from the cellular tissue, hoping thereby to abort 
the disease and prevent the formation of solid plastic exudation 
with possibly a subsequent abscess. Accordingly an aspirator 
needle was thrust into the tumor from the vagina at three differ- 
ent points successively and about an ounce in all of serum tinged 
with blood was withdrawn. The tumor was then found to be so 
softened and diminished in size as to be scarcely perceptible to 
the touch. A quarter grain of morphine was given hypodermi- 
cally, and the patient ordered to remain perfectly quiet in bed 
and take only liquid diet. When seen twenty-four hours later 3 
she had had a good night's sleep, the pain in the pelvis was 
almost entirely gone, defecation was no longer painful, appetite 
had returned, the pulse had fallen to 80, the temperature to 99, 
and the patient begged to be allowed to get up. The mass in 
the posterior fornix could be felt only as a slight thickening. Two 
days later the patient was apparently in her usual health. 
From a clinical point of view there are three stages in the 
progress of an attack of acute pelvic cellulitis, viz., the stage of 
serous infiltration, the stage of solidification and the stage of 
suppuration. Under favorable circumstances a stage of absorp- 
tion takes the place of the stage of suppuration and the patient is 
spared the suffering and danger involved in the formation of an 
abscess. The stage of serous infiltration is a brief one, lasting 
usually not more than forty-eight hours. Hence it often hap- 
pens that the patient is not seen by the physician until this stage 
has passed. The most prominent physical feature of this stage 
is the infiltration of the cellular tissue with serum, so that it is in 
an oedematous condition and presents to the finger what has been 
described as a boggy or doughy feeling, which is characteristic 
of oedema and is readily recognized by the educated touch. This 
infiltration of serum is a consequence of arterial congestion and the 
transudation through the walls of the blood-vessels might be said 
to be nature's method of relieving such congestion. As soon as this 
transudation takes place the arterial tension is lessened, or, in 
other words, the congestion is diminished, and the effect of such 
diminution is shown by a decline of the pulse and temperature 
and a general abatement of the constitutional symptoms. The 
progress of the disease would probably be arrested at this point 
were it not for the fact that the infiltrated serum, inclosed within 
the meshes of the cellular tissue, soon becomes solidified and is 
converted into so-called plastic exudation which acts as a foreign 
and irritating substance and is gotten rid of only by the tedious 
process of absorption or the dangerous process of suppura- 
tion. 
An obvious indication then during the stage of serous infiltra- 
tion is to get rid of the effused serum before it has undergone 4 
solidification and thus to arrest the disease at that point. Can 
this be accomplished? Emmet recommends for this purpose 
vaginal injections of hot water, which he says "should be con- 
tinued liter ally for if possible, and be repeated at short 
intervals." He further adds, .in his characteristic positive style, 
" It is the only means we possess for aborting an attack of cellu- 
litis, which tt ivtll do if thoroughly emfloyed at the beginning fl 
(The italics are Emmet's). I am prepared to indorse this re- 
commendation of Emmet's, but I must decline to admit that the 
metnod is infallible, or that all other methods are futile. The 
vaginal douche of hot water is unquestionably a very efficient 
piomoter of absorption. But when the effused serum is large in 
quantity the absorbent vessels are sometimes apparently unequal 
to the task of disposing of so extensive an accumulation. 
As a result of my own experience, I feel justified in claiming 
that the mechanical removal of the infiltrating fluid by aspiration 
offers a valuable addition to our resources in such cases. My 
method of procedure is to introduce the aspirator needle into the 
infiltrated ceituiar tissue and to maintain a constant suction until 
the serum ceases to flow. I then withdraw the needle and intro- 
duce it at another point and repeat the suction as before. By 
continuing these punctures at various points the distention will 
gradually be diminished and the tissues will be reduced very 
near±y to theii normal condition. The pain will be relieved, the 
febrile action will subside, and the patient will progress to a rapid 
convalescence. The disease is thus effectually aborted and does 
not go on to the stage of solidification, and hence the tedious 
process of absorption and the danger of suppuration are avoided. 
When the effusion has taken place into the broad ligament on 
one or both sides of the cervix, I have found that some care in 
aspirating is necessary in order to avoid wounding the uterine 
artery. If deep pressure be made the pulsation of this artery 
may usually be detected by the finger, and thus the danger of 
its injury may be avoided. The punctures may safely be made 
to the depth of a half an inch or even more, since the peritoneum 
'Principles and Practice of Gynaecology, New York, 1884, p. 261. 5 
is pressed upward toward the abdominal cavity as much as the 
mucous membrane is pressed downward into the vagina, and 
hence the thickness of the cellular tissue at the point of infiltra- 
tion is much greater than in its normal condition. Emmet says: 
" I cannot regard the introduction of the trocar into the inflamed 
tissues of the pelvis as a procedure free from danger under all 
circumstances."1 As far as my experience goes, I am satisfied 
that this statement is not true of the introduction of the aspirator 
needle into the infiltrated pelvic cellular tissue. 
My experience with this method of treatment has been con- 
fined to a small number of cases, and I would feel a diffidence in 
presenting it to the profession were it not that the results in the 
few instances in which it has been used have been so eminently 
satisfactory. As far as I am aware the method has never been 
made use of in any other hands than my own, as I find no 
allusion to it in the gynaecological literature at my disposal. 
Brick ell, of New Orleans, published an article ten years ago,2 
in which he described a form of pelvic cellulitis in which the in- 
flammatory process terminated in the formation of permanent 
collections of serum within the pelvic cellular tissue and advo- 
cated the evacuation of such collections by means of the aspi- 
rator. But this condition is quite different from that to which I 
refer. It is only to the first stage of those cases which, if let 
alone, would go on to solidification that my method is applicable. 
The following case illustrates the failure of the vaginal douche 
of hot water to cause absorption of the infiltrated serum when 
the infiltration involves a large extent of tissue. 
Case ii.-E. G., colored, married, age 26, was delivered Jan- 
uary 16, 1886, of her sixth child after an easy labor. All went 
well until the morning of the ninth day, when she got up and sat 
in her stocking feet by the fire. Late in the afternoon she was 
seized with a chill, and had severe pain in the pelvis, abdomen 
and back. I saw her the following morning, when she complained 
of severe pain, tenderness of the abdomen, thirst, anorexia, and 
1 Op. cit., p. 270. 
2 "The Proper Treatment of Pelvic Effusions," Amer. Journal of Medical Sciences 
April, 1877. 6 
intense headache and nausea. Defecation and micturition gave 
intense pain. Pulse 140, temperature 102 2-5. By vaginal ex- 
amination the cellular tissue on each side of and behind the cer- 
vix was found to be swollen, bulging into the vagina and pre- 
senting the characteristic boggy feeling of acute cellulitis. The 
patient was ordered to remain in bed, was given a quarter grain 
of morphine hypodermically, and was directed to use a copious 
hot vaginal douche of not less than two gallons every two hours. 
She possessed unusual intelligence for a negro, and I satisfied 
myself that my directions were faithfully carried out. This free 
use of hot water was kept up for forty-eight hours. At the end 
of that time solidification had taken place and the womb had 
become immovably fixed in a hard mass of plastic exudation 
which surrounded it on three sides and pushed it forward against 
the bladder. Suppuration subsequently took place, the abscess 
discharging through the vagina, and the patient recovered only 
after a long and exhausting illness. 
In this case I consider that the amount of serum was so great 
that the pelvic absorbent vessels were unable to remove it. Had 
the tissues been punctured at various points, as in Case 1, and the 
serum withdrawn by aspiration, I believe that the disease might 
have been aborted. Such would be my treatment of a similar 
case at the present time. 
CHRONIC PELVIC CELLULITIS. 
Case hi.-A. C., white, married, age 36, has had one miscar- 
riage and five children at term, the last one six years ago, since 
which time she has been in bad health. Five years ago she had 
perineorraphy performed in New Orleans. She experienced 
some relief from the operation, but still remained an invalid. The 
last menstrual period was delayed two weeks beyond the usual 
time. As she had always been regular, she attributed the delay 
to a severe cold from which she suffered at the time. The flow 
was accompanied by excessive pain and by high fever, loss of ap- 
petite, thirst, great tenderness in the abdomen and scanty and 
painful micturition. 
I was requested by Dr. D. H. Howell, of Atlanta, to see this 7 
patient, November 23, 1885. Examination revealed great ten- 
derness throughout the vagina. The cervix was about an inch 
from the vulva, pointing in the direction of the vaginal axis. It 
was lacerated on both sides and the lips were everted. The 
body was retroflexed, pressing against the rectum, and was ten- 
der, enlarged and congested. The cervix was surrounded and 
held in its position of prolapse by a firm deposit in the cellular 
tissue on all sides, exceedingly tender to the touch. The womb 
was absolutely immovable. The sound passed backward at an 
acute angle. There was no prolapse of bladder or rectum. 
The results of physical examination, taken in connection with 
the history of the case, made the diagnosis easy. I had to do with 
a case of acute pelvic cellulitis in the stage of solidification. The 
cervix and the whole vaginal roof were painted with compound 
tincture of iodine twice a week, a pledget of cotton saturated with 
glycerine was inserted in the vagina daily, and the copious vagi- 
nal douche of hot water was directed to be used night and morn- 
ing. This treatment was continued for two months, except dur- 
ing the menstrual period. The hardness and tenderness about 
the womb gradually diminished and the organ became movable. 
On the 15th of January the womb could be restored to its normal 
position without pain. All the tenderness and congestion had 
ceased, and the patient had improved greatly in appetite, strength 
and flesh. 
On the 26th of January, five days after the cessation of the 
menses, with the assistance of Drs. Harris and Wile, the patient 
was etherized and trachelorraphy performed. Perfect union 
resulted, and since that time the patient has enjoyed robust 
health. 
Case iv.-A. M., white, married, age 34, has been gradually 
failing in health since the birth of her last child two years ago. 
Has lost flesh, strength and appetite without any apparent reason. 
Has bearing-down pains and painful locomotion. Her greatest 
suffering, however, is from frequent micturition. She is obliged 
to urinate about every hour during the day and to rise several 
times during the night for this purpose. This symptom is ag- 
gravated at the menstrual periods. 8 
Examination made February 23, 1887, showed the womb to 
be low down in the pelvis, but perfectly movable. The cervix 
was lacerated bilaterally and the lips everted. On each side of 
the cervix, in the cellular tissue of the broad ligaments, could be 
felt two hard, irregular masses about the size of an almond, which 
were tender to the touch. There were no indications of any 
disease of the bladder or urethra, and the urine showed nothing 
abnormal by chemical or microscopical examination. 
The womb was restored to its normal position and its normal 
axis in the pelvis, and held in that position by the supporting 
tampon, consisting of a ring of pledgets of cotton encircling the 
cervix and a larger underlying pad of cotton lifting it from the 
posterior vaginal wall. The patient was sensible of immediate 
relief of the bearing-down pain which she had previously ex- 
perienced. This supporting tampon was renewed every second 
day. No other treatment was used except a laxative pill occa- 
sionally. This course was pursued up to the next menstrual 
period, which occurred March 13th. 
On the night after the first tampon was applied, the patient was 
obliged to rise once to urinate. After that she never rose in the 
night as long as the tampon was worn. The bearing-down feel- 
ing, the pain and the difficulty of locomotion rapidly diminished, 
and before the end of ten days had ceased altogether. The hard 
and tender masses on each side of the cervix were sensibly di- 
minished at the second dressing, and at the fourth dressing on the 
seventh day could no longer be felt. 
Upon the appearance of the menses the patient came to At- 
lanta for the purpose of submitting to the operation of trachelor- 
raphy, which had been represented to her as the ultimatum of 
the treatment. But at the last moment her courage failed her. 
She declined to have the operation performed and returned to 
her home. I therefore resigned all connection with the case. I 
have met her frequently since, and she informs me that all her 
old symptoms have returned. 
These two patients furnish typical illustrations of two classes of 
cases which are constantly coming under my observation, which 
present many points of similarity upon superficial examination, 9 
yet which experience has taught me to differentiate. As I find 
no distinction between these two groups in gynaecological litera- 
ture, I am led to believe that such distinction is generally over- 
looked, and I believe further that a recognition of it will add 
much to the success with which such cases can be treated. 
The teachings of Emmet, the apostle of pelvic cellulitis, are 
that as long as there are hardness and tenderness in the vaginal 
roof, these two phenomena furnish sufficient evidence of the ex- 
istence of chronic pelvic celluli'.is, and that during the persistence 
of these symptoms no operative procedures within the pelvis, not 
even the passage of a sound, can be safely undertaken. The in- 
fluence of this teaching has been widely felt, and as far as it re- 
lates to the last stage, the chronic stage, of pelvic cellulitis, it is 
unquestionably good doctrine. But I have so often met with 
cases presenting hardness and tenderness of the vaginal roof with- 
out previous history of acute cellulitis, which bear with impunity any 
amount of operative interference, that I have been led to believe 
that a radical difference exists between the two classes of cases, 
and to seek out the cause for such a difference. I have found 
that the latter class of cases includes the larger number of those 
which have their origin in injuries received in labor, and particu- 
larly in lacerations of the cervix, especially when such lacerations 
have been of long standing. 
In such cases I have found the womb to be of greater than 
normal size, and low down in the pelvis, so that the cervix is sup- 
ported by the posterior vaginal wall. The lips are everted, 
exposing the mucous membrane of the cervical canal, which is in 
a state of inflammation and studded with enlarged Nabothian fol- 
licles. On either side of the cervix, extending outward, are 
irregular hard masses which are tender to the touch. These 
masses do not disappear upon pressure. The womb is not fixed 
in its abnormally low position, but may be easily elevated or 
moved from side to side. When the womb is raised upon the 
finger, so as to lift it from the posterior vaginal wall and restore 
it to its normal elevation, and maintained in that position for ten 
or fifteen minutes, I have so repeatedly felt these hard masses 
soften and diminish in size under my touch that I consider it im- 10 
possible for me to have been deceived in regard to the occur- 
rence of this phenomena. Basing a plan of treatment upon this 
observation, I have for a long time been in the habit of making 
use of a mechanical device for keeping the womb thus elevated, 
and under such treatment I have been amazed at the rapidity 
with which the tenderness and the hardness have disappeared. I 
have known them, even when well marked, to be entirely gone at 
the end of forty-eight hours, and their disappearance is quickly 
followed by the abatement of all pelvic symptoms, such as pain, 
bearing-down, frequent micturition, leucorrhoea and irregular 
menstruation. The patient rapidly gains flesh and strength, 
nervous symptoms are relieved, and, after a week or ten days of 
such treatment, she feels like a new creature. If examined at 
the end of that time the hardness and tenderness are sought for 
in vain, the womb is notably diminished in size and the patient 
feels so well that it is difficult to convince her of the necessity of 
operative treatment for the relief of the injury which formed the 
starting point of her disease. This is no fancy picture, but a 
description of what I have seen over and over again, and it will 
be corroborated by gentlemen who have had an opportunity of 
watching my practice. I have under my care at the present 
time, at the Benevolent Home, in this city, by the courtesy of the 
attending physician, Dr. N. O. Harris, two patients of this class, 
who form striking illustrations of the results of this mode of 
treatment. Three weeks ago they were anaemic, nervous, suffer- 
ing, sleepless, bed-ridden creatures, a burden to themselves and 
to all about them. To-day they are free from pain, they sleep 
and eat normally, are rapidly gaining flesh and express them- 
selves as feeling well in all respects. In neither case is there a 
history of any acute pelvic inflammation. The one has a double 
laceration of the cervix, with marked eversion and a laceration of 
the perineum to the sphincter. The other has an equal degree of 
perineal laceration and a prolapse of the urethra. In both cases 
these injuries still remain unrepaired. 
Let us contrast with these a case in which the disease has orig- 
inated in an acute pelvic cellulitis, and has progressed through 
the stages of infiltration and cf solidification until it comes under 11 
the notice of the physician in the latter stage. (As in Case iii.) 
Here also the womb is found heavy, tender and low in the pelvis. 
On each side are felt irregular, hard masses, extending from the 
cervix outward, along the broad ligaments, tender to the touch. 
But if any attempt be made to raise such a womb, it will be found 
to be more or less immovable, and any endeavor to alter its posi- 
tion, even temporarily, will result in an increase of pain and 
probably a renewal of the acute stage of inflammation. Under 
favorable treatment the hard masses of plastic exudation will 
soften down and disappear in a period varying from two to four 
months. The subjective symptoms will be relieved only pari 
-passu with the disappearance of the exudation in the cellular 
tissue. My experience has led me to believe that this condition 
exists in only a small minority of the cases of pelvic tenderness 
and hardness which come under the notice of the physician. 
These are undoubtedly cases of true chronic pelvic cellulitis. 
On the other hand, I believe that the class first alluded to are 
not cases of pelvic cellulitis, but of some condition entirely differ- 
ent. My reason for this belief is found chiefly in the rapidity 
with which the physical phenomena disappear under appropriate 
treatment. It is inconceivable that a chronic inflammatory 
deposit, which has existed for months and perhaps for years, 
should be appreciably diminished in a few minutes, or that it 
should be entirely taken up and carried off by the blood-vessels 
and absorbents in forty-eight hours. No solid tissue undergoes 
such rapid changes as that. The only theory which appears to 
me to accord with these facts is that the hard masses on either 
side of the cervix are accumulations of venous blood within the 
distended venous sinuses, which are so abundant and so large in 
this locality. Such accumulations could be caused only by some 
obstruction to the venous current at some point within the pelvis. 
A study of the anatomical distribution of the veins of the 
pelvis, and of the inevitable results of uterine congestion 
upon the pelvic circulation, lends confirmation to this theory. 
The uterine vein passes downward along the lateral border 
of the uterus, receiving at various points horizontal branches 
from that organ. At a point about midway between the 12 
external and internal os it passes outward through the cel- 
lular tissue to the wall of the bony pelvis and thence upward 
toward the heart. In its passage through the cellular tissue 
of the broad ligament it loses the characteristics of a vein and 
develops into a series of enormous distensible sinuses. Through- 
out its course it is entirely free from valves. Any obstruction at 
any point in the uterine vein must, therefore, necessarily result in 
damming up the blood behind the obstruction and causing a dis- 
tention of that vein. 
Whenever any injury of any kind to the pelvic organ takes 
place during labor, and remains unrepaired, involution is 
interfered with. The womb fails to return to its normal size and 
is therefore of greater than normal weight. Consequently the 
natural equilibrium between the uterine supports and the weight 
to be supported is destroyed, and the organ sinks below its normal 
level in the pelvis. Savage has shown that when the womb 
sinks below its normal level traction is first exerted upon the cel- 
lular tissue of the broad ligaments, " especially where it surrounds 
and accompanies the uterine blood-vessels."1 Traction upon an 
elastic tissue necessarily involves traction upon the blood-vessels 
within that tissue, and traction upon an elastic tube, like a blood- 
vessel, means diminution of its calibre and obstruction of the flow 
of blood through it. Hence, when the womb, in a state of sub- 
involution from parturient injury, sinks below its normal level 
from increased weight, a condition exists which can give rise to 
obstruction of the uterine vein and its consequent distention. 
When the womb is raised the obstruction is removed and the 
distention of the venous sinuses is at once relieved. 
I have never been so situated, much to my regret, as to be able 
to corroborate this theory by systematic yW mortem study. I 
have sought in vain for the observations of others in this field 
until the recent appearance of an article by Henry C. Coe, Path- 
ologist to the New York State Woman's Hospital.2 The writer 
iThe Surgery, Surgical Pathology and Surgical Anatomy of the Female Pelvic Organs. 
New York, 1880. Plates XVIII and XIX. 
2 " Exaggerated Importance of Minor Pelvic Inflammations." New York Medical Journal, 
May 15, 1886. 13 
of this article concludes, from the examination of a large number 
of subjects who, during life, presented the hard and tender masses 
on one or both sides of the cervix, which are commonly regarded 
as evidence of the existence of chronic pelvic cellulitis, that no 
appearances are found after death to correspond with the condi- 
tion existing during life. No such masses in the pelvic cellular 
tissue can be detected. He says: "In by far the greater number 
of cases where a well-marked laceration of the cervix was present, 
there was absolutely no induration whatever in the broad liga- 
ments. This ' thickening,' ' increased tension,'or whatever it is, 
which we find at the examining table and promptly enter in our 
case-books as ' cellulitis,' frequently vanishes after death, when 
the natural tension of the tissues has disappeared." "I would 
add briefly that in only a single case have I felt satisfied that I 
found well-marked remains of a cellulitis in a case of laceration 
of the cervix." There is no tissue of the body, either normal or 
abnormal, which can so completely disappear in a few hours after 
death as to leave no trace of its existence. But if, as I believe, 
the masses in question are simply accumulations of venous blood, 
it can readily be seen how it may become impossible to discover 
their existence in the dead-house. As far as they go, therefore, 
the results of -post mortem investigation confirm my theory. 
The treatment based upon these views is simple and obvious. 
It consists in maintaining the womb at its normal level by some 
mechanical device. The one which I have been led to adopt 
as preferable to all others is that which I have called the support- 
ing tampon. It consists of a ring of four pledgets of cotton 
placed around the cervix, so graduated in size as to bring the 
cervix as nearly as possible into the normal axis, and a larger 
underlying pad of the same material, of such size as to raise the 
womb as a whole to its normal level. Any other device, which 
accomplishes the same purpose without producing undue pressure 
at any point, would be equally good. I use the supporting tam- 
pon because, after long experience, I have found it most practi- 
cable and most satisfactory. 
By this mode of treatment patients are sometimes permanently 
cured. When the parturient injury is slight, the good results of 14 
treatment sometimes persist, and the symptoms do not return. 
Such results, however, form the exception. In the majority of 
cases before a permanent cure can be effected, the parturient 
injury must be repaired. Otherwise the womb will again sink 
below its normal level as soon as the mechanical support is re- 
moved and the original condition will be reproduced. It may be 
asked, "What, then, is gained by this treatment? Why not oper- 
ate at first?" My answer is that such patients are not usually 
in a condition for operation when first seen by the physician. 
They are debilitated, nervous, depressed, sleepless, dyspeptic, 
and require " building up" before any operation can be success- 
fully undertaken. If the womb in such cases be maintained at 
its normal level for a short time, the nervous symptoms subside, 
the general health is restored, the morale is improved and confi- 
dence is inspired, all of which are valuable factors in the success 
of an operation. 
My object in writing this paper is to submit the following prop- 
ositions: 
1. Acute pelvic cellulitis in the stage of infiltration may fre- 
quently be aborted by aspiration. 
2. Chronic pelvic cellulitis rarely, if ever, exists except as a 
sequence of a previous acute pelvic cellulitis. 
3. Hardness and tenderness in the broad ligaments, as a result 
of pelvic venous engorgement, are commonly mistaken for chronic 
pelvic cellulitis. 
4. The treatment of such engorgement by raising the womb 
in the pelvis relieves the constitutional as well as the local symp- 
toms and places the patient in a suitable condition for a radical 
operation more speedily than the methods of treatment com- 
monly in vogue.