Volume 1

A system of gynecology / by American authors ; edited by Matthew D. Mann.

Date:
1887-1888
Catalogue details

Licence: Public Domain Mark

Credit: A system of gynecology / by American authors ; edited by Matthew D. Mann. Source: Wellcome Collection.

    753/805 (page 746)
    are obscure and are largely obtained from ctlinical study. Time is not measured by its ordinary periods in gynecology, and the year 1859, when Simpson wrote upon hsematocele, while near in the matter of years, is remote in view of the rapid advance of a great science; and yet, crowded as is the intervening time with facts, nothing has been added to the truth as he expi-essed it, that there is almost no limit to the variety of the situations in which a pelvic thrombus or a h£ematoma may be found, for the veins may give way in any part of the pelvis, and the blood which escapes may fill sometimes one facial loculament only of the pelvis, at other times several at once. Snow Beck says that the arrangement of the fascia in the pelvis covering the various muscles, and converging to a central part at the neck of the uterus, is very complicated, and often presents a weak point behind the OS internum, into which the finger can be pressed and through which a heiniial pi'otrusion of the veins may occur. This was the seat of an effusion observed by him. There are other and less complicated rea- sons why the haematic affusion is generally noticed in the recto-uterine pouch. The Fallopian tubes are always directed backward, never for- ward, so that a blood-effusion naturally takes the direction downward and backward. Periuterine and anteuterine hsematoceles are usually secondary to retro-uterine hsematocele, or when anteuterine htematocele exists without the retro-, it is because Douglas's space is obliterated by adhesions and fibrous bands, so as to prevent the accumulation at this point. A case recorded by Schroeder demonstrates this fact. AV^hile, however, the ovaries and tubes lie mostly in the posterior wings of the broad ligaments, and the escaping blood most easily finds its way into the recto-uterine duplicature of the peritoneum, it is a mistake to sup- pose that all blood so effused will do this if this cavity is free. Small blood-masses will become entangled in the vesico-uterine pouch or even lie above the broad ligament. These are marked exceptions to the rule, which may be said to hold true when Douglas's space is free. Courty says that if the hemorrhage comes from the tubes or ovarian venous plexus, the resulting htematocele may be limited to the folds of the broad ligament, or under the peritoneum covering the uterus, in periuterine cellular tissue, not only behind and in the broad ligament of the other side, but also in front under the peritoneal fold covering the uterus and bladder. These limits of the hasmatic tumor define the hjematoma rather than the hsematocele, and the disposition of the blood affused into one broad ligament to pass over to the other develops the central constriction in the tumor, to which considerable importance is given in the differentiation of the two forms of pelvic effusions. Emmet defines three sources of hemorrhage. The first is from the mass of vessels known as the bulb of the ovary, from which the blood would pass into the peritoneal cavity; second, from the pampiniform