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.

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    pain and less sliock. Kulino says that the pain is due to the rending of the conneetive-tissiie elements. The pain is intermittent, eaused by the successive escapes of blood. We may note the absence of peritonitis, meteorisni, and the clear definition of the line of dulness if the mass presents above the pelvic brim. In examination by the vagina the tumor is found just within the vulva, nearly always below the normal limits of Douglas's sac. Bernutz reports cases of lateral tumor at the junction of the middle and lower third, and existing in the recto-vagi- nal cells. The lateral situation is rare, but M'heu found it is character- istic of a lunematoma only. Poncet says that he has never seen hsema- toma develop in the vaginal wall anterior to the cervix; while Nona has rarely seen them in this situation. Prost assigns great importance to the fact that luematonui will displace the nterus upward, just as hiematocele will displace the organ downward and forward, while the cervix is displaced sometimes to the right or left. The uterus does not lose its mobility as in liEematocele. Kuhue calls attention to the bridge uniting two lateral tumors, which has been already described. Through the speculum the vagina presents a violet color in those portions con- tiguous to the tumor. Nona gives this appearance high diagnostic value, but according to Bernutz it is not always constant. The htem- atoma has a doughy consistency, a false fluctuation, and maintains its characteristics longer than hsematocele, as its contents change less rap- idly. Absorption is more prolonged in htematocele, while the latter is more disposed to rupture into the rectum or the vagina. Treatment.—The primary indications are, first, to arrest hemor- rhage and avert or mitigate the shock ; secondly, to treat the inflamma- tory complications, and lastly, the blood-poisoning that may result from septic changes in the effused blood. To arrest hemorrhage we may employ cold irrigation of the vagina or rectum—three to five minim doses of the liquor sesquichloride of iron, sulphuric acid, tannin, alum, or acetate of lead and opium, avoid- ing hot baths and hot applications, sitz-baths especially, as favoring hem- orrhage. Shock closely follows the blood-loss. The head should be placed lower than the body by removing pillows and raising the foot of the bed. Vomiting should be checked by pounded ice, while pain may be subdued as well as the system stimulated by ether or Holf- mann's anodyne. Moderate use may be made of stimulants or cor- dials, if retained by the stomach, without fear of renewing the hem- orrhage. Sinapisms to the arms or inside of the thighs may be emjiloyed, as the pain of the application retards shock. The cataclysmic cases are treated on the same principle as rupture of the uterus or of (he cyst of extra-uterine pregnancy, or other great pelvic lesion ; when peritonitis is present, with opium and the hori- zontal position. Purgatives should be avoided, as breaking (he law