Uterine hæmatocele : experience in the Royal Infirmary / by J. Matthews Duncan.

  • Duncan, J. Matthews (James Matthews), 1826-1890.
Date:
1862
Catalogue details

Licence: Public Domain Mark

Credit: Uterine hæmatocele : experience in the Royal Infirmary / by J. Matthews Duncan. Source: Wellcome Collection.

    13/16 (page 13)
    only a thickening and induration of the tissues in the former site of the bloody tumour, and restored mobility of the uterus. The remark of Dr West, that most examples of uterine hsemato- cele are connected with some derangement of menstruation, is amply confirmed by the histories of the preceding cases. The most cursory perusal of these reports also shows that the disease may be de¬ scribed as sudden in its supervention, that it produces great agony and often cramplike pain in the stomach, bearing-down pain, and irritation of the bladder; that there is great tenderness in the seat of the effusion, and that the belly generally becomes more or less distended with flatulence. Besides these symptoms, vomiting, generally of bilious character, and constipation are frequent occur¬ rences. In case second, diarrhoea was present. It is natural to expect, as is always observed, that an anaemic condition should be produced when the extravasated blood is large in amount; but besides anaemia, and more or less severe feverish excitement, there is generally no farther peculiar constitutional disturbance. The disease may be mistaken for ovarian dropsy, fibrous tumour, pelvic inflammatory induration or abscess, pelvic peritonitis, uterine and extra-uterine pregnancy, and retroversion of the gravid uterus. I shall not enter into the details of its diagnosis from these various diseases. Most of them will suggest themselves to any person ordinarily intelligent in the diseases of women. I may, however, remark, that the history, if well made out, offers great assistance in this matter. But even when the history is pretty distinct, it will be often impossible, particularly when the tumour is small, to make a satisfactory diagnosis from pelvic inflammatory induration or abscess, from pelvic peritonitis, and from extra-uterine pregnancy ; and fortunately the diagnosis from these diseases is not of very great importance, so far as the practice to be employed is concerned. I would particularly remark that elongation of the uterus is given by Dr West as a diagnostic indication of extra-uterine pregnancy, and that this statement appears to me to require to be carefully guarded. No doubt, in extra-uterine pregnancy the uterine cavity will be elongated; but, on the other hand, in the cases recorded above, the uterus was found greatly elongated in every instance where the hematocele was large, and in all it contracted with the contraction of the blood sac. In all, this elongation co-existed with a cervix uteri, having none of the conditions of the cervix in preg¬ nancy. In all, a careful examination of the case led to the belief that no form of pregnancy existed ; and although in some there was room for suspicion of the existence of pregnancy, in others there was none. The general treatment of the various distressing symptoms of this disease requires no special remark in this place. I shall only consider briefly the surgical treatment of the tumour. On this subject there is a great divergence of opinions, some believing that it is best, in all cases, to abstain from interfering with the hasmato-